Cortet B, Flipo R M, Duquesnoy B, Delcambre B
Rheumatology Department, Lille Regional Teaching Hospital, France.
Rev Rhum Engl Ed. 1995 Mar;62(3):197-204.
Rheumatoid arthritis is associated with locoregional decalcification, which can be clearly demonstrated at the distal radius using single-photon absorptiometry. Bone loss at this site is probably due to the predominant involvement of the hands and wrists during rheumatoid arthritis. Estimates of the frequency of generalized bone loss have varied with the measurement technique used and the study design. Studies using dual-photon absorptiometry with a radioactive source have yielded conflicting data. The most recent studies of bone mineral density used dual energy X-ray absorptiometry, which is currently the best method in terms of reproducibility and precision; results suggested bone loss in the proximal femur, whereas lumbar spine measurements were usually normal or very slightly decreased. Findings from the few longitudinal studies are discordant; this may be ascribable to differences in bone mass measurement techniques, study population characteristics, and follow-up duration. Whereas bone loss was not demonstrated in the earliest longitudinal studies, recent investigations suggested that bone mineral density was decreased in rheumatoid arthritis patients as compared with controls. Corticosteroid therapy, even in daily dosages of less than 10 mg/d prednisone-equivalent, was associated with an approximately 10% decrease in bone mass after six months, in both cross-sectional and longitudinal studies. Rheumatoid arthritis patients had a two-fold increase in fracture risk, independently from their bone mass. Factors associated with higher fracture risks were corticosteroid therapy, physical inactivity, and female gender.
类风湿关节炎与局部脱钙有关，使用单光子吸收法可在桡骨远端清楚地显示这种情况。该部位的骨质流失可能是由于类风湿关节炎期间手和腕部受累为主所致。对全身性骨质流失频率的估计因所使用的测量技术和研究设计而异。使用带有放射性源的双光子吸收法的研究得出了相互矛盾的数据。最近关于骨密度的研究使用了双能X线吸收法，就可重复性和精确性而言，这是目前最好的方法；结果表明股骨近端存在骨质流失，而腰椎测量结果通常正常或略有下降。少数纵向研究的结果不一致；这可能归因于骨量测量技术、研究人群特征和随访时间的差异。虽然在最早的纵向研究中未显示骨质流失，但最近的调查表明，与对照组相比，类风湿关节炎患者的骨密度降低。在横断面和纵向研究中，即使皮质类固醇治疗的每日剂量低于相当于10mg/d的泼尼松，六个月后骨量也会下降约10%。类风湿关节炎患者的骨折风险增加两倍，与骨量无关。与较高骨折风险相关的因素包括皮质类固醇治疗、缺乏身体活动和女性性别。
