Impact of osteoporosis on the quality of life in patients with rheumatoid arthritis

Abstract

Introduction. Rheumatoid arthritis (RA) patients have poor quality of life due to inflammation and joint destruction that characterizes the disease. Osteoporosis, through the fragile osteoporotic fractures as a complication, also associates an important decrease in the quality of life. Knowledge of the impact of osteoporosis on quality of life in patients with RA is currently required. Objectives. The main objective of the study is to evaluate the impact that osteoporosis has on the quality of life in patients with RA. The secondary objective of the study is to identify correlations that the quality of life quantified by health assessment questionnaire (HAQ) has with nonspecific inflammatory syndrome (erytrocyte sedimentation rate – ESR, C-reactive protein – CRP, fibrinogen – FI), rheumatoid autoimmunity (rheumatoid factor – RF and anti-citrullinated protein antibodies – ACPA) and osteoporosis assessment elements (T score and bone mineral density – BMD of the lumbar spine and hip, FRAX algorithm). Material and methods. This is a descriptive, retrospective, observational clinical study based on the observation sheets found in the database of the “Sf. Maria” Clinical Hospital, Department of Internal Medicine and Rheumatology, Bucharest, Romania which included patients with RA hospitalized during the period November 2018-December 2019. The patients studied were divided into two groups according to the presence or not of osteoporosis: group A patients with RA without osteoporosis and group B patients with RA and osteoporosis. Multiple paraclinical variables related to biological investigations (hemoglobin, hematocrit, alcaline phosphatase – AF, TSH), nonspecific inflammatory syndrome (ESR, FI, CRP), RA evaluation items (RF, ACPA, disease activity score 28 – DAS28 and HAQ) and evaluation elements of osteoporosis (T score and BMD at lumbar spine and hip, FRAX algorithm) were followed in the studied group. Results. The study included 85 patients diagnosed with RA with an average age of 67.64 years (95% CI 65.7885 to 69.5018) and SD of 9.01 years. There were no statistically significant differences between the 2 groups of paraclinical variables used. Significant statistical differences were established between the 2 groups regarding ESR and CRP in favor of lot B, which seems to have high values of FB, but without statistical significance; in addition, there were statistically significant differences between the 2 groups in favor of group B regarding all the elements of evaluation of osteoporosis except the FRAX algorithm (risk of major osteoporotic fractures and hip fracture within 10 years) which were higher in the group B compared to group A but without statistical significance, confirming there is osteoporosis in this group. By analyzing the correlation relation on the whole group of patients between the activity of the disease objectified by DAS28 and the quality of life quantified by HAQ, a directly proportional and highly statistically significant relation is obtained (r = 0.64, p < 0.0001). Discussion. Although in “real life”, patients with RA and osteoporosis have a lower quality of life than patients with RA without osteoporosis as established by the current study, there is only a relationship between the quality of life of patients evaluated by HAQ and the activity of the disease evaluated by DAS28. But, there is no relationship between HAQ and osteoporosis assessment elements. Conclusions. The quality of life of patients with RA is related to the activity of inflammatory disease (DAS28), and the overlap of osteoporosis does not lead to a statistically significant decrease in quality of life, which makes us conclude that osteoporosis per se does not lead to decreased quality of life

Keywords

• osteporosis
• rheumatoid arthritis
• quality of life