Fractal bone analysis (Hmean) is a texture parameter reflecting bone microarchitecture. The BMA device (D3A™ Medical Systems, Orléans, France) is a high-resolution X-ray device that allows assessment of bone texture analysis. We aimed to measure Hmean in rheumatoid arthritis patients at the second and third metacarpal bones, at baseline and after 1year of follow-up, and to assess the relationship of Hmean and rheumatoid arthritis disease parameters.

Patients with rheumatoid arthritis according to ACR criteria were included. They were assessed over 1year, in the context of a prospective study conducted in Maastricht. For this substudy, activity of the disease was assessed by erythrocyte sedimentation rate, C-reactive protein and Disease Activity Score 28 performed at each visit. Radiographic bone damage was assessed using hand and feet radiographs at baseline and on a 1-year basis. The bone texture parameters were evaluated on the second and third metacarpal heads of the left hand using BMA device.

One hundred and sixty-five rheumatoid arthritis patients were included in this study. At baseline, Hmean was negatively correlated with age [r=−0.22 (P=0.013)] and erythrocyte sedimentation rate [r=−0.16 (P=0.039)]. No significant correlation was found between Hmean and Disease Activity Score, disease activity Visual Analog Scale, daily corticosteroid dose and C-reactive protein. There was a significant increase in Hmean of second and third metacarpal bones over 1year (1.6% and 1.3%, P<0.01) except in patients with local second and third metacarpal bones erosion.

The bone texture parameter Hmean is influenced by age, inflammation and local erosions in rheumatoid arthritis.