Efficient treatment
dxr-online offers an objective tool to identify patients with increased risk of joint destruction, to avoid unnecessary drug treatment of patients with a more favorable prognosis, and to quantify treatment effect.
Early prognosis
It is a well known fact that periarticular osteoporosis precedes erosions in RA. The very high precision of DXR makes it possible to make an accurate assessment of the bone destruction process and to identify those RA patients who have the greatest bone loss rate within a three-month period.
Early RA patients have been observed to demonstrate a sharp decline in DXR. The decline in DXR is associated with an increased risk of joint damage at one, two, five and ten years after the dxr-online prognosis [see references and below]. The association is strong and independent of other known risk factors such as biomarkers (anti-CCP) and joint destruction detectable at baseline.
Several independent studies show that bone loss measured with DXR predicts joint destruction in RA (see references & articles).
Treatment effect
Treatment effect of costly medicines can be quantified with DXR. Five randomized trials have investigated Sectra DXR for monitoring treatment effect in RA (including BeSt, PREMIER, BARFOT and the Kirwan study on low dose prednisolone) [see references]. The results are consistent and show that patients receiving more efficient treatment as assessed by visual X-ray RA damage scoring also destruct less bone as measured by DXR. This is visualized in the graph below, where the BeSt randomized treatment strategy cohort shows that patients in the two most aggressive treatment groups (the infliximab and the prednisolone combination treatment) lose less DXR-BMD than mono therapy and sequential step up therapy.
Figure ref: Güler-Yüksel M, Bijsterbosch J, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Hulsmans HM, de Beus WM, Han KH, Breedveld FC, Dijkmans BA, Allaart CF, Lems WF. Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis. Annals of the Rheumatic Diseases 2009 Mar;68(3):330-6. Epub 2008 Mar 28.
Monitoring of treatment efficiency allows the physician greater flexibility in timely adjusting treatment to fit each patients needs e.g. switching treatment in lack of efficacy, or taper dose on patients with very good response.