Yoshii Ichiro, Chijiwa Tatsumi, Sawada Naoya
Department of Rheumatology and Musculoskeletal Medicine, Yoshii Hospital, Shimanto City, Japan.
Department of Rheumatology, Kochi Memorial Hospital, Kochi, Japan.
Osteoporos Sarcopenia. 2020 Jun;6(2):75-81. doi: 10.1016/j.afos.2020.04.002. Epub 2020 Jun 4.
Rheumatoid arthritis (RA) is an independent risk factor of osteoporosis. However, if disease activity is successfully controlled using the treat-to-target (T2T) strategy, the risk of bone mineral density (BMD) loss can be diminished. We evaluated if RA is a risk factor even when the T2T is applied in clinical cases.
From September 2017 to August 2019, 741 patients were examined using dual-energy X-ray absorptiometry; of these, 279 were diagnosed with RA who attained clinical remission within 6 months (RA-rem) and 53 could not attain clinical remission (RA-nonrem), while 409 were not diagnosed with RA (non-RA). The following characteristics between RA-rem and non-RA were matched using the propensity score matching (PSM) technique: age, sex, past bone fragility fracture experience, osteoporosis drug intervention ratio, glucocorticoid administration ratio, mean dose, Barthel Index score, body mass index, serum-creatinine-to-cystatin C ratio, and the number of comorbidities. The BMDs and changes of the lumbar spine, femoral neck, total hip, and greater trochanter were statistically compared between the RA-rem and the non-RA after PSM, and between RA-nonrem and RA-rem after PSM using the Mann-Whitney U test.
In total, 107 patients of RA-rem and 108 of non-RA were recruited. BMDs and changes of every part demonstrated no significant differences between the 2 groups. BMDs in every part of RA-rem after PSM were significantly greater than those in every part of RA-nonrem, while no significant difference in change during follow-up.
If disease activity is controlled in clinical remission, RA will not contribute to BMD reduction.
类风湿关节炎（RA）是骨质疏松的独立危险因素。然而，如果采用达标治疗（T2T）策略成功控制疾病活动，骨矿物质密度（BMD）丢失风险可降低。我们评估了在临床病例中应用T2T时RA是否仍是一个危险因素。
2017年9月至2019年8月，741例患者接受双能X线吸收法检查；其中，279例被诊断为RA且在6个月内达到临床缓解（RA-rem），53例未达到临床缓解（RA-nonrem），409例未被诊断为RA（非RA）。采用倾向评分匹配（PSM）技术对RA-rem和非RA之间的以下特征进行匹配：年龄、性别、既往脆性骨折史、骨质疏松药物干预率、糖皮质激素给药率、平均剂量、巴氏指数评分、体重指数、血清肌酐与胱抑素C比值以及合并症数量。采用Mann-Whitney U检验对PSM后的RA-rem和非RA之间以及PSM后的RA-nonrem和RA-rem之间腰椎、股骨颈、全髋和大转子的BMD及变化进行统计学比较。
共纳入107例RA-rem患者和108例非RA患者。两组各部位的BMD及变化无显著差异。PSM后RA-rem各部位的BMD显著高于RA-nonrem各部位，而随访期间变化无显著差异。
如果在临床缓解中控制疾病活动，RA不会导致BMD降低。
