Department of Rheumatology, Central Clinical Hospital, 02-507 Warsaw, Poland.
Rheumatol Int. 2009 Oct;29(12):1403-9. doi: 10.1007/s00296-009-0867-x. Epub 2009 Feb 15.
Joint inflammation in rheumatoid arthritis (RA) induces local periarticular osteoporosis. Generalised bone mineral density (BMD) decrease concerns approximately 50% of rheumatic patients. Both types of bone mass depletion can issue from cytokine-induced (TNF-alpha, IL-1, IL-6) osteoclasts' activation, osteoprotegerin and its ligand's (RANKL) function disorders, patients' immobilisation and glucocorticosteroid (GCS) intake, as well as from hormonal alterations in postmenopausal women, predominate among RA individuals. The aim of the study was to compare serum concentrations of marker of bone formation--serum aminoterminal propeptide of type I collagen (PINP), and bone resorption, carboxy (C) terminal telopeptide (Ctx), bone turnover markers in RA and osteoarthritis (OA) patients and in RA groups of different disease activity, different degree of joint damage and the history of GCS intake. A total of 50 RA female patients and 50 women with knee OA were included in the study. Blood for morphology and biochemistry laboratory tests was taken. Joint X-rays to establish OA and RA diagnosis and the degree of RA progression, as well as DEXA BMD measurements were performed. PINP and Ctx concentrations were assessed. In RA patients the number of swollen and painful joints, the duration of morning stiffness, visual analogue scale values and Waaler-Rose's test activity were recorded. The Disease Activity Index (DAS 28) was counted from the appropriate formula. No differences in bone turnover markers' concentrations were noted neither between RA and OA patients nor between the RA group when compared to the one without the history of GCS use. Bone turnover markers' concentrations in RA were proportional to the number of swollen and painful joints. However, no correlation was found between the markers' concentrations and RA activity assessed by DAS 28 or by laboratory means. Ctx concentrations were higher in patients at II degree joint damage according to Larsen and Dale's than at more advanced stages. Ctx concentrations decreased with the disease duration. Serum morphogenesis and resorption markers' concentrations change in course of RA indicating the decrease in bone metabolic activity with the disease duration and progression. High RA activity and severity correlate with increased markers' levels-the resorption one. The influence of GCS on bone metabolism in RA requires further study.
类风湿关节炎（RA）的关节炎症会引起局部关节周围骨质疏松。大约 50%的风湿患者会出现全身性骨密度（BMD）下降。这两种类型的骨质流失都可能是由细胞因子诱导的（TNF-α、IL-1、IL-6）破骨细胞激活、骨保护素及其配体（RANKL）功能紊乱、患者固定和糖皮质激素（GCS）摄入以及绝经后妇女的激素变化引起的，在 RA 患者中更为常见。本研究的目的是比较 RA 和骨关节炎（OA）患者以及不同疾病活动度、不同关节损伤程度和 GCS 摄入史的 RA 组中，骨形成标志物——血清 I 型胶原氨基末端前肽（PINP）和骨吸收标志物——羧基（C）末端肽（Ctx）的血清浓度，以评估骨转换标志物。研究共纳入 50 名女性 RA 患者和 50 名膝关节 OA 女性患者。采集血液进行形态学和生化实验室检查。进行关节 X 射线检查以确定 OA 和 RA 诊断以及 RA 进展程度，并进行 DEXA BMD 测量。评估 PINP 和 Ctx 浓度。在 RA 患者中，记录肿胀和疼痛关节的数量、晨僵持续时间、视觉模拟量表值和 Waaler-Rose 试验活动度。根据适当的公式计算疾病活动指数（DAS 28）。RA 患者与 OA 患者之间以及与未使用 GCS 史的 RA 患者组之间，骨转换标志物浓度无差异。RA 患者的骨转换标志物浓度与肿胀和疼痛关节的数量成正比。然而，标志物浓度与 DAS 28 或实验室方法评估的 RA 活性之间未发现相关性。根据 Larsen 和 Dale 的标准，CTX 浓度在关节损伤 II 度的患者中高于更晚期的患者。CTX 浓度随疾病持续时间而降低。RA 过程中血清形态发生和吸收标志物浓度的变化表明，随着疾病持续时间和进展，骨代谢活性降低。高 RA 活性和严重程度与标志物水平升高相关，即吸收标志物。GCS 对 RA 骨代谢的影响需要进一步研究。
