Background Several studies have related ACPA with the presence of bone erosion in rheumatoid arthtitis patients as they induce the differentiation and activation of osteoclasts
Objectives Our main aim is to evaluate the association of ACPA with bone mineral density (BMD) in RA
Methods Case-control study of 73 RA patients (2010 EULAR criteria) and a long standing disease of 5 years. Demographic and clinical variables were collected. BMD values using densitometry at the lumbar (CL), hip (CT) and femoral neck (CF) were collected. The presence of low bone mineral density (osteopenia: tscore≤-1) and ACPA levels were compared using logistic regression analysis, adjusting variables related to BMD: age, sex, menopause, body mass index (BMI), habit Smoking, disease duration, daily corticoid doses, methotrexate treatment and inflammatory disease activity (DAS28)
Results A group of 73 patients were included (14 men) with a mean age of 66,45±10,41 years, mean body mass index 28,48±5,22 kg/m2, mean long standing disease of 2,28±1,75 years and mean DAS 28 of 3,17±1,18. A total of 29 patients were negative for ACPA compared to 44 patients that were positive for ACPA. Osteopenia in lumbar spine was found in 82.2% of patients 65.8% hip and 75.3% in femoral neck. Logistic regression was performed without finding statistically significant association between osteopenia and inflammatory activity (DAS 28), vitamin D levels and positive rheumatoid factor, adjusted for variables that can modify BMD. ACPA Positive (any titer) were associated with the presence of lumbar spine osteopenia (OR 7.19, 95% CI 1.77–29.17) (p=0.006), hip (OR 15.17, 95% CI 3.96–58.18) (p=0.001) and femoral neck (OR 3.76; 95% CI 1.20–11.82) (p=0.023). In addition, a simple variance analysis (ANOVA) was performed to compare T scores and ACPA levels divided into three categories: ≤25U/mL, 25–300U/mL and>300U/mL. ACPA group ≤25U/mL differed in mean T score values in lumbar spine, hip and femoral neck. No differences were found between ACPA positive patients with low and high levels for T score values.
Conclusions ACPA positivity in RA is associated with an increased risk of osteopenia in lumbar spine, hip and femoral neck independently of other variables that may modify bone mineral density. These data suggest that ACPA may play a role in bone remodeling
Referencias: Harre et al.J Clin Invest (2012), 122(5):1791–1802.
Bugatti et al. Arthritis Research & Therapy (2016), 18:226.
Geusens and Lem. Arthritis Research & Therapy (2011), 13:242.
Disclosure of Interest None declared