Book C, Karlsson M, Akesson K, Jacobsson L
Department of Rheumatology, Malmö University Hospital, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Scand J Rheumatol. 2008 Jul-Aug;37(4):248-54. doi: 10.1080/03009740801998747.
Osteoporosis is a known complication of rheumatoid arthritis (RA). This prospective study aimed to evaluate whether disease activity, disability, and glucocorticoid (GC) treatment in early RA were risk factors for loss of bone mineral density (BMD).
We followed 97 women (mean age 58 years), for 24 months, with a history of RA of less than 12 months. At baseline, 77 women were receiving standard treatment with disease-modifying antirheumatic drugs (DMARDs) and 20 were receiving no treatment. Risk factors for osteoporosis were recorded. Disease activity score (DAS28), Health Assessment Questionnaire (HAQ) score, and medications were registered at baseline and every 6 months and calculated as areas under the curve (AUCs). Femoral neck and lumbar spine BMD were measured at baseline and after 2 years and compared to BMD in age- and gender-matched controls. Risk factors were analysed by linear regression models.
BMD loss was comparable to that of age-matched women in both the lumbar spine and the femoral neck, although neither was significantly different from baseline. In multivariate analyses the AUC for DAS28 was an independent predictor of changes in lumbar spine BMD (p = 0.003) and that for HAQ of changes in femoral neck BMD (p = 0.018). GC use was not an overall predictor of BMD loss.
BMD loss was predicted by high disease activity and disability but not by GC treatment. With the DMARD, GC, hormone replacement therapy (HRT), and bisphosphonate treatment strategies used during the study period, the general outcome seems favourable concerning loss of BMD in patients with early RA.
骨质疏松是类风湿关节炎（RA）已知的并发症。这项前瞻性研究旨在评估早期RA的疾病活动度、功能障碍及糖皮质激素（GC）治疗是否为骨密度（BMD）丢失的危险因素。
我们对97名女性（平均年龄58岁）进行了为期24个月的随访，她们的RA病史少于12个月。基线时，77名女性接受改善病情抗风湿药物（DMARDs）标准治疗，20名未接受治疗。记录骨质疏松的危险因素。在基线及每6个月时记录疾病活动评分（DAS28）、健康评估问卷（HAQ）评分及用药情况，并计算曲线下面积（AUCs）。在基线及2年后测量股骨颈和腰椎的BMD，并与年龄和性别匹配的对照组的BMD进行比较。通过线性回归模型分析危险因素。
腰椎和股骨颈的BMD丢失与年龄匹配的女性相当，尽管两者与基线相比均无显著差异。在多变量分析中，DAS28的AUC是腰椎BMD变化的独立预测因素（p = 0.003），HAQ的AUC是股骨颈BMD变化的独立预测因素（p = 0.018）。GC的使用并非BMD丢失的总体预测因素。
BMD丢失可由高疾病活动度和功能障碍预测，但不由GC治疗预测。在研究期间采用DMARD、GC、激素替代疗法（HRT）和双膦酸盐治疗策略，早期RA患者BMD丢失的总体结果似乎良好。
