Background Minimal bone mineral density (BMD) changes in the form of epiphyseal osteoporosis of the hands and feet joints are the typical radiological characteristics of the early rheumatoid arthritis (eRA). In elderly patients with onset RA BMD changes in the epiphyses zone more pronounced. We postulated that BMD changes of the hands, as a result of systemic and local inflammatory processes in RA, may be important as additional criteria for the diagnosis RA in early stage.
Objectives To examine the BMD hands in early RA patients by dual-energy x-ray absorptiometry (DXA) started in postmenopausal women.
Methods 42 postmenopausal women with eRA (ACR/EULAR; 2010); average age 64.23 (13.75) years; disease duration 17.25 (8.15) weeks, menopause duration 14.41 (6.10) years were studied. Two groups were formed: first (n=24) include eRA patients with postmenopausal osteoporosis (OP); second (n=18) eRA without osteoporosis. 30 postmenopausal women without RA, average age: 60.92 (14.00) years, menopause duration 11.80 (4.90) years were studied as comparison group and were divided into two groups: first (n=12) include patients with OP; second (n=18) without OP. BMD was assessed by DXA of the axial skeleton and the bone density of the hands (right and left). Quantitative evaluation of the BMD was determined by T-criterion. Excluded criteria were osteoarthritis of the hands, pretreatment of glucocorticoids.
Results Early RA patients with OP had significantly lower BMD left and right hands (0.237±0,036 g/cm2 and 0.244±0,036 g/cm2) then eRA patients with normal axial skeleton BMD (0.304±0,042 g/cm2 and 0.319±0,050 g/cm2 p=0.047; p=0.031).
A similar changes were observed in comparison groups without eRA: BMD left and right hands (0.285±0,034 g/cm2 and 0.304±0,042 g/cm2) were significantly lower in patients with OP versus patients with normal axial skeleton BMD (0,355±0,039g/cm2 and 0,361±0,038 g/cm2; p=0,038; p=0,049).
In eRA patients with OP were revealed significantly lower levels of BMD left (0,237±0,036 g/cm2 and 0,285±0,034 g/cm2, p=0.022 - patients eRA and comparison group, respectively) and right (0,24±0,036 g/cm2 and 0,304±0,042 g/cm2, p=0.012 patients eRA and comparison group, respectively) hands. Patients with eRA without OP had similar changes: BMD left and right hands were significantly lower comparison group (left hand: 0,304±0,041 g/cm2 and 0,355±0,039 g/cm2, p=0, 007, right hand: 0,319±0,050 g/cm2 and 0,361±0,038 g/cm2, p=0, 011 patients eRA without OP and comparison group, respectively)
Conclusions 1. Postmenopausal osteoporosis patients with and without eRA have been started in postmenopausal period have significantly lower levels BMD of the hands comparison women and patients with RA without OP.
2. Our research revealed significantly lower levels of BMD hands in eRA patients have been started in postmenopausal period versus postmenopausal women independently of the total BMD (with OP and with without OP) that may be useful for RA diagnosis in elderly started RA.
Disclosure of Interest None Declared
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