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Effects of leflunomide and methotrexate in rheumatoid arthritis detected by digital X-ray radiogrammetry and computer-aided joint space analysis

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Abstract

The aim of the present study was to evaluate the effect of long-term leflunomide and methotrexate (MTX) therapy during the course of rheumatoid arthritis (RA) estimated by digital X-ray radiogrammetry (DXR) and computer-aided joint space analysis (CAJSA) as diagnostic tools for the quantification of disease-related periarticular osteoporosis and joint space narrowing. Fourty matchable patients with verified RA were treated with leflunomide or MTX during an observation period of 2.5 years. All patients underwent complete computerized calculations of bone mineral density (BMD) and metacarpal index (MCI) by DXR as well as semi-automated measurements of joint space widths (JSW) at the metacarpophalangeal articulations (MCP, thumb to small finger) and proximal interphalangeal joints (PIP, index finger to small finger) using digitized hand radiographs. DXR-BMD revealed an increase of 0.4% (leflunomide-group) versus a reduction of −9.1% (MTX-group). Regarding DXR-MCI, a reduction of −1.1% (leflunomide-group) and −5.3% (MTX-group) was observed. The CAJSA parameters showed a decline of −2.7% (JSW-MCP) versus −2.1% (JSW-PIP) in patients treated with leflunomide. An accentuated joint space narrowing was revealed (JSW-MCP: −5.7%; JSW-PIP: −6.2%) in the MTX group. Digital X-ray radiogrammetry and CAJSA could discriminate the influence of different therapeutic regimes on periarticular osteoporosis and joint space narrowing showing a less accentuated radiographic progression in patients treated with leflunomide.

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Abbreviations

BMD:

Bone mineral density (g/cm²)

CAJSA:

Computer-aided joint space analysis

CRP:

C-reactive protein

CV:

Coefficient of variation

DMARD:

Disease-modifying anti-rheumatic drug

DXA:

Dual X-ray absorptiometry

DXR:

Digital X-ray radiogrammetry

DXR-BMD:

Bone mineral density (g/cm²), estimated by means of digital X-ray radiogrammetry

DXR-MCI:

Metacarpal index, estimated by means of digital X-ray radiogrammetry

ESR:

Erythrocyte sedimentation rate

JSW:

Joint space width

JSW-MCP:

Joint space width of the metacarpophalangeal joint

JSW-PIP:

Joint space width of the proximal interphalangeal joint

JSW-DIP:

Joint space width of the distal interphalangeal joint

MCP:

Metacarpophalangeal joint

NS:

Not significant

NSAID:

Non-steroidal anti-inflammatory Drug

PIP:

Proximal interphalangeal joint

RA:

Rheumatoid arthritis

SD:

Standard deviation

VPA:

Volume per area

W:

Bone width

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Acknowledgments

The authors thank Monika Arens (managing director, Arewus GmbH) and Jacob Algulin (Sectra, Sweden) for the use of digital X-ray radiogrammmetry, Anders Rosholm (PhD) for the use of the computer-aided joint space analysis and Rüdiger Vollandt (PhD) for the statistical advice. Finally the authors would also like to thank Dieter Felsenberg, MD (Berlin, Germany) and Claus C. Gluer, PhD (Kiel, Germany) for their comments regarding the study design.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Alexander Pfeil, Julia Lippold, Diane M. Renz, Andreas Hansch, Werner A. Kaiser & Joachim Böttcher

  2. Clinic of Internal Medicine III, Department of Rheumatology and Osteology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Thorsten Eidner, Gabriele Lehmann, Peter Oelzner & Gert Hein

  3. Clinic of Internal Medicine III, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Gunter Wolf

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  1. Alexander Pfeil
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Correspondence to Joachim Böttcher.

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Pfeil, A., Lippold, J., Eidner, T. et al. Effects of leflunomide and methotrexate in rheumatoid arthritis detected by digital X-ray radiogrammetry and computer-aided joint space analysis. Rheumatol Int 29, 287–295 (2009). https://doi.org/10.1007/s00296-008-0682-9

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  • DOI: https://doi.org/10.1007/s00296-008-0682-9

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