类风湿关节炎和强直性脊柱炎患者的骨质疏松分析

骨质疏松不仅威胁着人们的健康而且已成为严重的社会问题。骨质疏松可分为原发性、继发性两种 ,多种骨折的发生在很大程度上与骨质疏松有关。类风湿关节炎(ｒｈｅｕｍａｔｏｉｄａｒｔｈｒｉｔｉｓ,ＲＡ )和强直性脊柱炎 (ａｎｋｙｌｏｓｉｎｇｓｐｏｎｄｙｌｉｔｉｓ ,ＡＳ)可导致继发性全身性骨质疏松 ,国内这方面的报道还比较少。我们通过测定骨密度 (ＢＭＤ)及骨代谢指标来了解二者骨质疏松的发生情况、类型及相关因素。1　资料与方法1 1　病例选择 :ＲＡ和ＡＳ患者为我院风湿科 2 0 0 0年 11月至 2 0 0 2年 6月的住院病人 ,且除外病程…     

强直性脊柱炎骨质疏松30例临床分析

目的　研究强直性脊柱炎 (AS)骨质疏松的发生情况、相关因素及与骨代谢指标的关系。方法　 3 0例AS患者及对照组 2 0例 ,用双能X线吸收法 (DEXA)测定腰椎、股骨颈骨密度 (BMD) ,用酶联免疫法测定血清骨钙素 (BGP)、骨碱性磷酸酶 (BAP)及尿脱氧吡啶胶原交联 (D Pyr)。结果　AS早期腰椎及股骨颈BMD均较对照组低 ,而晚期椎体周围软组织骨化使腰椎BMD增加 ,但股骨颈BMD仍低于对照组。 3 0例AS中共有 6例骨质疏松 ,10例骨量减少。AS的股骨颈BMD与病程、ESR、CRP、X线分期呈负性相关 ,绝经前女性BMD变化不如男性明显 ,HLA B2 7阳性与阴性患者BMD无明显差异。AS骨质疏松组 ,骨形成的指标BGP、BAP与对照组无明显差异 ,骨吸收的指标D Pyr明显增高。结论　AS继发全身性骨质疏松并不少见 ,其发生与病程、疾病活动指标、疾病严重程度相关 ,AS骨质疏松主要与骨吸收增加有关。     

强直性脊柱炎与骨质疏松

强直性脊柱炎（AS）是一种慢性、进行性炎性疾病,主要累及中轴关节,新骨的形成是其主要特征,可以导致韧带骨赘的形成、脊柱和骶髂关节的强直。超过90％的强直性脊柱炎患者与HLA-B27相关。骨质疏松（OP）是一种以骨量减少、骨组织微结构退化为特征的疾病,可导致骨脆性增加,骨折危险性增加。     

强直性脊柱炎患者骨密度随年龄的变化

目的 采用双能X线吸收法测量强直性脊柱炎患者(AS)不同部位的骨密度(BMD),探讨其与年龄变化的关系,为临床防治AS患者BMD降低提供参考.方法 选取门诊50例符合纽约诊断标准的AS患者,按年龄≤40岁、年龄＞ 40岁分为两组,分别检测其侧位腰椎(L1-L4)、股骨颈、髋关节BMD,以T值≤-1.0定义为BMD降低,包括骨量减少(-2.5＜T＜-1.0)与骨质疏松(T≤-2.5).结果 两组AS患者出现BMD降低的比例均高于正常人,且年龄＞ 40岁组其腰椎BMD减少的比例高于年龄≤40岁组(P＜0.05),而其腰椎平均T值低于年龄≤40岁组(P＜0.05),在股骨颈测得的BMD、骨质疏松比例两组无明显差异(P＞0.05).结论 AS患者早期即可出现骨量减少甚至骨质疏松,随着年龄的增长其侧位腰椎BMD降低明显,骨折风险增大.临床上应当提高对AS合并骨质疏松的警惕,及时予补钙等治疗,提高患者的生活质量.     

应重视强直性脊柱炎骨质疏松的预防与治疗

强直性脊柱炎（ankylosing spondylitis，AS）的骨质改变一方面表现为特征性的慢性炎症部位的新骨形成，另一方面又表现为骨密度减低及骨折风险增加。近年来已经认识到AS患者病程早期即可有明显的骨密度（bone mineral density，BMD）下降和骨质疏松（osteoporosis，OP），而且往往同时伴有骨折及神经系统等并发症，使AS的预后更差。     

放射学髋关节损害的强直性脊柱炎骨强度分析

目的:分析放射学髋关节损害的AS患者骨强度指数、骨质疏松及骨折情况,探索该类患者骨强度变化的特点。方法:分析跟骨超声的骨强度指数与双能X线吸收法骨密度（DXA）值（全髋,g/cm 2）之间的相关性,采用Pearson相关统计分析。纳入研究的339例AS患者依据Bath AS髋关节放射学指数（BASRI-hi...     

阿仑膦酸钠对强直性脊柱炎伴骨质疏松患者的疗效

强直性脊柱炎是以中轴关节慢性炎症为特征的全身性疾病，除了有椎间盘纤维环及其附近韧带的钙化和骨性强直，还常伴有骨质疏松。近来的研究显示，骨质疏松或骨量减少在强直性脊柱炎患者中普遍存在，发生率为50％～92％。曾有文献报道，早期强直性脊柱炎患者中椎体骨密度下降，髋部是晚期强直性脊柱炎患者发生骨质疏松的易感部位。强直性脊柱炎患者早期腰椎、     

强直性脊柱炎合并骨质疏松症患者临床特点、骨密度及骨代谢相关指标的研究

目的探索强直性脊柱炎(AS)患者合并骨质疏松症的发病机制及AS患者骨密度和骨代谢变化的相关因素。方法收集189例AS患者临床症状、体征、实验室检查、影像学检查结果,与健康对照组进行对照并进行相关性分析。结果 189例AS患者腰椎、股骨颈、Word’s三角、粗隆的骨密度均与骶髂关节相分级、急时相反应物红细胞沉降率(ESR)、C反应蛋白(CRP)呈负相关,P值分别<0.01、<0.05和<0.05。AS患者血清骨钙素(BGP)与枕墙距、骨特异性碱性磷酸酶(BALP)、Ⅰ型胶原羧基端前肽(CICP)、甲状旁腺激素(PTH)呈正相关,P值分别<0.05、<0.05、<0.01和<0.05。与ESR、Ⅰ型胶原羧基端交联肽(CTX)、尿脱氧吡啶啉(尿DPD)呈负相关,P值分别<0.01、<0.01和<0.05。PTH与年龄、尿DPD呈负相关,P值均<0.01。男性患者BALP较女性更低,P<0.01,其与枕墙距、CICP呈正相关,P值分别<0.05和<0.01,与CTX呈负相关,P<0.01。CICP与骶髂关节相分级、CTX、尿DPD呈负相关,P值分别<0.05、<0.01和<0.05;与BGP呈正相关,P<0.01。CTX与年龄呈负相关,P<0.01;与骶髂关节相分级呈正相关,P<0.01。HLA-B27阳性者CICP值低于阴性者,CTX值则高于阳性者,P值分别<0.05和<0.01。结论 AS患者BGP与BALP、PTH、CICP、CTX、尿DPD之间相互交织成网状对骨代谢造成影响,其启始的触发点为全身或局部的免疫反应,而HLA-B27通过抑制骨胶原蛋白的合成及促进其分解加速了骨破坏,其机理尚待进一步深入研究。     

英夫利昔单抗对强直性脊柱炎患者骨代谢指标的影响

目的探讨英夫利昔单抗对强直性脊柱炎(ankylosing spondylitis,AS)患者骨代谢指标的影响,并分析其与AS活动性指标的相关性。方法选择2012年1至6月江苏省苏北人民医院风湿免疫科门诊及住院确诊为AS且使用英夫利昔单抗治疗患者,使用英夫利昔单抗治疗(治疗期为30周,剂量为3~5 mg·kg-1·次-1,共使用6次)。治疗前后采用酶联免疫吸附试验法测定血清抗酒石酸酸性磷酸酶异构体(tartrate-resistant acid phosphatase isomer,TRACP)-5b、骨碱性磷酸酶(bone-specific alkaline phosphatase,BALP)、C反应蛋白(C reactive protein,CRP)和红细胞沉降率(erythrocyte sedimentation rate,ESR)水平,计算AS病情活动度评分(ankylosing spondylitis disease activity score,ASDAS)。根据发病年龄、病程、ESR水平、CRP水平、ASDAS-ESR和ASDAS-CRP分组。分析骨代谢指标变化特点及与临床指标的相关性。结果共纳入30例AS患者,女6例,男24例,平均年龄为(35±12)岁。英夫利昔单抗治疗前,ESR20 mm1 h组与ESR≤20 mm1 h组[(3.25±0.96)UL vs.(2.05±0.70)UL]、CRP10 mgL组与CRP≤10 mgL组[(3.21±0.97)UL vs.(2.34±0.95)UL]、ASDAS-ESR3.1组与ASDAS-ESR≤3.1组[(3.04±1.06)UL vs.(2.24±0.80)UL]、ASDAS-CRP3.3组与ASDAS-CRP≤3.3组[(3.14±1.02)UL vs.(2.13±0.76)UL]比较,前者TRACP-5b均明显高于后者,差异有统计学意义(均P0.05)。30例AS患者经英夫利昔单抗治疗30周后与治疗前相比,ESR[(9.4±6.6)mm1 h vs.(28.4±24.4)mm1 h]、CRP[(4.89±3.26)mgL vs.(17.05±19.20)mgL]、ASDAS-ESR[(1.38±0.41)vs.(3.52±0.84)]、ASDAS-CRP[(1.46±0.47)vs.(3.63±0.82)]和TRACP-5b[(2.08±0.77)UL vs.(2.77±1.04)UL]水平均较治疗前降低,差异有统计学意义(均P0.05)。结论 AS患者TRACP-5b水平与ESR、CRP、ASDAS呈正相关,提示骨吸收是AS病情活动的临床表现之一;治疗30周后,英夫利昔单抗治疗组血清TRACP-5b水平较治疗前明显低,提示英夫利昔单抗可以抑制骨吸收,其治疗与破骨细胞抑制可能具有相关性。     

类风湿关节炎患者的骨质疏松分析

骨质疏松分为原发性和继发性两种 ,继发性骨质疏松中类风湿关节炎 (ＲＡ)占重要地位。我们通过测量ＲＡ患者骨密度 (ＢＭＤ) ,了解ＲＡ患者骨质疏松的发生情况 ,分析其与病程、疾病活动指标、病情严重程度的关系 ;并测定骨转换指标骨钙素 (ＢＧＰ)、骨碱性磷酸酶 (ＢＡＰ)、尿脱氧胶原吡啶交联(Ｄ Ｐｙｒ) ,以分析ＲＡ骨质疏松与骨代谢的关系。一、资料与方法1.病例选择 :ＲＡ患者为我院风湿科 2 0 0 0年 11月～ 2 0 0 1年 6月的住院病人 ,均符合 1987年美国风湿病学会的诊断标准。且除外使用过皮质激素 ,有肝病、肾病、糖尿病、甲状腺疾病…     

Osteopenia in men with mild and severe ankylosing spondylitis

We investigated the frequency and distribution of osteopenia according to the clinical severity in ankylosing spondylitis (AS). Bone mass was measured in men with mild (n=45) and severe AS (n=31) with dual-energy X-ray absorptiometry (DEXA). Definition of clinical severity was based on the Schobers test. Osteopenia was commonly detected (48% in mild AS and 39% severe AS) and, in mild disease, more frequently observed at the lumbar spine than any of the proximal femur sites. In severe AS, however, the frequency of osteopenia at the femoral neck and Wards triangle was as high as at the lumbar spine. Both bone mineral density and T-scores in severe disease were lower than in mild disease at the femur neck, Wards triangle, and total proximal femur, but not in the lumbar spine. The progression of osteopenia may be reflected more reliably at proximal femur sites than at the lumbar spine.     

Bone mineral density and bone remodelling in Tunisian patients with ankylosing spondylitis: A cross-sectional study

Aim of the workTo assess the bone turnover markers and bone mineral density (BMD) in ankylosing spondylitis (AS) patients and to evaluate their association with clinical variables.Patients and methodsForty-seven AS patients were compared with 47 matched control. Clinical features and inflammatory parameters were assessed. C-terminal telopeptide fragments of type I collagen (CTX), alkaline phosphatases (ALP), N-terminal propeptide of type I procollagen (PINP) serum levels, and BMD of the lumbar spine and femoral neck were evaluated. The Bath AS disease activity and functional indices (BASDAI and BASFI) were assessed.ResultsMean serum levels of C-reactive protein, ALP and CTX were higher in AS patients than control (p = 0.001, p = 0.001 and p = 0.027 respectively). Osteopenia and osteoporosis were significantly more frequent in AS patients (57.4%) than control (21.3%) (p < 0.001). The PINP and ALP significantly correlated with disease duration (r = 0.33, p = 0.02 and r = 0.3, p = 0.04 respectively). BMD of the femoral neck was significantly lower in AS patients with history of coxitis than AS patients without (p = 0.02). Patients on anti-tumour necrosis factor (TNFα) therapy had higher T score (lumbar spine) compared to those not. Multivariate regression showed that CRP levels and disease activity were independently associated with low BMD and T score (lumbar) was significantly associated with anti-TNF use (p = 0.007).ConclusionsAn increase in bone turnover markers and decrease of BMD were observed in AS patients. Inflammatory activity of AS was associated to hyper bone remodelling and decrease of BMD. Anti-TNF use seems to be beneficial on AS inflammation and therefore on the BMD.     

Bone and stone in ankylosing spondylitis: osteoporosis and urolithiasis

Ankylosing spondylitis (AS) has well-defined renal complications, but urolithiasis has not been studied in detail. We aimed to evaluate the relation between AS and urolithiasis presence and the effect of this coexistence on the bone mineral status of patients. By dual-energy x-ray absorptiometry measurements at the femoral neck and lumbar vertebrae, we assessed the influence of urolithiasis, disease activity, and duration on bone mineral density (BMD) at different sites. Fifty-three AS patients and 25 control subjects were enrolled in the study. Mean age was 39.49±13.01 years for the AS group and 43.80±10.69 years for the control group, with no statistically significant difference. Patients were accepted as having active disease if two of the following were present: (1) symptomatic peripheral arthritis, (2) erythrocyte sedimentation rate greater than 30 mm/h, (3) C-reactive protein greater than 5 mg/L, and (4) dorsal–lumbar morning stiffness more than 60 min. The ratios of urinary stone presence were 11.32 and 12% for AS and control groups, respectively. We observed that a statistically significant difference in femur neck BMD between AS patients with or without urolithiasis was apparent. The lumbar BMD values were also lower in the urolithiasis subgroup but could not reach the statistical significance. There were no significant BMD alterations in the control group due to stone presence. Comparison of active–inactive disease groups revealed significantly low T scores in either the femur neck or L2–4 regions of patients with higher activity indices, but this difference was more prominent in the femur neck. In the early AS group (23 patients), 18 patients (78.26%) had L2–4 T scores lower than −1 SD, and in the advanced AS population, 19 of 30 patients (63.33%) had either osteopenia or osteoporosis (OP). We conclude that severe disease and concomitant urolithiasis might increase bone loss and fracture risk especially at the femur neck.     

Osteoporosis in ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disorder, characterized by an inflammatory enthesopathy progressing to ossification and ankylosis. Osteoporosis is a well‐reported complication of AS. Bone loss begins early in the disease at the spine, and later progresses to the hip. This reduction in bone density leads to an increased risk of fractures. However, there is a lack of awareness regarding this common complication, thus adding to the morbidity associated with AS. Early recognition, appropriate assessment and timely treatment of this complication will help reduce the attendant fracture risk due to decreased bone mass.     

Variables related to utility in patients with ankylosing spondylitis

The objective of this study was to identify variables associated to the utility of the health states in patients with ankylosing spondylitis (AS). A cross-sectional study was performed in a tertiary care centre. AS patients (New York modified criteria) were included. Demographic and disease-related variables were collected. The social tariffs of the EuroQol-5D (EQ-5D) were used to obtain utility values. Univariate and multivariate regression analyses were used in order to identify variables associated with utility. Seventy patients, 52 male (74.3%), with age (mean ± SD) 43.7 ± 9.1 years and disease duration 10.8 ± 8.1 years, were included. The mean utility was 0.5625 ± 0.3364. In the univariate analysis, patient global assessment, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) had a good correlation with the EQ-5D values (Pearson’s product moment correlation coefficient r > 0.6) whereas physician global assessment, patient pain assessment, and cervical rotation had a moderate correlation with the EQ-5D (0.6 > r > 0.4). Patients with significant comorbidity had lower utility values (0.3563 ± 0.068) than those without it (0.6796 ± 0.041, p = 0.0001). In the multivariate analysis, BASFI and BASDAI kept an independent association with utility and they explained a 62% of the variance of the utility values. In this study, physical function and disease activity, two outcomes with good responsiveness to the treatment, were the main determinants of the utility of the health states in AS patients.     

The absence of circulating immune complexes in patients with ankylosing spondylitis

Summary Sera from 50 patients with well-defined ankylosing spondylitis were examined for circulating immune complexes using both a C1q binding (fluid phase) assay and a Raji cell assay. No more than five of the patients assessed had circulating immune complexes by either one of these techniques and none were positive in both. This result is in contrast to the high prevalence in sera from unselected patients with rheumatoid arthritis and systemic lupus used as positive controls.     

Cervical involvement in juvenile-onset ankylosing spondylitis with bone scintigraphy

Juvenile-onset ankylosing spondylitis is an unusual disorder which can present with either peripheral arthritis or more classic hip girdle and back symptoms. A 12-year-old child with this disease was admitted with walking disorder, cervical pain, restricted cervical motion, and right ankle swelling. Diffusely increased accumulation of radioactivity in the cervical spine, focally increased accumulation in bilateral sacroiliac joints, and diminished irregular uptake in thoracal spine were detected on technetium 99m methylene diphosphonate bone scintigraphy. As a result, this imaging technique may give important information for diagnosis and differential diagnosis in juvenile chronic arthritis.     

Intracellular and surface RANKL are differentially regulated in patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is characterized by ankylosis of axial joints but osteoporosis is also a well-reported feature. T cells have been implicated as a source of receptor activator of NFkappaB ligand (RANKL) in inflammatory bone diseases. Hence, we assessed whether T cells in patients with AS act as a source of RANKL too. Therefore, we investigated the expression of RANKL on T cells from 21 patients with AS by flow cytometry. Bone mineral density (BMD) was evaluated by quantitative computer tomography (QCT) and dual X-ray absorptiometry (DXA) and correlated with serum levels of osteoprotegerin (OPG) and RANKL. BMD was decreased in 45% of all patients when measured with DXA (48% with QCT) and correlated negatively with OPG. Expression of intracellular RANKL was increased on CD4+ (84 vs. 70%) and CD8+ (85.2 vs. 65.3%, P < 0.05) T cells in patients with AS, whereas expression of membrane-bound RANKL was significantly lower (CD4+: 2.2 vs. 8.5% and CD8+: 0.7 vs. 3.2%, P < 0.01). Our results indicate that surface and intracellular RANKL production is differentially regulated on T cells of patients with AS.