RESEARCH - Erosive disease associated with higher bone resorption and lower BMD in women with RA

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Erosive disease associated with higher bone resorption and lower bone

density in women with rheumatoid arthritis.

APLAR Journal of Rheumatology. 8(2):90-98, August 2005.

SURYANA, Bagus P. P. 1; WILL, K. 2; LIM, Annie 2; BREIDAHL, Bill 3

Abstract:

Objective: To evaluate the bone density and bone metabolism in women with

rheumatoid arthritis (RA), focusing on disease activity, joint erosion, and

RA-epitope.

Methods: Disease activity was assessed using erythrocyte sedimentation rate,

C-reactive protein, rheumatoid factor, Ritchie articular index (RAI), and

disease activity score (DAS). The presence of joint erosion was assessed

using wrist-hand and feet X-ray, and wrist-hand magnetc resonance imaging. A

fasting metabolic bone study was done including serum calcium, phosphate,

25(OH) vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP),

osteocalcin, and urine deoxypyridinoline/creatinine (DPD/Cr) ratio. Bone

mineral density (BMD) was measured at hip, spine, distal forearm, hand, and

total body using dual energy X-ray absorptiometry (DEXA) machine. HLA-DRB1

genes were examined using DNA sequencing based typing.

Results: Seventy-six women with RA according to 1987 American College of

Rheumatology (ACR) criteria with clinical onset equal to or less than 5

years were examined. Mean (SD) of age was 55.4 (13.7) years, disease

duration 34.9 (36.4) months, and 96% with ACR functional criteria class I

and II. HLA typing demonstrated that 61.4% of them have the RA

shared-epitope (QRRAA or QKRAA or RRRAA) in their HLA-DRB1 alleles. Most of

them had been receiving disease-modifying antirheumatic drugs and

glucocorticoid. Erosive disease was significantly correlated with

intertrochanter BMD (P = 0.044), serum calcium (P = 0.005), and urine DPD/Cr

ratio (P < 0.001). Patients with erosive disease had higher DAS (P = 0.017),

lower serum calcium (P = 0.006), and higher urine DPD/Cr ratio (P < 0.001).

There were no statistically significant differences in serum ALP,

osteocalcin, 25(OH) vitamin D, and PTH. Patients with erosive disease had

lower BMD at all sites including hip, forearm, hand, lumbar spine, and total

body, though only statistically significant at intertrochanter (P = 0.042).

Bivariate correlation demonstrated that at all sites BMD, except femoral

neck and hand BMD, negatively correlated with urine DPD/Cr ratio. Logistic

regression model showed that erosive disease was a significant factor for

low bone density (T-score < -1) at intertrochanter (OR = 6.0; 95% CI =

1.3-27.3; P = 0.020), total hip (OR = 5.5; 95% CI = 1.1-26.8; P = 0.035),

and distal radius-ulna (OR = 3.9; 95% CI = 1.1-14.0; P = 0.041).

Conclusion: Patients with erosive disease demonstrated lower BMD, lower

serum calcium level, and higher bone resorption. Erosive disease was a

significant factor for osteopenia or osteoporosis.

Copyright © 2005 Blackwell Publishing Ltd.

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