Cortet B, Flipo R M, Blanckaert F, Duquesnoy B, Marchandise X, Delcambre B
Rheumatology Department, Lille Teaching Hospital, France.
Rev Rhum Engl Ed. 1997 Jul-Sep;64(7-9):451-8.
To study bone mass and the factors that influence bone mass in rheumatoid arthritis patients versus controls.
85 patients (73 women) with a mean age of 57 +/- 11 years and a mean disease duration of 13 +/- 9 years were compared to 85 age- and sex-matched controls. Among the patients, 62 (76%) had positive rheumatoid factor tests and 51 (60%) were receiving steroid therapy, with a mean daily dose of 10 +/- 4 mg and a mean duration of 7 +/- 6 years. The following parameters were determined: morning stiffness duration, painful and swollen joint counts, Lee's and Ritchie's indices, Health Assessment Questionnaire score, erythrocyte sedimentation rate, and C-reactive protein. Bone mineral density was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (Sophos L-XRA).
In the nonsteroid-treated patients, bone mineral density was similar to that in controls at the lumbar spine but was decreased by 8% (95% confidence interval [CI], 1.8-14.2%) at the femoral neck (0.76 +/- 0.14 g/cm2 versus 0.83 +/- 0.15 g/cm2; P = 0.03). Decreases of 11.5% (95% CI, 8.1-14.9%) at the lumbar spine and 10.4% (95% CI, 6.4-14.4%) at the femoral neck were found in the steroid-treated patients versus the nonsteroid-treated patients. In the patient group, femoral neck bone mineral density was significantly negatively correlated with age (r = -0.5), the Heath Assessment Questionnaire score (r = -0.27), and the erythrocyte sedimentation rate (r = -0.25), whereas only the first two variables were significantly correlated with lumbar bone mineral density. A multiple linear regression model including age, glucocorticoid use, rheumatoid factor, the Health Assessment Questionnaire score, and the erythrocyte sedimentation rate was constructed and adjusted for the number of variables. This model explained 44.7% of the variance of femoral neck bone mineral density.
Rheumatoid arthritis is associated with a decrease in bone mass that is most marked in patients with active and/or severe disease and in those who take glucocorticoids.
研究类风湿关节炎患者与对照组的骨量及影响骨量的因素。
将85例平均年龄57±11岁、平均病程13±9年的患者（73例女性）与85例年龄和性别匹配的对照组进行比较。患者中，62例（76%）类风湿因子检测呈阳性，51例（60%）接受类固醇治疗，平均日剂量为10±4mg，平均疗程为7±6年。测定了以下参数：晨僵持续时间、疼痛和肿胀关节计数、李氏和里奇指数、健康评估问卷评分、红细胞沉降率和C反应蛋白。使用双能X线吸收法（Sophos L-XRA）测量腰椎和股骨颈的骨密度。
在未接受类固醇治疗的患者中，腰椎骨密度与对照组相似，但股骨颈骨密度降低了8%（95%置信区间[CI]，1.8-14.2%）（0.76±0.14g/cm²对0.83±0.15g/cm²；P=0.03）。与未接受类固醇治疗的患者相比，接受类固醇治疗的患者腰椎骨密度降低了11.5%（95%CI，8.1-14.9%），股骨颈骨密度降低了10.4%（95%CI，6.4-14.4%）。在患者组中，股骨颈骨密度与年龄（r=-0.5）、健康评估问卷评分（r=-0.27）和红细胞沉降率（r=-0.25）显著负相关，而只有前两个变量与腰椎骨密度显著相关。构建了一个包括年龄、糖皮质激素使用、类风湿因子、健康评估问卷评分和红细胞沉降率的多元线性回归模型，并对变量数量进行了调整。该模型解释了股骨颈骨密度变异的44.7%。
类风湿关节炎与骨量减少有关，在活动期和/或重症患者以及服用糖皮质激素的患者中最为明显。
