Progression of Bone Erosions in Rheumatoid Arthritis Assessed by HR-pQCT and Conventional X-ray

N/AEnrolling By InvitationNCT03429426

Aarhus University Hospital625 enrolled

Overview

Today, regular X-ray examination is not sufficiently sensitive for detecting progression of bone destruction in rheumatoid arthritis, but a new type of high-resolution CT scanner, the High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) can detect very early and minor joint injuries. The purpose of this study is to use HR-pQCT techniques to look at the damage and disease activity progression in the hand and wrist joints of patients with rheumatoid arthritis.

The design of the trial is an observational study with three distinct groups. At the start of the trial period and at one-year of follow-up, the trial subject will have their hand X-rayed by conventional radiography, and their metacarpophalangeal (MCP) joint and wrist scanned by HR-pQCT-Imaging. The 28-joint Disease Activity Score(DAS28-CRP), Health Assessment Questionnaire (HAQ), Visual analogue scale(VAS)-score for pain, fatigue and quality of life are performed to investigate the correlation between radiographic changes and disease activity. Blood samples are collected to investigate serological markers of bone metabolism and inflammation and the radiographic changes. The following groups are investigated: * Rheumatoid Arthritis(RA): Patients with RA ≥5 years according to the ACR/EULAR 2010 classification criteria or the American Rheumatism Association 1987 revised criteria are recruited from the outpatient clinic at the Department of Rheumatology, Aarhus University Hospital. Treatment will be adjusted according to the patient's need and according to national guidelines. (n=450) * Pre-RA patients: Patients with pre-RA, (joint pain, but no swelling and Anti-CCP 3 times above the upper limit) are recruited from the outpatient clinic at the Department of Rheumatology, Aarhus University Hospital. (n=75) * Healthy subjects: Healthy age- and sex-matched Individuals are recruited, as a control group, by posting at libraries in Aarhus, Aarhus University, Aarhus University Hospital and postings on the websites www.forsøgsperson.dk and www.Sundhed.dk. (N=100)

Study Type

OBSERVATIONAL

Enrollment

625

Conditions

Arthritis, Rheumatoid

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Rheumatoid arthritis patients Inclusion criteria * Patients (\> 18 years) with rheumatoid arthritis ≥5 years according to the ACR/EULAR (2010) classification criteria or American Rheumatism Association 1987 revised criteria for the patients who were diagnosed before 2010. * Patients who are receiving treatment on an outpatient basis. * Ability and willingness to give written informed consent and to meet the requirements of the trial protocol. Exclusion criteria * Patients who have previously suffered trauma in the form of fracture or luxation of the hand are excluded. * Evidence of active malignant disease. * Hypo- or hyperthyroidism. * Hypocalcaemia. * Impaired renal function (eGFR \<35ml/min). * Pregnancy. Pre-rheumatoid arthritis patients Inclusion criteria * Age over 18 years. * Anti-CCP 3 times the upper limit of the reference interval. * Arthralgia. * Ability and willingness to give written informed consent and to meet the requirements of the trial protocol. Exclusion criteria * Pregnancy. * Swelling of joints. Verified by clinical ultrasound. * Patients who have previously suffered trauma in the form of fracture or luxation of the hand are excluded. * Evidence of malignant disease. * Hypo- or hyperthyroidism. * Hypocalcaemia. Healthy subjects Inclusion criteria * Age over 18 years. * No joint complaints. * Ability and willingness to give written informed consent and to meet the requirements of the trial protocol. Exclusion criteria * Patients who have previously suffered trauma in the form of fracture or luxation of the hand are excluded. * Evidence of malignant disease. * Hypo- or hyperthyroidism. * Hypocalcaemia. * Impaired renal function (eGFR \<35ml/min). * Earlier or present rheumatological disease or bone metabolic disease. * Positive anti-CCP. * Pregnancy.

Locations (1)

Department of Rheumatology, Aarhus University Hospital

Aarhus, Denmark

Outcomes

Primary Outcomes

Erosion changes by HR-pQCT

Changes in bone erosions volume in mm3 by HR-pQCT-imaging from baseline to one-year follow-up, in the three groups.

Time frame: One year

Volumetric bone mineral density(vBMD) changes by HR-pQCT

Changes in volumetric bone mineral density(vBMD) in mgHA/cm3 by HR-pQCT-imaging from baseline to one-year follow-up, in the three groups.

Time frame: One year

Erosion changes by HR-pQCT

Changes in bone erosions width in mm by HR-pQCT-imaging from baseline to one-year follow-up, in the three groups.

Time frame: One year

Erosion changes by HR-pQCT

Changes in bone erosions depth in mm by HR-pQCT-imaging from baseline to one-year follow-up, in the three groups.

Time frame: One year

Secondary Outcomes

Radiographic erosion score

Change in Sharp/van der Heijde (SvH) score from baseline to one-year follow-up, in the three groups.

Time frame: One year

CTX

Changes from baseline to one-year follow-up in C-terminal telopeptide (CTX) in pg/mL, in the three groups.

Time frame: one year

P1NP

Changes from baseline to one-year follow-up in Procollagen type 1 N-terminal propeptide (P1NP) in pg/mL, in the three groups.

Time frame: one year

BAP

Changes from baseline to one-year follow-up in Bone-specific alkaline phosphatase (BAP) in pg/mL, in the three groups.

Data from ClinicalTrials.gov

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