Osteoporosis in patients with rheumatoid arthritis: tip of the iceberg?
Osteoporosis in patients with rheumatoid arthritis: tip of the iceberg?
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类风湿关节炎患者的骨质疏松症：冰山一角？
DOI：
10.1080/030097400750002148
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发表时间：
2000
影响因子：
2.1
通讯作者：
W. Lems
中科院分区：
文献类型：
--
作者：
M. Lodder;S. Bakker;B. Dijkmans;T. Kvien;A. Woolf;W. Lems
骨质疏松症被认为是类风湿性关节炎（RA）的一种并发症，不仅在接受过皮质类固醇治疗的患者中如此，在没有（以前）使用过皮质类固醇的患者中也是如此(1)。到目前为止，问题的严重程度还没有被阐明，也不清楚哪些类风湿性关节炎患者应该接受骨矿物质密度（BMD）测量。最近，提出了初步标准，以获得可能具有骨质疏松高风险的RA患者的BMD印象(2)。有人建议，骨密度测量可能是有用的，在存在两个或两个以上的患者特征：高疾病活动性，高年龄和不动。在本研究中，应用这些初步标准，以确定根据这些标准推定为高风险的RA患者骨质疏松症的发生。通过对阿姆斯特丹门诊风湿病诊所的患者管理，登记了2100名RA患者，追踪了1997年进行的所有双能X线骨密度测量（髋关节和腰椎）测量。RA患者测量DXA的适应症由治疗风湿病的医生设定。回顾性地对医疗记录进行检查，以确定提出的标准(2)：高疾病活动性定义为1小时内平均ESR为20 mm和/或1年内平均CRP为20 mg/l，高年龄精确定义为女性为50岁，男性为60岁，Steinbrocker§3定义为不活动。强的松的使用（曾经与从未）被记录。记录Hologic 4500测量的DXA结果（T评分）。根据世界卫生组织的指南，骨质减少被定义为J1。0§T得分wJ2。5和骨质疏松症作为T评分ĶJ2。5(3)。患者被分为三个亚组。第一组至少满足了骨质疏松症三个高危标准中的两个。第二组要么不符合这些高风险标准，要么不符合其中之一。I组和II组患者从未使用过糖皮质激素（现在或过去）。III组包括使用糖皮质激素的患者（现在或过去），符合任何数量的高风险标准。2100例RA患者中有49例接受了DXA测量。
Sir, Osteoporosis is recognised as a complication of rheumatoid arthritis (RA), not only in patients treated with corticosteroids but also in those without (previous) use of corticosteroids (1). So far, neither the magnitude of the problem has been elucidated nor is it clear which RA patients should undergo a bone mineral density (BMD) measurement. Recently, preliminary criteria were proposed to get an impression of BMD in RA patients possibly at high risk of osteoporosis (2). It was suggested that BMD measurement might be useful in the presence of two or more of the following patient characteristics: high disease activity, high age and immobility. In the present study these preliminary criteria were applied in order to determine the occurrence of osteoporosis in RA patients with a supposed high risk according to these criteria. Via patient administration of the out-patient rheumatology clinics in Amsterdam, where 2100 RA patients are registered, all dual energy X ray absorptiometry (DXA) bone density (hip and lumbar spine) measurements carried out in 1997 were traced. The indication for the measurement of DXA in RA patients was set by the treating rheumatologist. Retrospectively, medical records were checked for the proposed criteria (2): high disease activity defined as mean ESR w20 mm in one hour and/or mean CRP w20 mg/l during one year, high age precised as women w50 years (yrs), men w60 yrs, and immobility which was defined as Steinbrocker § 3. Prednisone use (ever versus never) was noted. DXA result measured by Hologic 4500 (T score) was recorded. According to the WHO guidelines, osteopenia was defined as J1. 0 § T score wJ2. 5 and osteoporosis as a T score ĶJ2. 5 (3). Patients were divided into three subgroups. Group I fulfilled at least two out of the three proposed high risk criteria for osteoporosis. Group II fulfilled either none or one of these high risk criteria. Patients in group I and II never used glucocorticoids (now or in the past). Group III consisted of patients using glucocorticoids (now or in the past), meeting any number of the high risk criteria. A total of 49 out of 2100 RA patients underwent DXA measurement.