Терапевтический архив (May 2014)
Association between bone mineral density and erosive and destructive changes in patients with rheumatoid arthritis: Preliminary results
Abstract
AIM: To obtain information on and to study an association between the erosive and destructive changes in the hand and foot joints, bone mineral density (BMD) in different parts of the skeleton and the X-ray alterations in the thoracic and lumbar vertebrae of patients with rheumatoid arthritis (RA)/MATERIAL AND METHODS: The investigation enrolled 66 women with a valid RA diagnosis, whose mean age was 51.6±9.6 years and the disease duration was 13.2±9.1 years. All the patients underwent clinical, laboratory, and X-ray studies assessing the progression of joint changes by the Sharp/van der Heijde method and estimating the vertebral body deformity index by the Genant technique, and BMD in 3 skeletal regions by dual-energy X-ray absorptiometry employing a Holovic Discovery A device/RESULTS: With X-ray higher-stage RA and higher Sharp total scores, regardless of age, there was a decrease in BMD in all skeletal areas and an increase in the number of patients with deformities of vertebrae and osteoporosis (OP) in at least one of the analyzed skeletal part. Thus, OP was found in 29% of the patients with Stages I and II RA and in 65% of those with Stages IV; deformities of vertebrae were in 12 and 22%, respectively. Comparative analysis of BMD and erosive and destructive changes in the patient groups different in age at onset of the disease has established that its young onset (from 16 to 30 years) and long duration have a negative effect on bone status. Femoral neck BMD in these patients is significantly lower than that in patients who were ill at older age (31-50 or over 50 years) (0.661±0.080, 0.739±0.111, and 0.713±0.120 g/cm2, respectively) and the Sharp total score was higher (181.1±91.3, 100.5±71.5 and 103.9±74.5, respectively). The patients' mean age in these groups at the study inclusion was 46.7±12.1, 51.9±6.7, and 60.3±3.3 years, respectively./CONCLUSION: With the longer disease duration, regardless of the age of patients with RA, there are increases in both Sharp total scores, X-ray RA stage, and the number of patients with OP, deformities of thoracic and lumbar vertebrae (however, there is no evidence of significant differences), BMD decrease in all skeletal parts.
