Background Rheumatoid arthritis (RA) - chronic immune inflammatory joint disease leading to early disability of patients at high risk for cardiovascular events and osteoporotic fractures. Of particular relevance, this problem becomes in men with RA, due to more frequent severe disease and increased mortality in the year after the fracture. Reduced bone mineral density (BMD) and muscle mass are significant predictors of fracture, which leads to the high importance of studying the state of the IPC and body composition.
Objectives To improve the diagnosis of osteoporosis in patients with RA male subjects.
Methods A total of 146 male patients with definite diagnosis of RA at the age of 59 years. Depending on the reception of glucocorticosteroids (GCS) is allocated two subgroups: I subgroup - 40 patients not receiving corticosteroids and II subgroup - 66 patients receiving corticosteroids. The control group consisted of 24 healthy men, matched by age and body mass index. IPC Study in the lumbar spine (L1-L4) and femoral carried out by dual-energy X-ray absorptiometry using osteodensitometry. Evaluation of body composition was carried out with the help of “Pod” program.
Results In 63% of patients with RA revealed male BMD reduction corresponding to osteopenia/OP (OP was diagnosed in 36 (24.7%) patients with RA, and osteopenia - in 56 (38.4%)). The incidence of OP in the II subgroup was significantly higher (p<0,05), than in the I subgroup (48.5% and 5% respectively). The most significant decrease in BMD observed in femoral neck in the study group as a whole, and in individual subgroups. There was a negative correlation between the degree of RA activity and performance of the IPC as a lumbar spine (r = -0,4, p<0.05), and the proximal femur (r = -0,38, p<0.05). Evaluation of body composition showed that the treatment group had a significant decrease in total lean mass (TM) body, as well as the trunk and extremities TM compared with those of control group (p<0,05). Sarcopenia detected in 80 (55.8%) of RA patients, whereas in the control group it was absent. In 50 (67.6%) of patients with RA male sarcopenia observed to decrease the level of the IPC osteopenia (35.2%) and OD (32.4%). After receiving a negative correlation parameters TM and the absolute 10-year risk of osteoporotic fractures (r = -0,302, p<0,05) on the FRAX.
Conclusions 63% of men suffering from RA, observed BMD decrease corresponding OP/osteopenia with a primary decrease in BMD at the femoral neck. Reduced BMD in patients with RA was significantly associated with a high degree of disease activity (r = -0,4, p<0.05). Receiving corticosteroids had no significant effect on BMD at the femoral neck. Analysis of body composition in 55% of RA patients revealed a decrease in TM limbs to the level of sarcopenia. Received correlation decrease BMD and TM limbs (p<0,05; r =0,28). Thus, in patients with RA males along with OP/osteopenia revealed a significant decrease in TM, that in view of the biomechanics of the movements may be an additional risk factor for falls and fractures.
Disclosure of Interest None declared