Senior Resident, Department of Nephrology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Additional Professor, Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Assoc Physicians India. 2024 Jan;72(1):47-50. doi: 10.59556/japi.71.0404.
Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects the bony architecture. Nevertheless, it remains uncertain whether these effects are due to disease progression, limited mobility, or medication. We conducted this study to analyze changes in bone mineral density (BMD) in patients with RA and its relationship with various disease parameters, such as demographic factors, disease activity, functional disability, duration since onset of symptoms, cumulative steroid dose, and titers of rheumatoid factor (RF).
This cross-sectional study was conducted at the Rheumatology Clinic of the Tertiary Care Hospital of Mumbai. We included 96 consecutive patients diagnosed with RA using the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. Demographic, clinical, and biochemical data were also collected. Disease severity was assessed using the Disease Activity Score 28 with Erythrocyte Sedimentation Rate (DAS28-ESR) score, and physical disability was assessed using the Health Assessment Questionnaire (HAQ) score. BMD was calculated using dual-energy X-ray absorptiometry (DEXA). Significant variations among continuous variables were examined using the -test, while disparities between categorical variables were evaluated using the Chi-squared test. Statistical significance was set at < 0.05 within the 95% confidence interval (CI) range.
Of the 96 patients, 77 were female, and 19 were male. The mean age of the study population was 45.28 ± 10.15 years. As the age of patients increased, BMD was found to decrease in the total lumbar spine, neck of the femur, and total hip region ( < 0.05). Sex did not seem to affect BMD. In all three regions, a decrease in BMD with increasing duration since the onset of RA symptoms was observed. Disease severity, measured using the DAS28-ESR score, did not decrease BMD. There was an increase in functional disability, calculated using the HAQ score, with a decrease in BMD at all sites. RF positivity was associated with decreased BMD at the neck of the femur and total hip region but not the total lumbar spine. Long-term use of steroids (≥30 days) decreased BMD at all three sites.
Our study reiterates the effect of RA on the BMD of patients. Advanced age, duration since symptom onset, physical disability, RF positivity, and long-term corticosteroid use are disease-related factors affecting BMD in patients with RA.
类风湿关节炎（RA）是一种慢性炎症性疾病，会影响骨骼结构。然而，目前尚不清楚这些影响是由于疾病进展、活动受限还是药物引起的。我们进行这项研究，旨在分析 RA 患者的骨密度（BMD）变化及其与各种疾病参数的关系，如人口统计学因素、疾病活动度、功能障碍、症状出现后的时间、累积类固醇剂量和类风湿因子（RF）滴度。
这是一项横断面研究，在孟买的三级保健医院的风湿病科进行。我们纳入了 96 例连续确诊的 RA 患者，使用美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）标准进行诊断。还收集了人口统计学、临床和生化数据。疾病严重程度使用红细胞沉降率（DAS28-ESR）评分的疾病活动评分 28 （DAS28-ESR）进行评估，身体残疾使用健康评估问卷（HAQ）评分进行评估。使用双能 X 线吸收法（DEXA）计算 BMD。使用 t 检验检验连续变量之间的显著差异，使用卡方检验检验分类变量之间的差异。置信区间（CI）范围为 95%时，统计显著性设为 < 0.05。
在 96 例患者中，77 例为女性，19 例为男性。研究人群的平均年龄为 45.28 ± 10.15 岁。随着患者年龄的增长，总腰椎、股骨颈和全髋关节的 BMD 呈下降趋势（< 0.05）。性别似乎对 BMD 没有影响。在所有三个区域，随着 RA 症状出现后时间的延长，BMD 呈下降趋势。使用 DAS28-ESR 评分测量的疾病严重程度并未降低 BMD。使用 HAQ 评分计算的功能障碍增加，所有部位的 BMD 均下降。RF 阳性与股骨颈和全髋关节的 BMD 下降有关，但与总腰椎无关。长期使用类固醇（≥30 天）会降低三个部位的 BMD。
我们的研究再次强调了 RA 对患者 BMD 的影响。高龄、症状出现后时间、功能障碍、RF 阳性和长期使用皮质类固醇是影响 RA 患者 BMD 的与疾病相关的因素。
