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1.
Keller C Hafström I Svensson B;BARFOT study group 《Scandinavian journal of rheumatology》2001,30(4):213-220
OBJECTIVE: To study bone mineral density (BMD) in patients with early rheumatoid arthritis. METHODS: Dual x-ray absorptiometry was performed in 227 patients, 149 women and 78 men, with rheumatoid arthritis (RA) of no more than 12 months duration. RESULTS: Women, as well as men above 60 years of age, had a BMD at spine and hip comparable with age and sex matched reference populations. Men younger than 60 years had a tendency to lower BMD. Although the proportion of female patients with osteoporosis was not higher than in the reference, population the proportion of patients with reduced bone mass was increased, and this was found also in men. There was no significant association between BMD and disease duration, disease activity or disability. CONCLUSION: Untreated patients with early RA have a BMD in spine and hip not significantly different from that of normal reference populations. However, an increased number of the patients had reduced bone mass already at disease onset. 相似文献
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Shankar S Handa R Aneja R Marwaha V Ammini AC Aprajita V 《Rheumatology international》2009,29(4):377-381
Osteoporosis (OP) is being increasingly recognized in inflammatory rheumatic diseases like rheumatoid arthritis (RA). Ethnicity
influences bone mineral density (BMD) and fracture risk. Due to paucity of data on this aspect of RA from Asian countries
including India, we prospectively studied 84 premenopausal women with RA of at least 2 years duration and 247 healthy, age
(within 5 years) and sex-matched controls. A significant difference in BMD between patients and controls was observed only
at the femoral neck. As many as 22% patients with RA exhibited osteoporosis at least one site in contrast to 9% controls.
Nearly 40% of patients exhibited osteopenia at all the three sites. Modified Sharp score, disease duration and DMARD naive
period were found to correlate with low BMD. However, on multivariate analysis, only modified Sharp score was shown to be
significantly associated with low BMD. Our study draws attention to the poor bone health in Asian Indian women with RA. 相似文献
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The aim of this study was to evaluate the bone mineral density (BMD) in patients with early rheumatoid arthritis (RA) prior to and 6 months after adding low-dose corticosteroid (CS) treatment. Adult patients (>21 years old) with early RA (symptom duration <1 year) and severe joint pain under maximal dose of nonsteroidal anti-inflammatory drugs (NSAIDS) were started on low-dose prednisone (10 mg/day). Patients were evaluated after 1, 3, and 6 months. Disease activity measures including swollen and tender joint count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were documented, and the dose of prednisone was adjusted according to the level of pain at each visit. BMD of the femoral neck (FN) and lumbar spine (LS) was measured using dual energy X-ray absorptiometry prior to and 6 months after starting CS treatment. Calcium supplements, vitamin D, bisphosphonates, or hormonal therapy that may affect BMD were not permitted during the study. Twenty patients were eligible and 16 completed the study; 75% were female. The mean age was 47.2±12 years and mean duration of symptoms was 7±2 months. The mean BMD at the FN prior to and 6 months after starting CS treatment were 0.8080 g/cm2±0.1145 and 0.8242 g/cm2±0.1122, respectively (p=0.04). The mean BMD at the LS prior to and 6 months after starting CS treatment were 0.9429 g/cm2±0.1406 and 0.9490 g/cm2±0.1277, respectively (p=0.423). There was a significant correlation between the mean change of BMD at the FN and mean change of tender joint count (p=0.01), ESR (p=0.008), and CRP (p=0.006) but not with swollen joint count (p=0.099). However, there was no correlation between the change of BMD at the FN or LS and the change of any of the disease activity measures of every patient. Also, no correlation was seen between the cumulative dose of CS and the change in BMD. BMD increases significantly at the FN in early RA patients 6 months after adding low-dose CS to the treatment. 相似文献
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B D Shenstone A Mahmoud R Woodward D Elvins R Palmer F Ring A K Bhalla 《Annals of the rheumatic diseases》1994,53(10):681-684
OBJECTIVES--To determine whether significant reduction in bone mass is detectable in early disease in patients with rheumatoid arthritis (RA) and to examine the possible influences of disease activity and physical disability on bone mineral density (BMD) of the lumbar spine (LS) and femoral neck (FN). METHODS--LS and FN BMD values were measured and Z scores determined in a cross-sectional study of 104 patients with RA of less than five years duration. BMD values were also compared between a subgroup of 64 patients and a normal control group matched for age, sex, menopausal status and body mass. BMD values and Z scores were correlated with disease activity, measured by the Stoke Index, disability, measured by HAQ score, and disease duration. RESULTS--Premenopausal female patients with RA had significantly reduced mean FN Z scores (-0.62, 95% CI -0.30 to -0.94) which correlated with HAQ scores (Rs 0.358, p = 0.05) and age (Rs 0.397, p = 0.03). There were no significant changes of BMD in males or postmenopausal females. Disease duration and disease activity did not correlate with BMD changes. CONCLUSION--BMD is reduced in premenopausal female patients with early RA possibly related to the attainment of peak bone mass. No significant reduction of BMD was found in males or postmenopausal females with early disease. Physical disability but not disease activity appears to play a role in the reduction of FN bone mass. 相似文献
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N. F. A. Peel A. J. Spittlehouse D. E. Bax R. Eastell 《Arthritis \u0026amp; Rheumatology》1994,37(7):983-991
Objective. To determine the reproducibility, accuracy, and linearity of hand bone mineral content (BMC) measurements, and to evaluate the influence of hand posture; to determine the relationship of hand bone mineral density (BMD) to generalized osteopenia in rheumatoid arthritis (RA); and to determine the relationship between hand BMD and disease severity in early RA. Methods. Hand BMD was measured by dual-energy x-ray absorptiometry (DXA). We studied 70 postmenopausal women with steroid-treated RA (established RA), ages 49–79, and 20 age-matched healthy controls to determine the relationship to generalized osteoporosis; we also studied 20 patients ages 23–74 years with early RA to determine the relationship between disease severity and hand BMD. Results. Reproducibility of hand BMD was to within 1%. In established RA, there was a greater decrease in juxtaarticular BMD (23% at the hand) than in generalized BMD (16% at the femoral neck, 11% at the lumbar spine, and 11% total body) compared with that in age-matched controls. Hand BMD correlated with skeletal size and BMD at other skeletal sites. In established RA, there was no effect of disease duration, disability, or steroid therapy. In early RA, hand BMD correlated with age and disease activity. Conclusion. Measurement of hand BMD by DXA is accurate and precise. Hand BMD reflects BMD at other skeletal sites in patients with RA, and is a marker of disease severity in patients with early disease. It may be a sensitive marker of disease progression and response to therapeutic intervention. 相似文献
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Doi S Kushida K Miyamoto S Sekioka Y Suzuki M Inoue T Nagano A 《Rheumatology international》2005,25(3):195-200
Objectives The aim of this study was to investigate the relationships among bone mineral densities (BMD) in the calcaneus and leg activity of daily living (L-ADL) in rheumatoid arthritis (RA) patients.Methods We measured and compared calcaneus BMD using single X-ray absorptiometry and lumbar spine and femoral neck BMD using dual X-ray absorptiometry in 158 Japanese female outpatients with RA and 358 normal controls (NC).Results Regardless of whether the women were premenopausal or postmenopausal, calcaneus and femoral neck BMDs in the RA group were significantly lower than in the NC group. Calcaneus BMD correlated with the modified health assessment questionnaire, L-ADL score, and 10-m walking time, regardless of whether the patients were premenopausal or postmenopausal (P<0.01).Conclusions We conclude that calcaneus BMD reflects the L-ADL of RA patients very well and allows us to perform the same level of BMD evaluation as that with current BMD measurement methods. 相似文献
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Idiopathic osteoporosis is a frequent cause of osteoporosis in young premenopausal women. However, there are no data about
the treatment of these patients. The aim of this study was to analyse the evolution of bone mineral density (BMD) in premenopausal
women with idiopathic osteoporosis treated with a conservative approach. Retrospective study of 16 premenopausal women with
idiopathic osteoporosis (aged 35.7±7 years) with a mean follow-up period of 3 years (1–6 years). BMD measurements at the lumbar
spine and femoral neck were obtained in all patients at baseline and yearly (patients had one or more fragility fractures
and/or a Z score <−2 in the lumbar spine or femur). Secondary causes of osteoporosis were excluded in all patients. Patients were treated
with calcium and vitamin D to achieve a calcium intake of up to 1,500 mg/day and were advised to increase physical activity.
A significant increase in lumbar and femoral BMD was observed after 2 and 3 years of follow-up, respectively (1.9±1.9% mean
increase in lumbar spine, p= 0.021, at 2 years) (5.6±4.5% mean increase in femur, p=0.04, at 3 years). The serum total alkaline phosphatase (TAP) values increased at 2 years (122±46 vs 140±36 U/l, p=0.054). In addition, a negative correlation between baseline TAP serum values and lumbar BMD evolution at 2 years was observed
(r=−0.748, p=0.013). No patient developed new skeletal fractures during the follow-up period. In young premenopausal women with idiopathic
osteoporosis the conservative treatment with supplements of calcium and vitamin D associated with an increase of physical
activity is associated with an increase in BMD without evidence of further skeletal fractures after more than 3 years of follow-up. 相似文献
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OBJECTIVE: To examine the bone mineral density (BMD), frequency of osteoporosis, and risk factors for BMD reduction in a representative population of female rheumatoid arthritis (RA) patients ages 20-70 years. METHODS: BMD in the femoral neck, total hip, and spine L2-4 (anterior-posterior view) was measured in 394 RA patients recruited from a validated county RA register (completeness 85%) comprising 721 women ages 20-70 years. BMD was measured with dual-energy x-ray absorptiometry, and age-specific values were compared with pooled values from a European/US population of healthy subjects free from earlier fractures, chronic diseases, and medications influencing bone metabolism. A multiple linear regression model was used to determine individual predictors of BMD. RESULTS: No statistically significant differences were found in demographic, disease activity, disease severity, or health status parameters between the RA register patients in whom BMD was measured and the remaining register patients. Femoral neck BMD was significantly reduced by 4.2% in the age group 50-59 years, and by 5.0% in those ages 60-70 years. For BMD in the total hip, the significant reductions were 3.7%, 6.0%, and 8.5% in the age groups 40-49 years, 50-59 years, and 60-70 years, respectively. No significant reduction in spine L2-4 BMD was found. A 2-fold increased frequency of osteoporosis was observed in all 4 age groups of RA patients compared with the reference population, ranging from 0% to 28.6% in the femoral neck, 0% to 29.9% in the total hip, and 1.8% to 31.5% in the spine. Predictors of reduced BMD were as follows: at the femoral neck, older age, low body weight, current use of corticosteroids, greater physical disability (as measured by the modified Health Assessment Questionnaire [M-HAQ]), and presence of rheumatoid factor; at the total hip, older age, low weight, current use of corticosteroids, and higher M-HAQ disability score; and at the lumbar spine, older age, low weight, and current use of corticosteroids. CONCLUSION: Register-based prevalence data on BMD reduction in female RA patients ages 20-70 years are presented for the first time in this report, which demonstrates a 2-fold increase in osteoporosis in this representative population. 相似文献
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Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis 总被引:1,自引:0,他引:1
Güler-Yüksel M Bijsterbosch J Goekoop-Ruiterman YP de Vries-Bouwstra JK Ronday HK Peeters AJ de Jonge-Bok JM Breedveld FC Dijkmans BA Allaart CF Lems WF 《Annals of the rheumatic diseases》2007,66(11):1508-1512
OBJECTIVES: Osteoporosis is a well-known extra-articular phenomenon in patients with uncontrolled, long-standing rheumatoid arthritis (RA). In the present study, the extent of osteoporosis and reduced bone mineral density (BMD) and the disease-related and demographic factors that are associated with osteoporosis and reduced BMD were examined in patients with recently diagnosed, active RA. METHODS: BMD of the total hip and the lumbar spine was measured using dual-energy x ray absorptiometry in 381 patients with recently diagnosed active RA, who had never been treated with DMARDs or corticosteroids. Osteoporosis was defined as a T score 相似文献
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Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density 下载免费PDF全文
Lodder MC de Jong Z Kostense PJ Molenaar ET Staal K Voskuyl AE Hazes JM Dijkmans BA Lems WF 《Annals of the rheumatic diseases》2004,63(12):1576-1580
OBJECTIVE: To examine variables associated with bone mineral density (BMD) in patients with rheumatoid arthritis (RA). METHODS: We investigated 373 patients with low to moderately active RA. Patients with low disease activity were recruited from a cohort of patients in clinical remission. Patients with moderately active disease were included in a trial comparing the effects of long term high intensity exercise programme and conventional physical therapy. Demographic and clinical data were collected. Bone mineral density (BMD) was measured by means of dual x ray absorptiometry (DXA). Associations between demographic and clinical measurements on the one hand and BMD on the other were investigated in regression analyses. RESULTS: The patient group consisted of middle aged, mainly female, patients. The median (interquartile range) disease duration was 7 (4 to 13) years, the mean disease activity score (standard deviation) was 3.2 (1.4). Of the group, 66% was rheumatoid factor positive, and 83% (n = 304) had never used corticosteroids. The median Larsen score of hands and feet was 27 (5 to 61). Greater age and low body mass index were related to low BMD at the hip and spine. High Larsen score for hands and feet was significantly associated with low BMD at the hip. The use of corticosteroids was not independently associated with BMD. The results of the multiple regression analyses also applied to the subgroup of corticosteroid naive patients. CONCLUSION: BMD data of patients with low to moderately active RA demonstrated an association between high radiological RA damage and low BMD at the hip, which suggests an association between the severity of RA and the risk of generalised bone loss, which also occurred in corticosteroid naive patients. 相似文献
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Low bone volume with reduced trabecular thickness and the increased eroded surface are common features in periarticular bone histology in patients with rheumatoid arthritis;however, there is no consensus on the change in bone formation. Main histological changes of iliac bone in rheumatoid arthritis are reduced bone volume, low trabecular thickness, and decreased trabecular connectivity caused by increased bone resorption. Results in parameters for bone formation are conflicting. The experimental model for arthritis demonstrates that bone turnover changes with the severity of arthritis. 相似文献
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Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis 总被引:9,自引:0,他引:9
Harrison BJ Hutchinson CE Adams J Bruce IN Herrick AL 《Annals of the rheumatic diseases》2002,61(11):1007-1011
BACKGROUND: Periarticular osteoporosis is an early finding in the hands of patients with rheumatoid arthritis (RA), due to release of bone resorbing cytokines from the inflamed synovium. There has been disagreement as to whether periarticular bone loss occurs in psoriatic arthritis (PsA). Bone mineral density (BMD) can now be measured accurately using dual energy x ray absorptiometry (DEXA). Recently, DEXA has been used to measure periarticular BMD at predefined regions of interest (ROIs) around the joints. OBJECTIVES: Firstly, to compare periarticular BMD around the finger joints of patients with early RA or PsA. Secondly, to determine whether periarticular bone loss is related to joint inflammation and radiological erosions in RA and PsA. METHODS: Seventeen patients with RA and 15 with PsA were recruited, all with disease duration of less than five years. All finger joints were examined by one person for swelling, or tenderness, or both. Hand radiographs were scored for the presence of erosions. Periarticular BMD was measured at 10 predetermined ROIs using a Hologic QDA-4500A fan-beam densitometer. RESULTS: Patients with PsA were less likely to be positive for rheumatoid factor (RF) (13% v 94%) and more likely to be men (60% v 23%) than patients with RA. There were no other clinical differences between patients with RA or PsA. Patients with RA had significantly lower BMD at each of the ROIs than those with PsA (p<0.05). However, these differences disappeared after adjusting for age and sex. Among patients with RA, those with a higher total number of swollen and/or tender hand joints had significantly lower periarticular BMD at the metocarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. No such association was found for patients with PsA. CONCLUSIONS: In early disease, periarticular bone loss occurred both in patients with RA and those with PsA. Among patients with RA, periarticular osteoporosis was related to measures of joint inflammation. There was no association between joint inflammation and periarticular bone loss in patients with PsA, which lends support to the hypothesis that the primary site of inflammation in PsA is extrasynovial. 相似文献
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《Reumatología clinica》2014,10(2):89-93
ObjectiveTo assess the bone mineral density (BMD) and the frequency of osteoporosis and clinical fractures in a large group of Spanish patients with psoriatic arthritis (PsA).Patients and methodsBMD was determined by DXA in all the patients who were willing to participate and had peripheral PsA regularly evaluated in a tertiary university hospital. All patients underwent a physical examination and general laboratory analysis. We gathered demographic and clinical variables related with BMD and risk of fractures. We also recorded the history of clinical low impact fractures. The population of reference to calculate T-score and Z-score came from a Spanish database.ResultsOne hundred and fifty-five patients were included (64 postmenopausal women, 26 premenopausal women and 65 men). The clinical forms of PsA were: 46% oligoarticular and 54% polyarticular. Mean disease duration was 13.7 ± 9.4 years and mean ESR was 21.8 ± 13.9 mm/h; 66% of patients had received glucocorticoid treatment.We found no differences in BMD status between the patients and the Spanish general population, neither in the whole series nor in each defined subgroup. Frequency of osteoporosis was 16%; it was higher in postmenopausal women (28%) than in men (9%) or premenopausal women (4%). Frequency of clinical fractures was 13%; it accounted specially in postmenopausal women.ConclusionsThe magnitude of the problem of osteoporosis in PsA seems to be mild. 相似文献
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Head AJ Myers LK Watsky MA Greenwell MW Barrow KD Michelson JA Carbone LD 《The Journal of rheumatology》2006,33(5):1001-1003
OBJECTIVE: To determine bone mineral content (BMC), bone mineral density (BMD), Z scores, and markers of bone turnover in African American children with juvenile rheumatoid arthritis (JRA). METHODS: Eight children with JRA with no prior exposure to corticosteroids were evaluated. Lumbar spine (L1-L4) and total body and total hip BMC and BMD were determined using dual x-ray absorptiometry (DXA), and Z scores (BMD) were calculated. Serum samples of markers of bone turnover including pyridinoline (PYR), N-terminal propeptide of type I procollagen (P1NP), osteocalcin (OC), and bone-specific alkaline phosphatase (BSAP) were measured. RESULTS: The mean Z score (BMD) at the lumbar spine (L1-L4) in patients with JRA was -1.2+/-0.8. Z scores for total body and total hip were within 1 standard deviation of normal compared with healthy historical controls matched for age, sex, and race. CONCLUSION: BMD was normal for chronological age (defined as Z score >or= 2.0) in African American children with JRA who had not previously been treated with corticosteroids. Further studies are needed on the effects of JRA on skeletal health in African American children. 相似文献
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Bone mineral density in systemic lupus erythematosus: comparison with rheumatoid arthritis and healthy controls 总被引:6,自引:0,他引:6 下载免费PDF全文
OBJECTIVES: To examine bone mineral density (BMD) frequency of osteoporosis and reduced bone mass in systemic lupus erythematosus (SLE), and compare the data of the SLE patients with matched rheumatoid arthritis (RA) patients and healthy controls. Secondly, to study possible correlations between BMD, demographic and disease variables in the SLE patients. METHODS: Measures of BMD assessed by dual energy x ray absorptiometry were obtained from 75 SLE patients aged = 70 years, 75 RA patients matched for age, sex and disease duration, and from 75 healthy controls matched for age, sex and geographical area. Disease activity and accumulated organ damage were assessed in the SLE patients. RESULTS: The SLE patients had significantly lower BMD values at lumbar spine L2-L4 and hip, and higher frequency of osteoporosis at all sites of measurement compared with matched healthy controls. The matched SLE and RA patients had similar BMD, prevalence of osteoporosis and reduced bone mass. In the SLE patients BMD was more strongly correlated with accumulated organ damage than with markers of disease activity or duration. In multivariate analyses BMD was at all sites predicted by age and body mass, at lumbar spine also by the current corticosteroid dose. CONCLUSION: The study showed reduced BMD in patients with SLE compared with matched healthy controls. Premenopausal women taking corticosteroids were especially affected. Furthermore, the BMD of matched SLE and RA patients was reduced to a similar extent. 相似文献
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Bone mineral density in patients with psoriatic arthritis 总被引:3,自引:0,他引:3
Frediani B Allegri A Falsetti P Storri L Bisogno S Baldi F Filipponi P Marcolongo R 《The Journal of rheumatology》2001,28(1):138-143
OBJECTIVE: Little information is available concerning bone mass in patients with psoriatic arthritis (PsA): the existence of less severe periarticular osteoporosis is considered possible, but there are no data concerning the existence of systemic osteoporosis. We investigated bone mineral density (BMD) in patients with PsA. METHODS: We studied 186 patients with non-axial PsA and 100 healthy subjects, equally divided into 3 groups: women of child-bearing age, women in menopause, and men. No patient had previously received steroid treatment. In all patients, evaluation was made of disease duration, inflammation indices (erythrocyte sedimentation rate, C-reactive protein), functional indices (Steinbrocker scale), and the Health Assessment Questionnaire (HAQ). BMD was measured by fan-beam x-ray densitometry of the lumbar spine, femur, and total body (evaluating the whole skeleton, as well as the spine, trunk, and upper and lower limbs). Ultrasound densitometry of the heel was also performed. RESULTS: BMD was significantly lower in the arthritic than in the healthy subjects regardless of sex, menopausal status, or age, as expressed in g/cm2 (lumbar spine 1.112 vs 1.326; femoral neck 0.870 vs 1.006; total body 1.125 vs 1.203) or by T and Z scores (lumbar T = -1.36, Z = -0.98; femoral neck T = -1.12, Z = -0.83; total body T = -1.09, Z = -0.65). Ultrasound densitometry of the heel was similarly altered (stiffness 96 vs 77; T -1.78; Z -1.29). Among the PsA patients, demineralization in at least one skeletal region was observed in 67% of premenopausal women (marked in 11%), 100% of postmenopausal women (marked in 47%), and 80% of the men (marked in 29%). In premenopausal women, demineralization did not correlate with the disease variables; in postmenopausal women and the men, it correlated with a decline in the functional indices and the HAQ score. This was confirmed by analysis of the relative risk of osteoporosis expressed in odds ratios (HAQ: 1.6; age: 1.4; years since menopause: 1.7). CONCLUSION: Demineralization was observed in more than 2/3 of our PsA patients without axial involvement. This demineralization was not related to the indices of inflammation or disease duration, but there is a delayed correlation with HAQ score, as well as age and the number of years since menopause. 相似文献