Characteristics of fracture and related factors in patients with rheumatoid arthritis
Characteristics of fracture and related factors in patients with rheumatoid arthritis
复制标题
DOI：
10.1007/s10165-008-0032-5
复制
发表时间：
2008-04-01
影响因子：
2.2
通讯作者：
Yoshikawa, Hideki
中科院分区：
文献类型：
--
作者：
Nampei, Akihide;Hashimoto, Jun;Yoshikawa, Hideki
为了研究类风湿性关节炎（RA）患者椎体和非椎体骨折的临床特征，包括不全骨折，并评估骨折的危险因素，我们对209例门诊类风湿性关节炎患者进行了为期1年的前瞻性研究。评估患者的年龄、性别、Steinbrocker功能分级、糖皮质激素使用、下肢手术史、血清c反应蛋白（CRP）和双膦酸盐使用情况。骨折检查通过x线摄影、计算机断层扫描（CT）、磁共振成像（MRI）和骨扫描进行。在1年的研究期间，24例患者发生33例骨折，发生率为15.8例/ 100例患者年。骨折发生在不同部位。多数（70%）为不完全性骨折，50%以上为活动功能障碍。39%的骨折在疼痛发作时没有影像学表现。功能分级和糖皮质激素剂量与骨折发展有显著相关性。本前瞻性研究表明，类风湿性关节炎患者骨折，尤其是不全性骨折的发生率非常高，且多数骨折引起步态障碍。建议早期干预预防继发性骨质疏松，以维持类风湿关节炎患者的生活质量，特别是那些有功能障碍或正在接受糖皮质激素治疗的患者。
To examine the clinical features of vertebral and non-vertebral fractures in patients with rheumatoid arthritis (RA), including insufficiency fractures, and to assess the risk factors for fracture, we prospectively studied 209 outpatients with rheumatoid arthritis for 1 year. The age, gender, Steinbrocker's functional class, glucocorticoid use, history of lower limb surgery, serum C-reactive protein (CRP), and use of bisphosphonates were evaluated. Examination for fractures was performed by radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scanning. Thirty-three fractures occurred in 24 patients over the 1-year study period, and the incidence was 15.8 fractures per 100 patient-years. Fractures occurred at various sites. The majority (70%) was insufficiency fracture, and more than 50% caused ambulatory dysfunction. Radiographic findings were absent in 39% of the fractures at the onset of pain. The functional class and glucocorticoid dose were significantly associated with fracture development. This prospective study showed that the incidence of fractures, especially insufficiency fractures, was very high in patients with rheumatoid arthritis and that most of their fractures caused gait disturbance. Early intervention to prevent secondary osteoporosis is recommended to maintain the quality of life in patients with rheumatoid arthritis, especially those with functional impairment or undergoing glucocorticoid therapy.