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Impact of sustaining SDAI remission for preventing incident of bone fragility fracture in patient with rheumatoid arthritis
  1. Ichiro Yoshii1,
  2. Naoya Sawada2,
  3. Tatsumi Chijiwa3,
  4. Shohei Kokei4
  1. 1 Musculoskeletal Medicine, Yoshii Hospital, Shimanto-City, Kochi, Japan
  2. 2 Department of Rheumatology, Dohgo-Onsen Hospital Rheumatology Center, Matsuyama, Ehime, Japan
  3. 3 Department of Rheumatology, Kochi Memorial Hospital, Kochi, Kochi, Japan
  4. 4 Department of Internal Medicine, Yoshii Hospital, Shimanto-City, Kochi, Japan
  1. Correspondence to Dr Ichiro Yoshii, Orthopaedics, Yoshii Hospital, Shimanto-City, Kochi 787-0033, Japan; ichiroyo{at}

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It is well known that rheumatoid arthritis (RA) has a determinant risk for bone fragility, and patient with RA has a seriously high risk for bone fragility fracture (BFF).1 On the other hand, the BFF risks in the patient with RA owe disease activity.2 3 We hypothesised that if disease activity is successfully controlled and achieved clinical remission, adverse effects on bone metabolism would be minimised, resulting in a lower incidence of BFF.4 We therefore statistically examined whether there was a difference in the incidence of BFF between patients with and without RA who achieved clinical remission.

Patients who matched the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria under the T2T since August 2010, have been treating RA and were measured bone mineral density (BMD) with dual-energy X-ray absorptiometry, were recruited. The initial target of therapy is the attainment of remission with a Simplified Disease Activity Index (SDAI) within 6 months of initiation.5 The primary outcome was incident BFF. Follow-up started at BMD measurement (baseline) and continued until the development of the first fracture or censoring at death, loss to follow-up or end of the study. Kaplan-Meier survival curves were determined for incident BFF incidence up to the last observation. Risks for the incidence of BFF were classified as RA specific and general candidate. In general candidate, comorbidities that might affect the incidence of BFF, such as lifestyle-related diseases,6 and increased ability to fall or a disorder were included. Candidate risk factors …

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  • Handling editor Josef S Smolen

  • Contributors IY contributed to conceptualisation, part of methodology, software, validation, formal analysis, investigation, resources, data curation, writing–original draft, visualisation, project administration. NS and TC contributed to recorded data. SK contributed to recorded data, part of methodology, writing–review & editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests IY, NS, TC and SK declare that they have no conflict of interest. And their families have nothing to declare for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.