Background Erosive and destructive changes in joints of hand and foot, bone mineral density (BMD) decrease and vertebral deformation are more common in patients with rheumatoid arthritis (RA) than in population. The association between these events is poorly investigated. There is a few published literature with conflictive results, and no information on national researches.
Objectives to acquire information and determine the association between erosive and destructive changes in joints of hand and foot, BMD in different skeleton segments and vertebral deformity in thorax and lumbar spine in patients with RA.
Methods 66 women with RA aged 18-62 years were enrolled. Radiological assessment of disease progression was performed with Sharp/van der Heijde method. Radiomorphogenic analysis of vertebral deformities was performed with Genant method. BMD evaluation in the three skeleton segments: lumbar spine (L1-4), femoral neck (FN) and distal forearm (DF) was performed with dual X-ray energy absorptiometry.
Results the mean age of enrolled patients was 51,6±9,6 years, mean duration of the disease was 13,2±9.1 years. Vertebral fractures were detected in 3(5%) of the patients, vertebral deformations – in 11(17%). Rheumatoid factor (RF) was positive in 54(82%) patient, negative – in 11(18%). Glucocorticoid therapy received 45(68%) patients. Depending on the X-ray grade of RA patients were divided in 3 age-comparable groups: grade 1-2 (group 1) - 24(36%) patients, grade 3 (group 2) - 19(29%) patients, grade 4 (group 3) – 23(35%) patients. The mean age in group 1 was 49.1±12.9 years, in group 2 - 51.5±6.3 years, in group 3 - 54.4±7.1 years. The duration of RA in group 3 was longer, than in 2 and 1 groups - 20.4±10.4 years, 11.7±5.9 years and 7.5±3.1 years respectively (p<0.001). It was established, that the RA X-ray grade of RA increase is accompanied by the decrease of the BMD in L1-L4 - 0.972±0.170 g\cm2 and 0.867±0.090 g\cm2 (p=0.014), in FN 0.725±0.120 g\cm2 and 0.614±0.110 g\cm2 (p=0.003) and in DF 0.505±0.110 g\cm2 и 0.426±0.110 g\cm2 (p=0.026) (patients from group 2 and 3 respectively) and the increase of the number of patients with vertebral fractures and deformations – 3(13%) cases in group 1, 4(21%) cases in group 2 and 7(30%) cases in group 3. The mean patient’s age with patients rearrangement according to number of erosions (0-30 erosions in 39(59%) patients, 31-70 erosions - 14(21%) patients, more than 70 erosions -13(20%) patients) was 49.4±10.7*years, 53.1±7.9*years and 56.6±5.4*years respectively (*p<0,05). The increase in number of erosions was accompanied by BMD decrease in all skeleton segments: in L1-L4 segments 0.923±0.160*g\cm2, 0.920±0.110g\cm2 and 0.838±0.090*g\cm2 respectively (*p=0.045), in FN - 0.736±0.110g\cm2, 0.669±0.090g\cm2 and 0.582±0.120g\cm2 respectively (p<0.005), in DF - 0.488±0.090g\cm2, 0.479±0.110g\cm2 and 0.382±0.070g\cm2 respectively (p<0.001). In addition, the decrease in thorax and lumbar vertebral deformity index (0.79±0.02 - 0.72±0.07, p<0.001 and 0,80±0,00 - 0,74±0,16 respectively) was accompanied by increased number of patients with vertebral deformities and fractures – 6(15%) and 6(46%) respectively.
Conclusions the increase in number of erosions in joints of hand and foot is accompanied by bone mineral density (BMD) and vertebral deformity decrease in patients with longer disease duration regardless of their age.
Disclosure of Interest None Declared
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