Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Sweden.
RMD Open. 2020 Feb;6(1). doi: 10.1136/rmdopen-2019-001142.
To investigate changes in bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) over a 10-year period.
Consecutive patients with early RA (symptom duration <12 months) were followed according to a structured programme and examined with dual-energy X-ray absorptiometry (DXA) at inclusion and after 2, 5 and 10 years. Mean Z-scores over the study period were estimated using mixed linear effect models. Changes in Z-scores between follow-up visits were analysed using paired T-tests.
At inclusion, 220 patients were examined with DXA. At the femoral neck, the mean Z-score over 10 years was -0.33 (95 % CI -0.57 to -0.08) in men and -0.07 (-0.22 to 0.08) in women. Men had significantly lower BMD at the femoral neck than expected by age at inclusion (intercept Z-score value -0.35; 95 % CI -0.61 to -0.09), whereas there was no such difference in women. At the lumbar spine, the mean Z-score over the study period for men was -0.05 (-0.29 to 0.19) and for women 0.06 (-0.10 to 0.21). In paired comparisons of BMD at different follow-up visits, femoral neck Z-scores for men decreased significantly from inclusion to the 5-year follow-up. After 5 years, no further reduction was seen.
In this observational study of a limited sample, men with early RA had reduced femoral neck BMD at diagnosis, with a further significant but marginal decline during the first 5 years. Lumbar spine BMD Z-scores were not reduced in men or women with early RA. Data on 10-year follow-up were limited.
研究 10 年内早期类风湿关节炎（RA）患者的骨密度（BMD）变化。
对符合条件的早期 RA（症状持续时间<12 个月）患者进行连续观察，根据结构化方案进行随访，并在纳入时和 2、5、10 年后采用双能 X 线吸收法（DXA）进行检查。使用混合线性效应模型估算研究期间的平均 Z 评分。采用配对 t 检验分析各随访间 Z 评分的变化。
纳入时，220 例患者接受了 DXA 检查。在股骨颈处，男性 10 年的平均 Z 评分值为-0.33（95%置信区间-0.57 至-0.08），女性为-0.07（-0.22 至 0.08）。男性股骨颈的 BMD 明显低于纳入时年龄的预期值（截距 Z 评分值-0.35；95%置信区间-0.61 至-0.09），而女性则无此差异。在腰椎处，男性研究期间的平均 Z 评分值为-0.05（-0.29 至 0.19），女性为 0.06（-0.10 至 0.21）。在不同随访时的 BMD 配对比较中，男性股骨颈 Z 评分值从纳入时开始显著下降，至 5 年随访时进一步显著下降，但之后未见进一步下降。
在这项有限样本的观察性研究中，男性早期 RA 患者在诊断时股骨颈 BMD 降低，在最初 5 年内有进一步显著但略有下降。男性和女性早期 RA 患者的腰椎 BMD Z 评分值均未降低。10 年随访的数据有限。
