Gong Xun, Xu Sheng-Qian, Tong Hui, Wang Xin-Rong, Zong He-Xiang, Pan Mei-Juan, Ten Yu-Zhu, Xu Jia-Hua, Wei Wei
Institute of Clinical pharmacology, Anhui Medical University.
Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University.
Rheumatology (Oxford). 2019 Mar 7. doi: 10.1093/rheumatology/kez042.
RA is a systemic auto-immune inflammatory disease that can lead to local bone erosions and generalized osteoporosis (OP). The aim of this study was to investigate the relationship between systemic osteoporosis and local bone erosion with RA patients in the Chinese population.
In total, 1235 patients with RA and 158 normal subjects were enrolled in this study. Clinical and laboratory features were recorded in detail. Information about functional class and physical activity was collected using specific questionnaires. Dual-energy X-ray absorptiometry was used to measure BMD. The MECALL castor-50-hf model X-ray scanner was used for two-hand (including wrist) photographs.
The median Sharp scores differed significantly between the normal bone mass group, osteopenia group and OP group (P < 0.001). There was a modest negative linear correlation between Sharp and HAQ scores and longer disease duration (P < 0.001). There was a clear increasing trend in Sharp score, incidence of OP and HAQ score in the different DAS in 28 joints (DAS28) activity groups (P < 0.001). Spearman's correlation test showed that Sharp and HAQ scores were negatively correlated with BMD at all measured sites (femoral neck, total hip and L1-4) (P < 0.001). Logistic regression indicated that age, female gender, and Sharp and HAQ scores were independent risk factors in the occurrence of OP in RA patients. The use of DMARDs and BMI were protective factors for OP.
These results suggest that BMD is associated with local bone erosion among Chinese patients with RA. Local bone erosion is closely related to clinical symptoms and BMD in patients with RA.
类风湿关节炎（RA）是一种全身性自身免疫性炎症性疾病，可导致局部骨侵蚀和全身性骨质疏松（OP）。本研究旨在探讨中国人群中RA患者全身性骨质疏松与局部骨侵蚀之间的关系。
本研究共纳入1235例RA患者和158例正常受试者。详细记录临床和实验室特征。使用特定问卷收集功能分级和体力活动信息。采用双能X线吸收法测量骨密度。使用MECALL castor - 50 - hf型X线扫描仪拍摄双手（包括腕部）照片。
正常骨量组、骨量减少组和OP组的Sharp评分中位数差异有统计学意义（P < 0.001）。Sharp评分与健康评估问卷（HAQ）评分及病程较长之间存在适度的负线性相关性（P < 0.001）。在28个关节疾病活动评分（DAS28）的不同活动组中，Sharp评分、OP发生率和HAQ评分呈明显上升趋势（P < 0.001）。Spearman相关性检验显示，在所有测量部位（股骨颈、全髋和L1 - 4），Sharp评分和HAQ评分与骨密度呈负相关（P < 0.001）。Logistic回归表明，年龄、女性性别以及Sharp评分和HAQ评分是RA患者发生OP的独立危险因素。使用改善病情抗风湿药（DMARDs）和体重指数（BMI）是OP的保护因素。
这些结果表明，中国RA患者的骨密度与局部骨侵蚀有关。RA患者的局部骨侵蚀与临床症状和骨密度密切相关。
