Forslind Kristina, Keller Catharina, Svensson Björn, Hafström Ingiäld
Rheumatology Section, Department of Medicine, Helsingborg's lasarett, Helsingborg, Sweden.
J Rheumatol. 2003 Dec;30(12):2590-6.
Data suggest that reduced bone mass may be associated with radiological damage in rheumatoid arthritis (RA). We investigated if patients with reduced bone mineral density (BMD) at onset of RA had more radiological damage at onset and after 2 years than patients with normal BMD.
BMD at lumbar spine and hip was measured in 204 patients with recent RA at presentation. At baseline and after 2 years, radiographs of hands and forefeet were evaluated according to the Larsen method. At the same time-points, Disease Activity Score (DAS 28) and functional disability (the Stanford Health Assessment Questionnaire, HAQ) were assessed.
The 134 women and 70 men had a mean age of 55 and 61 years, respectively. Reduced bone mass (RBM, Z score < or = 1.0 SD) in at least one site was found in 46.0% of women and 62.5% of men. T and Z scores correlated significantly with Larsen scores both at baseline and after 2 years for the total patient cohort. Calculated separately for the sexes, significant correlations were found only for women. Women but not men with reduced bone mass and osteoporosis had higher Larsen scores at baseline and after 2 years than those without. From a stepwise multiple logistic regression analysis Z score trochanter and baseline C-reactive protein were selected as independent predictors of joint damage, measured as proportion over the median Larsen scores. This model could explain about 25% of the "variance" in outcome (Nagelkerke R2 = 0.27).
Reduced BMD at onset of RA in women was associated with a higher Larsen score at baseline and after 2 years, indicating that the development of reduced bone mass and joint destruction in RA may have a common pathophysiological mechanism.
数据表明，类风湿关节炎（RA）患者骨量减少可能与放射学损伤有关。我们研究了RA发病时骨矿物质密度（BMD）降低的患者在发病时及2年后是否比BMD正常的患者有更多的放射学损伤。
对204例近期发病的RA患者进行腰椎和髋部BMD测量。在基线和2年后，根据Larsen方法对手和前足的X线片进行评估。在同一时间点，评估疾病活动评分（DAS 28）和功能残疾情况（斯坦福健康评估问卷，HAQ）。
134名女性和70名男性的平均年龄分别为55岁和61岁。46.0%的女性和62.5%的男性至少有一个部位骨量减少（RBM，Z评分≤1.0 SD）。对于整个患者队列，T和Z评分在基线和2年后均与Larsen评分显著相关。按性别分别计算，仅在女性中发现显著相关性。骨量减少和骨质疏松的女性在基线和2年后的Larsen评分高于无此情况的女性，而男性则不然。通过逐步多元逻辑回归分析，选择转子Z评分和基线C反应蛋白作为关节损伤的独立预测因素，以超过Larsen评分中位数的比例来衡量。该模型可解释约25%的结果“方差”（Nagelkerke R2 = 0.27）。
RA发病时女性BMD降低与基线及2年后较高的Larsen评分相关，表明RA中骨量减少和关节破坏的发生可能有共同的病理生理机制。
