Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, China.
Front Endocrinol (Lausanne). 2022 May 17;13:867610. doi: 10.3389/fendo.2022.867610. eCollection 2022.
Osteoporosis is a common comorbidity of rheumatoid arthritis (RA). Although RA disease activity has been demonstrated to be associated with bone loss in previous studies, most of them were cross-sectional studies and not in the context of treat-to-target (T2T) strategies.
This study aimed to evaluate the association of disease activity with bone mineral density (BMD) changes in the context of T2T strategies in a prospective RA cohort.
RA patients were enrolled from a prospective CENTRA cohort of Peking University First Hospital. The follow-ups have been scheduled every 3 to 6 months. BMD was repeated at baseline, 1 year, and then every other year. Demographics, baseline clinical features, laboratory data, and medications at each visit were recorded. Time-adjusted mean disease activity scores were adopted to reflect the overall disease activity during follow-up. The influence of univariable associations between predictors and BMD was investigated using linear regression.
A total of 268 patients were included in our analysis. Their mean age was 50 (12.9) years, and 224 (83.6%) were women. The median (IQR) disease duration was 48.7 (107.6) months. Osteoporosis in the lumbar spine was observed in 23.1% of patients and 9.3% in the femoral neck at enrollment. Older age, higher SDAI score, and lower BMI were associated with osteoporosis at baseline. The proportion of patients who achieved DAS28-ESR, CDAI, and SDAI remission or LDA at the end of the first year was 71.5%, 68.8%, and 67.4%, respectively. Reevaluations of BMD at 1 year were applied to 144 patients. Mean decreases of BMDs were 1.75% at the lumbar spine and 1.40% at the femoral neck at 1 year from baseline, respectively. Patients who achieved remission had less yearly bone loss in the lumbar spine ( = 0.036). Female gender was identified as a risk factor in the multiple linear regression analyses, and lower disease activity and bisphosphonates were protective factors of continuous bone loss.
Disease activity is associated with bone loss in RA patients in the context of T2T strategies, and those who achieved remission had less yearly bone loss.
骨质疏松症是类风湿关节炎（RA）的常见合并症。虽然之前的研究已经表明 RA 疾病活动与骨质流失有关，但这些研究大多是横断面研究，而不是在治疗目标（T2T）策略的背景下进行的。
本研究旨在评估 T2T 策略背景下疾病活动与 RA 患者骨密度（BMD）变化之间的关系。
本研究纳入了来自北京大学第一医院前瞻性 CENTRA 队列的 RA 患者。随访计划每 3 至 6 个月进行一次。在基线、1 年时以及之后每两年重复进行 BMD 检测。记录每次就诊时的人口统计学、基线临床特征、实验室数据和药物使用情况。采用时间调整后的平均疾病活动评分来反映随访期间的总体疾病活动。使用线性回归分析来研究预测因素与 BMD 之间的单变量关联的影响。
共纳入 268 例患者进行分析。他们的平均年龄为 50（12.9）岁，224 例（83.6%）为女性。中位（IQR）疾病持续时间为 48.7（107.6）个月。在入组时，23.1%的患者存在腰椎骨质疏松症，9.3%的患者存在股骨颈骨质疏松症。年龄较大、SDAI 评分较高和 BMI 较低与基线时的骨质疏松症有关。在第 1 年末达到 DAS28-ESR、CDAI 和 SDAI 缓解或低疾病活动度的患者比例分别为 71.5%、68.8%和 67.4%。对 144 例患者进行了 1 年时的 BMD 重新评估。与基线相比，1 年后腰椎 BMD 分别下降 1.75%，股骨颈 BMD 下降 1.40%。达到缓解的患者腰椎骨丢失的年增长率较低（=0.036）。在多线性回归分析中，女性被确定为危险因素，而较低的疾病活动度和双膦酸盐类药物是持续骨丢失的保护因素。
在 T2T 策略的背景下，疾病活动与 RA 患者的骨质流失有关，达到缓解的患者每年的骨丢失量较少。
