Kareem Roaa, Botleroo Rinky A, Bhandari Renu, Ogeyingbo Opemipo D, Ahmed Rowan, Gyawali Mallika, Venkatesan Nanditha, Elshaikh Abeer O
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Cureus. 2021 Aug 28;13(8):e17519. doi: 10.7759/cureus.17519. eCollection 2021 Aug.
Rheumatoid arthritis (RA) is an autoimmune chronic connective tissue disease that produces persistent systemic inflammation, with joint inflammation leading to function loss and joint destruction. Low bone mass causes skeletal bone loss, commonly referred to as osteopenia or osteoporosis. We conducted this literature review to examine the relationship between RA and osteoporosis and the variables contributing to this connection. We used articles from the US National Library of Medicine (PubMed), Google Scholar, Science Direct to access the required information. Eventually, our results concluded that RA could result in local periarticular and generalized bone loss. Many risk factors contribute to this association, such as chronic joints inflammation, glucocorticoid use, genetics, and estrogen hormone effects. Still, it is not clear yet whether this is due to a consequence of treatment, immobility, or the activity of the disease. There are many recommendations by the American College of Rheumatology for RA patients during the disease course to reduce the risk of osteoporosis development, which include early starts of disease-modifying anti-inflammatory drugs (DMARDs), doing a dual-energy x-ray (DXA) or quantitative ultrasound (QUS) for identifying a patient at risk of osteoporosis, taking vitamin D, calcium, and bisphosphonates. Further prospective studies and clinical trials are essential to provide a solid evidence-based recommendation that will help to prevent bone loss in RA patients.
类风湿关节炎（RA）是一种自身免疫性慢性结缔组织疾病，会引发持续性全身炎症，关节炎症会导致功能丧失和关节破坏。低骨量会导致骨骼骨质流失，通常称为骨质减少或骨质疏松症。我们进行了这项文献综述，以研究RA与骨质疏松症之间的关系以及促成这种关联的变量。我们使用了来自美国国立医学图书馆（PubMed）、谷歌学术、科学Direct的文章来获取所需信息。最终，我们的结果得出结论，RA可能导致局部关节周围和全身性骨质流失。许多风险因素促成了这种关联，如慢性关节炎症、糖皮质激素的使用、遗传因素以及雌激素的影响。不过，目前尚不清楚这是由于治疗、活动减少还是疾病活动所致。美国风湿病学会针对RA患者在病程中提出了许多建议，以降低骨质疏松症发生的风险，这些建议包括尽早开始使用改善病情的抗风湿药物（DMARDs）、进行双能X线吸收法（DXA）或定量超声（QUS）检查以识别有骨质疏松症风险的患者、补充维生素D、钙和双膦酸盐。进一步的前瞻性研究和临床试验对于提供坚实的循证建议至关重要，这将有助于预防RA患者的骨质流失。
