Abstract
Background Systemic osteoporosis (OP) is evident among patients with
early rheumatoid arthritis (ERA). This study aimed to investigate the OP risk
factors in patients with ERA and who was treatment-naïve at
inclusion.
Subjects and Methods Systemic bone mineral density (BMD) of the lumbar
spine (LS), femoral neck (FN) and total hip (TH) was measured in 135
treatment-naïve premenopausal females with early Rheumatoid Arthritis
(ERA). For all patients, demographic data, vitamin D status, and the specific
parameters of the disease, including disease activity, serum levels of
rheumatoid factor and anti-citrullinated protein antibodies (ACPA) were
evaluated.
Results T score was<−1.0 in the LS in 16.2%, in
the FN in 22.2% and in the TH in 23.7%. Among our patients,
29.6% had below normal T score at any site. Demographic characteristics,
RA duration, diseases activity did not significantly impact BMD. However,
patients with decreased BMD were more prevalent ACPA- and rheumatoid factor
(RF)-positive than patients with normal BMD. Also, high titer ACPA or RF is
associated with more marked reduction in BMD. In regression analysis, after
adjustment for possible confounders, patient stratification according to ACPA
status and RF status (into negative, low-positive and high positive) still a
significant independent variable associated with lower BMD values.
Conclusion Presence of ACPA or RF is associated with increased risk for
development of reduced systemic BMD from very early stage of rheumatoid
arthritis. Furthermore, this risk increases more with higher levels of ACPA or
RF. Measurement of BMD should be performed for ACPA- or RF-positive patients
with early RA.
Decline in Hand Bone Mineral Density Indicates Increased Risk of Erosive Change in Early Rheumatoid Arthritis