Forsblad D'Elia H, Larsen A, Waltbrand E, Kvist G, Mellström D, Saxne T, Ohlsson C, Nordborg E, Carlsten H
Department of Rheumatology and Inflammation Research, Göteborg University, Sweden.
Ann Rheum Dis. 2003 Jul;62(7):617-23. doi: 10.1136/ard.62.7.617.
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.
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.
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).
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.
研究未接受双膦酸盐或激素替代疗法的绝经后活动性类风湿关节炎（RA）女性关节破坏和骨矿物质密度（BMD）降低的决定因素，并评估是否存在侵蚀性疾病和骨质流失的共同标志物。
采用双能X线吸收法测量88例RA患者的BMD，并根据Larsen法通过X线检查评估关节损伤情况。通过简单和多元线性回归分析对BMD与Larsen评分之间以及人口统计学和疾病相关变量（包括促炎细胞因子、HLA - DR4表位以及骨和软骨转换标志物）之间的关联进行双变量检验。
49/88（56%）的患者至少在一个部位存在骨质疏松。BMD降低和关节破坏增加与以下因素相关：在前臂和股骨颈，Larsen评分高、体重低和年龄大（R² = 0.381，p < 0.001；R² = 0.372，p < 0.001）；在全髋关节，体重低、Larsen评分高和注射用糖皮质激素剂量（R² = 0.435，p < 0.001）；在腰椎，体重低、软骨寡聚基质蛋白降低和I型前胶原羧基末端前肽增加（R² = 0.248，p < 0.001）。Larsen评分与病程长和C反应蛋白（CRP）升高相关（R² = 0.545，p < 0.001）。
骨质疏松在绝经后RA患者中很常见。体重低和Larsen评分高与BMD降低密切相关。CRP升高和病程长是绝经后RA女性侵蚀性疾病的决定因素。这些发现表明RA中局部和全身性骨质流失存在共同机制。
