Involvement of interleukin-6 and prostaglandin E2 in periarticular osteoporosis of postmenopausal women with rheumatoid arthritis

In experimental arthritis, blocking of the receptor activator of nuclear factor κB ligand (RANKL) by osteo-protegerin (OPG) treatment prevents bone loss but not inflammation, suggesting that there are inflammation-related factors that regulate RANKL and OPG. However, it is not known which factors regulate RANKL and OPG in human inflammation-induced bone loss. To clarify the inflammation-related factors that play a role in periarticular osteoporosis in patients with rheumatoid arthritis (RA), the synovial fluid and synovium of the knee joint, and the periarticular cancellous bone of the femoral condyle were collected at surgery from postmenopausal women with RA or osteoarthritis (OA). All patients with RA had radiologic bone loss on the femoral condyles, while such a loss was not observed in patients with OA. The present study examined: (i) tumor necrosis factor α (TNFα), interleukin (IL)-1β and IL-6 levels in synovial fluid; (ii) TNFα, IL-1β and IL-6 messenger RNA (mRNA) expression in the synovium and the cancellous bone that contained bone marrow; and (iii) IL-6 and prostaglandin E₂ (PGE₂) production in cultured osteoblast-lineage cells derived from collagenase-treated cancellous bone fragments. Inflammation of the knee joints in patients with RA was confirmed by significantly higher proinflammatory cytokine levels in the synovial fluid and the synovium than those seen in patients with OA. In patients with RA, mRNA expression of IL-6, but not TNFα and IL-1β, in the cancellous bone and IL-6 and PGE₂ production in the osteoblast-lineage cells were significantly higher than in patients with OA. These findings suggest, for the first time, that IL-6 is involved in periarticular osteoporosis in postmenopausal women with RA. IL-6 and PGE₂ released from osteoblast-lineage cells could be, at least in part, responsible for human inflammation-induced bone loss. Received: August 28, 2000 / Accepted: November 9, 2000     

类风湿关节炎与骨质疏松症的生物信息学分析

目的 利用生物信息学分析类风湿关节炎（RA）与骨质疏松症（OP）的关系。方法 通过Genecards、OMIM、TTD等数据库查找RA和OP的疾病基因,对两组疾病的基因取交集,将共同基因导入STRING数据库构建蛋白互作（PPI）网络图,使用R软件筛选出PPI网络中的关键基因,利用DAVID数据库进行GO和KEGG富集分析。结果 通过检索数据库筛选出RA相关基因5 388个、OP相关基因4 587个,取交集后获得共同靶点基因1 899个,PPI网络图显示IL-6、INS、AKT1、TNF、TP53、VEGFA、EGFR等为RA与OP的共同关键基因,GO富集主要与受体配体活性、细胞因子受体结合、囊泡、T细胞活化、肽分泌的调节等相关,KEGG信号通路包括PI3K-Akt信号通路、JAK-STAT信号通路、破骨细胞分化、细胞凋亡、Th17细胞分化等。结论 所获得RA与OP的共同关键基因和涉及的信号通路,有助于理解两者在疾病过程中的相关性,为药物的研发提供理论参考。     

阿仑膦酸钠对类风湿关节炎合并骨质疏松患者骨强度的影响

目的 分析阿仑膦酸钠对类风湿关节炎（rheumatoid arthritis,RA）合并骨质疏松（osteoporosis,OP）患者骨强度的影响。方法 选取华北理工大学附属医院骨质疏松门诊2012年6月至2020年6月诊治的OP患者120例,分为RA+OP组（60例）和OP组（60例）,且均口服阿仑膦酸钠联合骨化三醇、钙尔奇D持续12个月。比较治疗前后表征髋部力学结构强度的参数值CSA、CSMI、Z、CT和BR值（分别代表股骨颈抗轴向压缩力、骨骼刚度、抗屈曲负荷系数、皮质骨厚薄及屈曲比）、骨密度（BMD）、骨折发生率、炎性指标及临床体征。结果 经治疗6月、12月后,除RA+OP组全髋部位BMD外,OP组全髋、两组患者腰椎、股骨颈BMD、CSA、CSMI、Z、CT值均高于治疗前（P＜0.05）,BR值均低于治疗前（P＜0.05）;治疗12月后,RA+OP组股骨颈、全髋BMD、CSA、CSMI、Z值均低于OP组（P＜0.05）,腰椎BMD、CT、BR值无差异;治疗6至12月期间,RA+OP组股骨颈、全髋BMD增长率低于OP组（P＜0.05）;RA+OP组治疗前骨折发生率显著高于OP组,所有RA患者疾病活动性控制良好。结论 阿仑膦酸钠联合骨化三醇和钙剂可明显提升RA患者骨密度及髋部骨强度,提高骨骼稳定性,这种提升随疗程延长比正常骨质疏松患者缓慢。     

男性类风湿关节炎患者骨量减低的相关研究

目的探讨男性类风湿关节炎(rheumatoid arthriti,RA)患者骨量减低的相关情况及合并骨质疏松的危险因素。方法收集2013年8月至2019年5月在苏州大学附属常州市肿瘤医院诊治的男性类风湿关节炎患者38例,年龄(64. 39±9. 44)岁,对照组为40例健康正常人群,年龄(63. 53±8. 14)岁。通过双光能X线骨密度仪测定正位腰椎(L1～4)及左侧股骨近端(包括FN、Troch、Ward、Total)骨密度;运用电化学发光免疫分析法检测BAP、BGP、CTX;记录RA患者的ESR、CRP、关节肿胀及压痛数、RF以及CCP等情况。分析比较两组骨密度及骨生化指标的差异,并采用单因素分析和多因素Logistic回归分析调查类风湿关节炎患者合并骨质疏松的危险因素。结果两组间年龄、体质量指数(body mass index,BMI)差异无统计学意义(P0. 05)。类风湿关节炎组左侧股骨颈、整体髋骨BMD测量值较对照组减低(P0. 05);且类风湿关节炎组骨量减少、骨质疏松发生率较对照组显著增高(P0. 05);在骨生化指标方面,类风湿关节炎组CTX水平高于对照组(P0. 05)。单因素分析显示BMI、CRP、DAS28-ESR及CTX与男性类风湿关节炎患者继发骨质疏松相关(P0. 05);多因素Logistic回归分析显示,BMI 18. 5 kg/m2(OR=0. 014),DAS28-ESR5. 1(OR=21. 433)及CTX0. 7 ng/m L(OR=25. 875)是男性类风湿关节炎继发骨质疏松的独立危险因素(P0. 05)。结论男性类风湿关节炎患者同样易合并骨质疏松的发生,BMI、DAS28及CTX等危险因素应高度重视。     

1 061例类风湿关节炎患者骨密度及相关危险因素分析

目的 通过对1 061例类风湿关节炎(RA)患者骨密度(BMD)及相关临床因素的分析,探讨RA合并骨质疏松症(OP)的影响因素。方法 选取2016年1月至2020年8月于我院确诊的1 061例RA患者,同期健康体检者636例,使用双能X线骨密度检测仪检测腰椎1~4、左股骨近端骨密度,收集RA患者一般资料,评估疾病活动度评分（DAS28评分）,检测抗环瓜氨酸肽抗体（抗CCP抗体）、类风湿因子(RF)、血沉、C-反应蛋白,分析RA患者骨密度及相关危险因素。结果 RA组股骨颈、股骨转子、转子间、全髋关节、腰椎1~4、全部腰椎骨密度较对照组均减低（P<0.001）,低骨量、骨质疏松占比分别为36.5 %、30.7 %,较对照组高（P<0.001）。RA是OP的独立危险因素,OR值为2.30(1.70~3.09),BMI是RA合并OP的保护因素,OR值为0.82（0.77~0.86）,年龄、女性、服用糖皮质激素大于1个月、脆性骨折史、股骨头坏死是RA合并OP的独立危险因素,OR值分别为1.14（1.12~1.16）、4.83（3.05~7.64）、2.31（1.57~3.41）、6.90(2.28~20.88)、16.19(3.20~81.90)。抗CCP抗体、RF、DAS28评分非RA合并OP的危险因素。结论 RA较健康人群骨密度显著减低,罹患OP风险增加,对高龄、女性、长病程、低体重、有脆性骨折史、股骨头坏死、使用糖皮质激素的患者尤其需要警惕骨质疏松的发生。     

类风湿关节炎骨质疏松危险因素分析

目的类风湿关节炎(RA)是继发性骨质疏松的常见原因,本研究旨在通过分析比较RA患者血清类风湿因子(RF)、抗环瓜氨酸多肽抗体(anti-CCP)、C-反应蛋白(CRP)、血细胞沉降率(ESR)及骨代谢六项指标水平,探讨RA患者骨质疏松的危险因素。方法 133例RA患者根据双能X线检测的骨密度(BMD)结果分为骨质疏松组、骨量减低组和骨量正常组,检测各组受试者RF、anti-CCP、CRP、ESR及骨代谢六项等指标,分析比较各组受试者各指标水平差异,并比较各组患者糖皮质激素用药情况,多元logistic回归分析上述指标与RA患者骨质疏松的关系。结果①RA患者血清RF、anti-CCP、CRP及ESR水平相较于正常人群显著升高;②骨质疏松和骨量减低组CRP、ESR及骨碱性磷酸酶(BALP)、β胶原特殊序列(β-CTx)两项骨代谢指标水平较RA骨量正常组显著升高,且OP组糖皮质激素使用率明显高于骨量正常组,差异有统计学意义;③患者年龄、病程、疾病活动度及使用糖皮质激素是RA患者发生骨质疏松的独立危险因素OR(95%CI)分别为1.116(1.013-1.230)、1.775(1.191-2.645)、4.356(1.741-10.898)和9.448(1.040-85.802)。结论 RA患者血清自身抗体、炎症指标及骨代谢指标水平存在不同程度异常,患者年龄、病程、疾病活动度及糖皮质激素使用情况可作为判断RA患者骨质疏松风险的参考指标,有助于指导临床对RA患者疾病发展和病程进行监测,并进行及时的合理治疗。     

绝经后活动性类风湿性关节炎患者低骨密度的相关危险因素分析

目的分析绝经后活动性类风湿性关节炎(rheumatoid arthritis,RA)患者出现低骨密度相关的危险因素。方法研究对象为106例患有活动性RA的绝经后妇女,患者按体质量指数(BMI)分组:I组消瘦(18.5～24.9 kg/m~2,n=36),II组超重(25.0～29.9 kg/m~2,n=35),III组肥胖(30.0 kg/m~2,n=35)。检测这些患者的股骨BMD和血清BTM水平:骨钙素(OC)和I型胶原交联C-端肽片段(CTX)和骨桥蛋白(OPN)、抵抗素、高敏C反应蛋白、白细胞介素-6、肿瘤坏死因子(TNF)-a。结果与较瘦的女性相比,肥胖女性的总股骨BMD和总T评分显然更高(P0.05);发现BMD和CTX水平与体重存在显著相关性(P0.05)。调整股骨颈BMD后,BMI与TNF-α水平呈负相关(P0.05)。骨钙素水平与抵抗素呈负相关(P0.05),CTX水平与OPN呈正相关(P0.05);并发现BTM和BMD与其他炎症指标之间的关联。观察到OPN水平与体重、腰围和绝经后时间之间呈负相关性(P0.05)。结论本研究结果表明,体重和OPN、抵抗素和TNF-α在绝经后活动性RA患者的骨密度降低中起重要作用。     

Low muscle mass and body composition analysis in a group of postmenopausal women affected by primary Sjögren’s syndrome

ObjectivesSarcopenia is the pathological reduction of skeletal muscle mass and strength. This condition is often underestimated in clinical practice, particularly in connective tissue diseases. The purpose of this study is to evaluate the prevalence of low muscle mass in primary Sjögren’s syndrome (pSS) and to explore the relationships linking muscles and bone tissue.Material and methodsTwenty-eight postmenopausal pSS patients were matched with 30 healthy controls and their body composition analysis was performed by dual-energy X-ray absorptiometry to investigate for sarcopenia considering appendicular lean mass (ALM) and the skeletal muscle mass index (SMI) as references. Bone mineral density analysis of lumbar spine (L1–L4), whole femur, femoral neck and whole body was also performed. Linear regression was used to assess the relationship between body composition and bone mineralization.ResultsLow muscle mass was significantly higher in the pSS group compared to controls whether expressed as ALM, SMI [odds ratio (OR) = 18.40, confidence interval (CI): 4.84–72.08, p < 0.0001] or considering total body lean masses. Lean masses appeared to be the best estimators of bone mineralization: total lean body mass (TLBM) lumbar spine R² = 0.72, p < 0.0001; TLBM femoral neck R² = 0.36, p < 0.004; lean mass of upper limbs lumbar spine R² = 0.70, p < 0.0001; femoral neck R² = 0.66; lean mass of lower limbs lumbar spine R² = 0.66, p < 0.0001; femoral neck R² = 0.44, p = 0.008). Primary Sjögren’s syndrome patients had a significantly higher android/gynoid fat ratio compared to controls.ConclusionsFemale pSS patients have lower muscle mass compared to healthy controls and are exposed to a higher risk of developing sarcopenia than healthy subjects. Our research demonstrates that the amount of lean tissue is the main predictor of bone mineralization in pSS.     

RA患者骨密度的特点及影响骨折风险的因素

目的探讨类风湿关节炎(rheumatoid arthritis,RA)患者骨密度的特点及其骨折的风险度,并分析其影响因素。方法选取2016年1月至2017年12月于我院已确诊的RA患者共70例(RA组),体检的正常健康人群共79例(对照组),收集两组人群的病史及骨折风险相关的基本临床资料,且采用双能X线骨密度仪测定两组人群股骨的3D骨密度、二维骨密度,并进行骨折跌倒评分及FRAX评分,分析RA患者的骨密度变化情况、骨折风险性和疾病的活动度,探讨影响RA骨密度减低的因素。结果与正常对照组相比,RA组患者无论是体积骨密度还是皮质厚度都明显降低(t=6.135,P0.01),且均与二维BMD的变化趋势相一致;RA患者骨折风险度明显高于正常对照组人群(t=6.663,P0.01),RA患者疾病的活动度与骨密度的改变之间无明显相关性(r=-0.085,P0.05),但激素的使用是其骨量流失的影响因素(χ~2=12.366,P0.05)。结论RA患者存在明显的骨量流失和骨折风险性增加,骨密度的改变主要表现为骨小梁和骨皮质密度均减低,因此,积极控制原发病并预防糖皮质激素性骨质疏松有重要的临床意义。     

Conventional disease-modifying agents in rheumatoid arthritis – a review of their current use and role in treatment algorithms

Despite the development of targeted therapies, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) remain the cornerstone of treatment of rheumatoid arthritis (RA). A literature search was conducted on treatment recommendations and relevant papers regarding new insights on therapeutics in rheumatoid arthritis. Methotrexate is considered the “anchor drug” due to its high efficacy as monotherapy and in combination with other conventional and targeted agents. Leflunomide and sulfasalazine are sound alternatives, whereas (hydroxy)chloroquine is primarily used in combination with other csDMARDs.Their use is encouraged in all treatment phases – in combination with targeted agents, and with other csDMARDs. Combining different csDMARDs is especially attractive in lower income settings given the evidence proving (almost) equal efficacy and safety of the csDMARD combination approach compared to the combination of targeted agents with a csDMARD.The aim of this review is to provide a clinically oriented insight into the pharmacology of each csDMARD and their place in treatment algorithms.     

体质指数和体脂百分比与类风湿关节炎继发骨质疏松的相关性研究

目的探讨体质指数(BMI)和体脂百分比(PBF)与类风湿关节炎(RA)继发骨质疏松(OP)间的相关性。方法采用生物电阻抗体成分测定法测量359例RA患者和158例年龄、性别相匹配的正常对照组体重(kg)、身高(m)和PBF,根据体重/(身高)2计算出BMI,并将BMI分为4组:消瘦BMI18.5,正常24BMI≥18.5,超重28BMI≥24,肥胖BMI≥28;PBF分为2组:肥胖为PBF男25%或女30%,否则为正常。采用双能X线骨密度吸收仪测定髋部(包括股骨颈Neck、Ward三角区、大转子GT、总髋部Hip)及腰椎1-4(L1-4)骨密度(BMD)。结果 RA患者BMI低于正常对照组(22.40±3.76 vs 23.66±3.24,t=3.813,P0.0001),其中消瘦患者百分比明显高于对照组(14.4%vs 5.8%,x~2=10.536,P=0.015);而PBF则高于对照组(32.45±10.38 vs 30.53±6.98,t=2.442,P=0.015)。RA患者OP发生率为37.9%(128/338),明显高于对照组的13.9%(22/158)(x~2=29.265,P0.0001)。RA患者不同BMI分组间各部位BMD均有显著不同,且都表现为消瘦组水平更低,超重或肥胖组水平更高(P0.0001～0.05);除Ward区的PBF正常组BMD高于肥胖组(t=2.224,P=0.027)外,其余各部位BMD均无明显差别(P0.05)。Hip区和L1-4区均表现为消瘦组OP发生率(27.8%、20.7%)明显高于肥胖组(3.7%、1.1%)(x~2=22.041,P=0.001;x~2=13.401,P=0.037)。不同PBF分组间骨量构成比的比较无差别(P0.05)。各部位BMD均与BMI成正直线相关(P0.0001～0.01);而Ward、GT、Hip区BMD与PBF成负直线相关(P=0.015～0.04)。多元Logistic回归分析结果显示:年龄(OR=1.114,95%CI:1.082～1.148,P0.0001)、性别(OR=5.802,95%CI:2.608～12.906,P0.0001)和病程(OR=1.050,95%CI:1.017～1.084,P=0.003)均为RA患者发生OP的危险因素,而BMI(OR=0.879,95%CI:0.815～0.946,P=0.001)为发生OP的保护因素。结论 BMI和PBF在RA中变化不同,且呈现出与BMD相反的相关性,BMI是RA患者发生OP的保护因素。     

427例类风湿关节炎患者骨质疏松阳性率分析

目的分析类风湿关节炎(rhuematoid arthritis,RA)患者骨质疏松症(osteoporosis,OP)的阳性率。方法回顾性分析近3年在解放军南京总医院接受双能X线吸收法(dual energy X-ray absorptiometry,DXA)检查的RA患者骨密度(bone mineral density,BMD)资料,DXA检测的部位包括腰椎L_(1～4)、左股骨颈和左全髋,以T值、Z值最低处作为诊断,并与同期体检人群进行对照。分别统计两组中骨量正常、低骨量、骨质疏松及严重骨质疏松的检出率,以及各检测部位BMD值,分析两组各部位BMD随年龄变化特点。结果 RA患者427例,骨量正常者占40.7%(174/427),低骨量者占34.0%(145/427),骨质疏松者占19.7%(84/427),严重骨质疏松者占5.6%(24/427);对照组人群1343例,骨量正常者占57.6%(773/1343),低骨量者占34.0%(456/1343),骨质疏松者占7.6%(102/1343),严重骨质疏松者占0.9%(12/1343)。经χ~2检验,两组人群BMD检测结果分布不同,差异有统计学意义(χ~2=97.673,P=4.918E-21),RA组BMD异常率明显高于对照组(χ~2=36.794,P=1.313E-9)。RA组腰椎L_(1～4)、左股骨颈、左全髋BMD较对照组均明显降低,差异有统计学意义。该现象在40～79岁年龄段的RA患者中尤为显著;随着年龄的增长,与对照组相比,40岁以上的RA患者左股骨颈、左全髋BMD的下降趋势尤为明显。结论 RA患者骨质疏松阳性率较高,40岁以上的RA患者随着年龄的增长BMD下降尤为明显,应尽早进行DXA检查并定期随访,积极防治OP及其并发症。     

类风湿关节炎继发骨质疏松症相关影响因素的Logistic回归分析

目的探讨类风湿关节炎患者继发骨质疏松症(osteoporosis,OP)的情况及相关影响因素。方法选择80例类风湿关节炎(rheumatoid arthritis,RA)患者,采用双能X线骨密度仪测定前臂、腰椎L1～4、股骨颈、Ward’s区的骨密度(bone mineral density,BMD),根据BMD将患者分为骨量正常组35例、骨量减少组26例和骨质疏松组19例。采用放射免疫法测定骨代谢指标,包括骨钙素(osteocalcin,OC)、Ι型胶原交联蛋白羧基末端肽(sputum collagen cross-linking protein carboxy terminal peptide,SCTX)、骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP),并同时测定RA患者相关指标,包括C反应蛋白(Creactive protein,CRP)、类风湿因子(rheumatoid factor,RF)、血沉(erythrocyte sedimentation rate,ESR)。采用Logistic回归分析RA患者继发骨质疏松症的影响因素。结果女性、骨折史、老龄、使用糖皮质激素史、病程、RF为RA继发OP的危险因素,体重指数为RA继发OP的保护因素。结论性别、年龄、使用糖皮质激素史和既往骨折史为RA患者继发骨质疏松症的显著影响因素,且骨质疏松的严重程度与病程长短、疾病活动程度等有关。     

Reduction of bone mineral density in rheumatoid arthritis: A longitudinal study

In the last decade, more accurate quantitative methods to assess bone mass in vivo have become available. We have applied these techniques to assess periodic changes of bone loss in rheumatoid arthritis (RA) patients. In this longitudinal study, 132 female RA patients were divided into two groups. The first group of 90 patients were postmenopausal, with a mean age of 60.2 years (PM group), whereas the second group of 42 patients were premenopausal, with a mean age of 42.7 years (M group). The clinical courses of these patients were followed for an average of 3 years. Bone mineral density (BMD) in the lumbar spine (L2–L4), and the femoral neck were measured by dual-energy X-ray absorptiometry (DXA), and second metacarpal bone mineral density was measured by using densitometric techniques periodically. Reduction of BMD in the lumbar spine was significant in both groups (P<0.01–0.05), but there was no statistical difference between the two groups. The BMD of the femoral neck had a tendency to decrease but this was not significant. The predictors for periodic bone loss in the PM group were aging and nutritional factors, whereas for the M group they were indices of rheumatoid arthritis disease activity.     

Risk factors for vertebral fracture in menopausal or postmenopausal Japanese women with rheumatoid arthritis: a cross-sectional and longitudinal study

The occurrence of vertebral fracture was examined cross-sectionally and longitudinally over a 4-year interval in 117 menopausal and postmenopausal Japanese women with rheumatoid arthritis (RA), whose ages ranged from 50 to 64 years. Patients treated with bisphosphonate were excluded. Vertebral fracture was diagnosed by lateral thoracic and lumbar spine radiography at the start and end of a 4-year period. Bone mineral density (BMD) at L2–L4 according to dual-energy X-ray absorptiometry (DXA), the administration of corticosteroids or methotrexate, and urinary excretion of N-telopeptide of type I collagen (NTx) were also recorded. In the cross-sectional study, the prevalence of vertebral fracture in the initial radiographs of RA patients was 21%, while it was 5% in healthy age-matched controls. Among RA patients treated with corticosteroids, 33% had vertebral fracture, which was a significantly higher prevalence than that in RA patients without steroid administration. In the longitudinal study, vertebral fracture prevalence was also increased in patients more than 60 years old. RA patients having steroid treatment and a BMD/YAM (young adult mean) ratio below 70% had higher risk of vertebral fracture than patients with a BMD/YAM ratio of 70%–80%, which in turn exceeded the risk with a BMD of 80% or more. No adverse effect of low-dose methotrexate on vertebral fracture was found. Urinary NTx was high in RA patients, as reported previously, and did not differ between patients with or without new fracture after 4 years. In conclusion, Japanese RA patients more than 60 years old who were treated with corticosteroid or had a BMD below 80% had high risk of vertebral fracture.     

FRAX评估类风湿关节炎患者骨折风险及相关临床危险因素的研究

目的运用FRAX探究中国RA患者骨折风险及相关临床危险因素。方法纳入52例RA、47例p SS以及41例体检健康者分别为RA组、p SS组、对照组,RA组患者检测ACPA、RF、ESR、CRP并计算DAS28-ESR、HAQ-DI,所有纳入者以双能X线吸收测定法测定骨密度并通过FRAX官方网站预估10年骨折风险。所有统计分析采用SPSS统计软件。结果 FRAX相关骨折危险因素包括身高、吸烟、饮酒、既往骨折、父母骨折,在3组间差异未见统计学意义。RA组糖皮质激素累积服用天数高于p SS组(P0.05)。通过FRAX无论是否结合骨密度评估,RA组主要骨质疏松性骨折风险及髋关节骨折风险均较对照组高(P0.01),主要骨质疏松性骨折风险亦较p SS组高(P0.05或P0.01)。通过FRAX结合骨密度评估,从年龄、糖皮质激素、绝经方面分析,RA组主要骨质疏松性骨折及髋关节骨折风险均较对照组高(P0.05或P0.01)。通过FRAX结合BMD评估RA组10年主要骨质疏松性骨折风险发生率分为低危、中危、高危组,ACPA、RF、ESR、CRP、DAS28-ESR、HAQ-DI在三组中均值呈上升趋势,差异均有统计学意义(P0.01)。结论 RA患者骨折风险评估可结合FRAX与骨密度;长期、大量服用糖皮质激素以及高龄、绝经后女性RA患者更应重视骨折风险评估;有效控制RA疾病活动度、改善关节功能情况有助于骨质疏松性骨折的预防。     

全程管理在类风湿关节炎患者脆性骨折中的应用研究

目的探讨疾病全程管理对类风湿关节炎(rheumatoid arthritis,RA)患者骨密度及脆性骨折发生率的影响。方法选取2013-2017年我科住院的RA患者108例,随机分为试验组54例(全程管理组)和对照组54例(常规管理组),随访1年,分别于基线时与12个月结束时测量腰椎、髋部及前臂骨密度,测定血清25-羟维生素D3水平,同时记录两组骨折发生情况。结果 (1)108例RA患者,合并脆性骨折者32例,发生率为29.6%,其中女性31例,男性1例;椎体骨折7例,非椎体骨折25例,足/踝骨折发生率最高(37.5%),其次为椎体骨折(21.9%);(2)RA患者中无脆性骨折和有脆性骨折患者在年龄、病程和糖皮质激素累积量上差异有统计学意义(P0.05或P0.01),而在DAS28和糖皮质激素使用时间上差异无统计学意义(P0.05),合并脆性骨折的RA患者股骨颈及前臂的骨密度低于无脆性骨折组,差异有统计学意义(P0.05),但两者间腰椎骨密度比较差异无统计学意义(P0.05)。(3)随访1年后,试验组股骨颈骨密度的增长显著高于对照组,差异有统计学意义(P0.05);(4)随访1年后,常规管理组患者新发骨折8例,发生率为14.8%,全程管理组患者新发骨折1例,发生率为1.9%,显著低于常规管理组患者,差异有统计学意义(P0.05)。结论与常规管理相比,全程管理可显著增加RA患者骨密度,并降低RA患者脆性骨折的发生率,具有一定的临床价值。     

Bone mineral density and urolithiasis interaction in rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic inflammatory disease with extraarticular manifestations involving many organs. Both urinary stone formation and bone mineral density (BMD) can be affected by calcium (Ca) metabolism changes in RA. We aimed, in our study, to investigate the incidence of urolithiasis in adult RA patients and to identify the BMD characteristics of stone-forming RA patients. Seventy-nine RA patients and 35 control subjects participated in our study. None had a known renal disease, except for urolithiasis. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), rheumatcoid factor (RF), and C-reactive protein (CRP) were recorded. Twenty-four-hour urinalysis, as well as plain X-ray, ultrasound imaging, and BMD measurements with dual-energy X-ray absorptiometry (DEXA) were performed. T scores more than 1 SD below the mean value were accepted as low BMD. There was no statistically significant difference between urinary stone incidence in RA patients and controls. There was a significant difference between BMD values in RA patients with and without urinary stone disease. The low T scores of stone-forming RA patients may be explained by the additive effect of two coexisting diseases, both shown to be related to low bone mass. From another point of view, both BMD loss and urolithiasis can be consequences of altered Ca metabolism in RA. So we suggest that RA patients with urolithiasis should be evaluated for BMD, and that RA patients with low BMD be evaluated for urolithiasis.     

重庆地区围绝经期与绝经后妇女骨密度及身体成分相关指标分析

目的 调查重庆地区围绝经期与绝经后妇女(5~10年）骨密度及相关身体成分指标,分析身体成分指标与骨密度的关系,为本地区骨质疏松的防治提供线索。方法 ①选取2017年于本院进行健康体检年龄≥45岁的妇女956名(排除相关原发疾病）,其中围绝经期510名,绝经后446名,并分别记录身高、体重,计算出体质量指数(body mass index, BMI）;②使用美国GE公司双能X线骨密度仪测定受试者腰椎1~4、左侧股骨颈、大转子、股骨干、全髋的骨密度以及全身脂肪、肌肉含量与骨矿含量。结果 一般情况分析发现,重庆地区围绝经期妇女身高明显高于绝经后妇女［分别为(156.81 ± 5.27) cm、(153.32 ±5.51) cm］,而体质量指数无明显差异。 绝经后妇女肌肉含量(37.91 ± 6.42) kg、脂肪含量(17.84 ± 2.16) kg、骨矿含量(1.58±0.41) kg均较围绝经期妇女 [(37.88 ± 6.15) kg、(19.21 ± 2.07) kg、(1.75±0.20) kg ]降低。绝经后妇女诊断骨质疏松与低骨量的比例分别为28.92%、41.03%,高于围绝经期妇女低骨量的发生率(28.63%)。围绝经期妇女腰椎1~4和左侧股骨颈、大转子、股骨干及全髋骨密度 (bone mineral density, BMD)明显高于绝经后妇女［分别是(1.0 959 ± 0.1 603) g/m2和(0.8 410 ± 0.1 606) g/m2,(0.8 178 ± 0.1 577) g/m2和(0.7 872 ± 0.1 585) g/m2,(0.6 946 ± 0.1 252) g/m2和(0.6 728±0.1 274) g/m2,(1.0 329 ± 0.1 712) g/m2和(1.0 030±0.1 737) g/m2,(0.8 773 ± 0.1 448) g/m2和(0.8 495 ± 0.1 478) g/m2］。结论 绝经后妇女髋部、腰椎等部位BMD均较围绝经期妇女明显降低;骨质疏松及低骨量的发生率随年龄增加显著升高;和围绝经期妇女相比,绝经后妇女全身脂肪含量偏低;BMD与全身肌肉含量呈正相关性。     

云克治疗类风湿关节炎患者合并骨质疏松的临床疗效观察

目的分析云克治疗类风湿关节炎(rheumatoid arthritis,RA)患者合并骨质疏松的临床疗效。方法选取我院2019年1月1日至2019年3月31日住院接受云克治疗的RA患者49名及未接受云克治疗的RA门诊患者30名并随访一年,收集患者临床资料。结果两组患者基线临床资料年龄、病程、体质量指数、晨僵时间、疼痛评分、ESR、CRP、RF、骨密度、关节肿胀及压痛数目差异无统计学意义(P0.05)。使用云克治疗的研究组患者在治疗1年后各项临床指标均低于对照组(P0.05)。研究组经云克治疗后12个月骨密度有所改善(P0.05),而对照组治疗前后腰椎及髋部BMD对比差异无统计学意义(P0.05)。结论云克治疗类风湿关节炎合并骨质疏松不仅有良好的抗炎效果,亦可增加骨密度、抗骨质疏松。