الفهرس 
Rheumatoid ArthritisOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a chronic systemic disease that causes pain and progressive decline of the functional capacity of the patients if not properly treated (van Nies et al., 2014).
Joint damage occurs in the course of RA and chronic inflammation due to RA disturbs the normal cycle of bone resorption and remodeling. Several scoring systems have been developed to assess the extent and changes of damage seen in X-ray images, such as the modified Sharp-van der Heijde score.
DXA can be considered an accurate, repeatable, and sensitive method to assess hand bone mineral density (BMD) in early RA (Kilic et al., 2015).
Hand function tests are important sensitive tools for the assessment of response to treatment in RA patients (Romero-Guzmán et al., 2016).
This study aimed to study the relation between generalized Bone Mineral Density (BMD) and each of hand joint destruction and hand function to find out its possible role in assessing rheumatoid hand disability.
This study was conducted on 50 patients diagnosed as RA based on the 2010 ACR Rheumatoid Arthritis Classification Criteria attended at the physical medicine, rheumatology and rehabilitation clinics at Ain Shams university hospital. All patients underwent Duruöz Hand Index (DHI), Grip Ability Test (GAT), Grip strength test, and Pinch strength tests for assessing the function of the dominant hand of the patients. Plain x-ray evaluated by van der Heijde-modified total Sharp score (vdH-S) was done to assess the damage of the joints of the dominant hand, and Dual-energy X-ray absorptiometry (DXA) to assess the Bone Mineral Density.
In our study, we found wrist osteopenia and osteoporosis more prevalent than that of the lumbar spine and neck of the femur among those patients. This proves that bone loss is marked around the most affected joints characteristically small joints of the hand.
Wrist BMD was significantly correlated with grip strength, pinch strength, grip ability test, and van der Heijde modified sharp score of the dominant hand. That indicates that osteoporosis is affected by each of hand function and joint damage.
Van der Heijde modified sharp score was significantly correlated with each of the total grip ability test, grip strength, and pinch strength which shows the more joint damage of the hand the more hand function disability although there was no significant correlation with duruőz hand index.
We found that Duruőz hand index (DHI) score was higher with the activity of the disease as DHI was significantly correlated with ESR and CRP.
Conclusion
Ra related osteoporosis is more evident with local joint damage and hand disability. Moreover, DXA scan can be an alternative assessment tool for RA joint destruction scores and hand function tests as well as a more precise measurement of hand BMD to properly assess therapeutic response and change management plans accordingly.
Recommendations
• We praise the routine use of DXA to assess the hand BMD among RA patients to modify the therapeutic plan accordingly in order to achieve higher rates of remission.
• We endorse using hand function tests and x-ray routinely to avoid early complication and adjust the treatment plan
• We recommend studies on a larger scale for better evaluation of the correlation between hand BMD using DXA and Grip Ability Test (GAT).
• Studies on the relation between the severity of RA and osteoporosis should be considered.