Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis
Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis
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DOI：
10.1136/ard.62.7.617
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发表时间：
2003-07-01
影响因子：
27.4
通讯作者：
Carlsten, H
中科院分区：
文献类型：
--
作者：
d'Elia, HF;Larsen, A;Carlsten, H
目的：研究绝经后女性活动性类风湿关节炎（RA）患者关节破坏和骨密度（BMD）降低的决定因素，并评估是否存在侵蚀性疾病和骨丢失的共同标志物。方法：采用双能X线骨密度仪测定88例RA患者的骨密度，并按Larsen方法进行关节损伤的X线检查。BMD和Larsen评分之间的关联，人口统计学和疾病相关变量，包括促炎细胞因子，HLA-DR 4表位，骨和软骨营业额的标志物之间的关联，通过简单和多元线性回归analysis.Results：49/88（56%）患者至少有一个网站骨质疏松症。骨密度降低和关节破坏增加与以下因素相关：前臂和股骨颈、Larsen评分高、体重低和年龄大（R-2 = 0.381，p < 0.001; R-2 = 0.372，p < 0.001）;在全髋关节、低体重、高Larsen评分和注射糖皮质激素剂量下（R-2 = 0.435，p < 0.001）;在腰椎，体重减轻，软骨寡聚基质蛋白减少，I型前胶原羧基末端前肽增加（R-2 = 0.248，p < 0.001）。Larsen评分与病程长、C反应蛋白（CRP）升高有关（R-2 = 0.545，p < 0.001）。低体重和高Larsen评分与BMD降低密切相关。CRP升高和病程长是绝经后RA女性糜烂性疾病的决定因素。这些发现表明RA局部和全身性骨丢失的共同机制。
Objectives: To investigate determinants of joint destruction and reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis ( RA) not treated with bisphosphonates or hormone replacement therapy and to evaluate if there are common markers of erosive disease and bone loss.Methods: BMD was measured using dual x ray absorptiometry and joint damage was examined by x ray examination according to the Larsen method in 88 patients with RA. Associations between BMD and Larsen score, and between demographic and disease related variables, including proinflammatory cytokines, HLA-DR4 epitopes, and markers of bone and cartilage turnover, were examined bivariately by simple and multiple linear regression analyses.Results: 49/88 (56%) patients had osteoporosis in at least one site. Reduced BMD and increased joint destruction were associated with: at the forearm and femoral neck, high Larsen score, low weight, and old age (R-2 = 0.381, p < 0.001; R-2 = 0.372, p < 0.001, respectively); at the total hip, low weight, high Larsen score, and dose of injected glucocorticosteroids (R-2 = 0.435, p < 0.001); at the lumbar spine, low weight, reduced cartilage oligomeric matrix protein, and increased carboxyterminal propeptide of type I procollagen (R-2 = 0.248, p < 0.001). Larsen score was associated with long disease duration and increased C reactive protein (CRP) (R-2 = 0.545, p < 0.001).Conclusions: Osteoporosis is common in postmenopausal patients with RA. Low weight and high Larsen score were strongly associated with BMD reduction. Increased CRP and long disease duration were determinants of erosive disease in postmenopausal women with RA. These findings indicate common mechanisms of local and generalised bone loss in RA.