LOW BONE MINERAL DENSITY AMONG PATIENTS WITH NEWLY DIAGNOSED RHEUMATOID ARTHRITIS

Authors

  • Shafique Rehman Arain Liaquat National Hospital. Karachi.
  • Amir Riaz Department of Rheumatology, Liaquat National Hospital, Karachi
  • Lubna Nazir Department of Rheumatology, Liaquat National Hospital, Karachi
  • Tahira Parveen Umer Department of Rheumatology, Liaquat National Hospital, Karachi

Abstract

Background: Osteoporosis is an early and common feature in rheumatoid arthritis. Apart from other manifestations, Osteoporosis is an extra-articular manifestation of rheumatoid arthritis which may result in increased risk of fractures, morbidity, mortality, and associated healthcare costs. This study evaluates bone mineral density changes in patients with rheumatoid arthritis of recent-onset. Methods: This descriptive case series was conducted in the Rheumatology Department of a tertiary care hospital in Karachi. Data was prospectively collected from 76 patients presenting with seropositive or seronegative rheumatoid arthritis. Bone mineral density of these patients measured at lumbar spine and hip by using dual energy x-ray absorptiometry scan. Variables like age, gender, BMI, menstrual status, disease duration, erythrocyte sedimentation rate, vitamin D level, clinical disease activity index and seropositivity for rheumatoid arthritis were measured along with outcome variables. Results: A total of 104 patients fulfilling inclusion criteria were registered with 28 excluded from study.  Among the remaining 76 patients, 68 (89.50%) were female, with mean age of patients (with low bone mineral density) as 50.95±7.87 years. Nineteen (25%) patients had low bone mineral density, 68.52% had low BMD at spine while 10.52% at hip and 21.05% at spine and hip both. Low bone mineral density was found higher in patients with seronegative 7 (50%) as compared to seropositive patients 12 (19.4%) (p-value 0.017), whereas low bone mineral density was found higher 12 (70.6%) among post-menopausal women. Conclusion: Low BMD was found in 25% of patients at earlier stage of the rheumatoid arthritis with seropositivity, age and menopausal status as significant risk factors. 

Author Biography

Shafique Rehman Arain, Liaquat National Hospital. Karachi.

Department of Rheumatology.Fellow Rheumatology.

References

Sarkis KS, Salvador MB, Pinheiro MM, Silva RG, Zerbini CA, Martini LA. Association between osteoporosis and rheumatoid arthritis in women: a cross-sectional study. Sao Paulo Med J 2009;127(4):216–22.

Sambrook PN. The skeleton in rheumatoid arthritis: common mechanism for bone erosion and osteoporosis? J Rheumatol 2000;27(11):2541–2.

Gough AK, Lilley J, Eyre S, Holder RL, Emery P. Generalized bone loss in patients with early rheumatoid arthritis. Lancet 1994;344(8914):23–7.

Böttcher J, Pfeil A. Diagnosis of periarticular osteoporosis in rheumatoid arthritis using digital X-ray radiogrammetry. Arthritis Res Ther 2008;10(1):103.

Xu S, Wang Y, Lu J, Xu J. Osteoprotegerin and RANKL in the pathogenesis of rheumatoid arthritis-induced osteoporosis. Rheumatol Int 2012;32(11):3397–403.

Vosse D, de Vlam K. Osteoporosis in rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol 2009;27(4 Suppl 55):S62–7.

Gonzalez-Lopez L, Gamez-Nava JI, Vega-Lopez A, Rodriguez-Jimenez NA, Gonzalez-Montoya N, Aguilar-Chavez E, et al. Performance of risk indices for identifying low bone mineral density and osteoporosis in Mexican Mestizo women with rheumatoid arthritis. J Rheumatol 2012;39(2):247–53.

Heberlein I, Demary W, Bloching H, Braun J, Buttgereit F, Dreher R, et al. Prophylaxis and treatment of osteoporosis in patients with rheumatoid arthritis (ORA study). Z Rheumatol 2011;70(9):793–8,800–2.

Mobini M, Kashi Z, Ghobadifar A. Prevalence of associated factors of osteoporosis in female patients with rheumatoid arthritis. Caspian J Intern Med 2012;3(3):447–50.

Bayat N, Hajiamini Z, Alishiri Gh, Paydar M, Ebadi A, Parandeh A, et al. Risk factors of low bone mineral density in premenopausal women. J Mil Med 2010;12(1):1–6.

Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Reduced bone mineral density in male Rheumatoid arthritis patients: frequencies and associations with demographic and disease variables in ninety-four patients in the Oslo County Rheumatoid Arthritis Register. Arthritis Rheum 2000;43(12):2776–84.

Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 Rheumatoid Arthritis Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010;62(9):2569–81.

Anderson J, Caplan L, Yazdany J, Robbins ML, Neogi T, Michaud K, et al. Rheumatoid Arthritis Disease Activity Measures: American College of Rheumatology Recommendations for Use in Clinical Practice. Arthritis Care Res (Hoboken) 2012;64(5):640–7.

Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO study group. Osteoporos Int 1994;4(6):368–81.

2015 ISCD Official Positions - Adult - International Society for Clinical Densitometry (ISCD) [Internet]. [cited 2015 Nov 20]. Available from: http://www.iscd.org/official-positions/2015-iscd-official-positions-adult/

van der Weijden MA, van Denderen JC, Lems WF, Heymans MW, Dijkmans BA, van der Horst-Bruinsma IE. Low bone mineral density is related to male gender and decreased functional capacity in early spondylarthropathies. Clin Rheumatol 2011;30(4):497–503.

Moula K, Esfehani A. A study of the bone density of rheumatoid arthritis patients in khoozestan province. J Shaheed Sadoughi Univ Med Sci 2002;10(3):8–12.

Yoon J, Kwon SR, Lim MJ, Joo K, Moon CG, Jang J, et al. A comparison of three different guidelines for osteoporosis treatment in patients with rheumatoid arthritis in Korea. Korean J Intern Med 2010;25(4):436–46.

Curtis JR, Arora T, Donaldson M, Alarcon GS, Callahan LF, Moreland LW, et al. Skeletal health among African Americans with recent-onset rheumatoid arthritis. Arthritis Rheum 2009;61(10):1379–86.

Güler-Yüksel M, Bijsterbosch J, Goekoop-Ruiterman YP, de Vries-Bouwstra JK, Ronday HK, Peeters AJ, et al. Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis. Ann Rheum Dis 2007;66(11):1508–12.

Reid IR, Plank LD, Evans MC. Fat mass is an important determinant of whole body bone den¬sity in premenopausal women but not in men. J Clin Endocrinol Metab 1992;75(3):779–82.

Lanyon L, Skerry T. Postmenopausal osteoporosis as a failure of bone’s adaptation to func¬tional loading: a hypothesis. J Bone Miner Res 2001;16(11):1937–47.

Chung CP, Russell AS, Segami MI, Ugarte CA. The effect of low-dose prednisone on bone mi¬neral density in Peruvian rheumatoid arthritis patients. Rheumatol Int 2005;25(2):114–7.

Hafez EA, Mansour HE, Hamza SH, Moftah SG, Younes TB, Ismail MA. Bone mineral density changes in patients with recent-onset rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord 2011;4:87–94.

Sarkis KS, Salvador MB, Pinheiro MM, Silva RG, Zerbini CA, Martini LA. Association between osteoporosis and rheumatoid arthritis in women: a cross-sectional study. Sao Paulo Med J 2009;127(4):216–22.

Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LM, Vieira JG, Maeda SS, et al. Prevalence of vitamin D deficiency, insuffi¬ciency and secondary hyperparathyroidism in the elderly inpatients and living in the com¬munity of the city of São Paulo, Brazil. Arq Bras Endocrinol Metabol 2007;51(3):437–42.

Published

2016-03-10

Issue

Vol. 28 No. 1 (2016): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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