Güler-Yüksel M, Bijsterbosch J, Goekoop-Ruiterman Y P M, de Vries-Bouwstra J K, Ronday H K, Peeters A J, de Jonge-Bok J M, Breedveld F C, Dijkmans B A C, Allaart C F, Lems W F
Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Ann Rheum Dis. 2007 Nov;66(11):1508-12. doi: 10.1136/ard.2007.070839. Epub 2007 Apr 24.
Osteoporosis is a well-known extra-articular phenomenon in patients with uncontrolled, long-standing rheumatoid arthritis (RA). In the present study, the extent of osteoporosis and reduced bone mineral density (BMD) and the disease-related and demographic factors that are associated with osteoporosis and reduced BMD were examined in patients with recently diagnosed, active RA.
BMD of the total hip and the lumbar spine was measured using dual-energy x ray absorptiometry in 381 patients with recently diagnosed active RA, who had never been treated with DMARDs or corticosteroids. Osteoporosis was defined as a T score <or=-2.5 SD and reduced BMD as Z score <or=-1 SD. Multivariate logistic regression analyses were performed to detect associations of osteoporosis and reduced BMD with disease activity, functional disability, joint damage (Sharp-van der Heijde score) and demographic factors.
Osteoporosis and reduced BMD were found in the spine and/or the hip in 11% and 25%, respectively, of the patients. Longer symptom duration and presence of rheumatoid factor (RF) were the only RA-specific markers for osteoporosis and reduced BMD. Further, postmenopausal status in women, a low body mass index, familial osteoporosis, and, remarkably, male gender, were independently associated with osteoporosis and reduced BMD.
In patients with recently diagnosed active RA who had never been treated with DMARDs or corticosteroids, BMD seems to be well-preserved and predominantly related to demographic factors. Longer symptom duration and a positive RF, but not higher disease activity or more joint damage, were related to osteoporosis and reduced BMD.
骨质疏松是未得到控制的长期类风湿关节炎（RA）患者中一种众所周知的关节外现象。在本研究中，我们对近期诊断为活动期RA的患者的骨质疏松程度、骨密度（BMD）降低情况以及与骨质疏松和BMD降低相关的疾病相关因素和人口统计学因素进行了检查。
采用双能X线吸收法测量了381例近期诊断为活动期RA且从未接受过改善病情抗风湿药（DMARDs）或皮质类固醇治疗的患者的全髋和腰椎BMD。骨质疏松定义为T值≤ -2.5标准差，BMD降低定义为Z值≤ -1标准差。进行多变量逻辑回归分析以检测骨质疏松和BMD降低与疾病活动度、功能残疾、关节损伤（Sharp-van der Heijde评分）和人口统计学因素之间的关联。
分别有11%和25%的患者在脊柱和/或髋部发现骨质疏松和BMD降低。症状持续时间较长和类风湿因子（RF）阳性是骨质疏松和BMD降低仅有的RA特异性标志物。此外，女性的绝经后状态、低体重指数、家族性骨质疏松以及值得注意的男性性别与骨质疏松和BMD降低独立相关。
在从未接受过DMARDs或皮质类固醇治疗的近期诊断为活动期RA的患者中，BMD似乎保存良好，且主要与人口统计学因素相关。症状持续时间较长和RF阳性，而非更高的疾病活动度或更多的关节损伤，与骨质疏松和BMD降低有关。
