Briot Karine, Etcheto Adrien, Miceli-Richard Corinne, Dougados Maxime, Roux Christian
Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and
Department of Rheumatology, Cochin Hospital, and Epidemiology and Biostatistics Unit, Sorbonne Paris Cité Research Center, Paris Descartes University, INSERM U1153, Paris and.
Rheumatology (Oxford). 2016 Feb;55(2):335-42. doi: 10.1093/rheumatology/kev332. Epub 2015 Sep 11.
The objectives of the study were to assess the 2 year BMD changes and their determinants in patients with early inflammatory back pain suggestive of axial spondyloarthritis (SpA) (DESIR cohort).
A total of 265 patients (54% male, mean age 34.4 years) had BMD measurements at baseline and at 2 years. Low BMD was defined as a Z score ≤-2 (at at least one site) and significant bone loss was defined by a decrease in BMD ≥0.03 g/cm(2). Clinical, biological and imaging parameters were assessed over 2 years.
Thirty-nine patients (14.7%) had low BMD at baseline; 112 patients (42.3%) had a 2 year significant bone loss. One hundred and eighty-seven (70.6%) used NSAIDs at baseline and 89 (33.6%) received anti-TNF therapy over 2 years. In anti-TNF users, BMD significantly increased at the lumbar spine and did not change at the hip site from baseline. In multivariate analysis, baseline use of NSAIDs [odds ratio (OR) 0.38, P = 0.006] had a protective effect on hip bone loss. In patients without anti-TNF treatments, baseline use of NSAIDs (OR 0.09, P = 0.006) and a 2 year increase in BMI (OR 0.55, P = 0.003) had protective effects on hip bone loss, whereas a 2 year increase in fat mass was associated with hip bone loss (OR 1.18, P = 0.046).
Among patients with symptoms suggestive of early axial SpA, 42.3% of patients have significant bone loss over 2 years. Anti-TNF therapy is protective against bone loss and baseline use of NSAIDs has a protective effect on hip bone loss.
本研究的目的是评估疑似轴向型脊柱关节炎（SpA）的早期炎性背痛患者（DESIR队列）两年内的骨密度（BMD）变化及其决定因素。
共有265例患者（54%为男性，平均年龄34.4岁）在基线和两年时进行了BMD测量。低骨密度定义为Z评分≤-2（至少在一个部位），显著骨质流失定义为BMD下降≥0.03g/cm²。在两年内评估临床、生物学和影像学参数。
39例患者（14.7%）在基线时骨密度低；112例患者（42.3%）在两年内有显著骨质流失。187例（70.6%）患者在基线时使用非甾体抗炎药（NSAIDs），89例（33.6%）在两年内接受抗TNF治疗。在使用抗TNF治疗的患者中，腰椎的BMD显著增加，而髋部的BMD与基线相比没有变化。在多变量分析中，基线时使用NSAIDs[比值比（OR）0.38，P=0.006]对髋部骨质流失有保护作用。在未接受抗TNF治疗的患者中，基线时使用NSAIDs（OR 0.09，P=0.006）和两年内体重指数（BMI）增加（OR 0.55，P=0.003）对髋部骨质流失有保护作用，而两年内脂肪量增加与髋部骨质流失相关（OR 1.18，P=0.046）。
在疑似早期轴向型SpA的患者中，42.3%的患者在两年内有显著骨质流失。抗TNF治疗可预防骨质流失，基线时使用NSAIDs对髋部骨质流失有保护作用。
Zotero 插件