Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto, 1, 71100, Foggia, Italy.
Arthritis Res Ther. 2021 Jul 6;23(1):180. doi: 10.1186/s13075-021-02562-3.
Glucocorticoids (GC) modulate several regulators involved in the pathogenesis of bone changes in rheumatoid arthritis (RA). Trabecular bone score (TBS) allows the indirect assessment of bone quality. The aim of this study was to investigate the effects of GC on TBS and serum levels of bone turnover regulators in patients with recent-onset RA.
Forty-seven subjects with recent-onset RA (< 6 months) were classified in two groups, low (lGC) and high (hGC) glucocorticoids, according to glucocorticoid dose regimens. Bone mineral density (BMD), TBS, and circulating Dickkopf-1 (Dkk1), sclerostin, osteoprotegerin (OPG), and RANK-L were evaluated at baseline and 6 and 12 months.
BMD significantly declined after 12 months with no significant difference between the lGC and hGC group, whereas TBS decreased in the hGC group only. Circulating OPG decreased during the follow-up period, the reduction being significantly greater in hGC group; conversely, sclerostin and RANK-L serum increased, in a significantly greater extent in the hGC group. TBS inversely correlated with sclerostin, RANK-L, and Dkk1 circulating levels whereas directly correlated with OPG circulating levels. GC cumulative dose showed an inverse relationship with BMD in both the hGC and lGC groups; TBS values showed an inverse relationship with GC cumulative dose in the hGC group only. GC cumulative dose was associated to higher sclerostin and lower OPG serum levels. TBS did not correlate with disease activity whereas BMD was inversely related to disease activity.
In early RA, GC exposure contributes to the reduction of BMD and affects bone quality depending on dose regimens. TBS could be a useful tool to evaluate the negative effect of GC on bone microarchitecture.
This study was ancillary to a parallel-group observational prospective study which was approved by the medical local ethics committee (protocol number DDG 334/19-06-2019).
糖皮质激素（GC）可调节类风湿关节炎（RA）骨病变发病机制中的几种调节剂。骨小梁评分（TBS）允许间接评估骨质量。本研究旨在探讨 GC 对 TBS 和血清骨转换调节剂水平在近期发病的 RA 患者中的影响。
47 例近期发病的 RA 患者（<6 个月）根据糖皮质激素剂量方案分为两组，低（lGC）和高（hGC）GC 组。基线、6 个月和 12 个月时评估骨密度（BMD）、TBS、血清中 Dickkopf-1（Dkk1）、骨硬化蛋白、骨保护素（OPG）和核因子-κB 受体活化因子配体（RANK-L）的水平。
12 个月后 BMD 显著下降，但两组间无显著差异，而 hGC 组 TBS 下降。随访期间，OPG 循环水平下降，hGC 组下降更为明显；相反，骨硬化蛋白和 RANK-L 血清水平升高，hGC 组升高更为明显。TBS 与血清中骨硬化蛋白、RANK-L 和 Dkk1 水平呈负相关，与 OPG 水平呈正相关。hGC 和 lGC 组的 GC 累积剂量与 BMD 呈负相关；hGC 组的 TBS 值与 GC 累积剂量呈负相关。GC 累积剂量与血清中更高的骨硬化蛋白和更低的 OPG 水平相关。TBS 与疾病活动度无关，而 BMD 与疾病活动度呈负相关。
在早期 RA 中，GC 暴露会导致 BMD 降低，并根据剂量方案影响骨质量。TBS 可能是评估 GC 对骨微结构负面影响的有用工具。
本研究是一项平行组观察性前瞻性研究的辅助研究，该研究得到了医学地方伦理委员会的批准（DDG 334/19-06-2019 号协议）。
