The Clinical Study On The Osteoporosis Of Rheumatoid Arthritis Patients

objective To study on the changes in bone mineral density(BMD)and the prevalenceof osteoporosis(OP)in patients with rheumatoid arthritis(RA)，and the effects ofrelated clinical factors．Methods Bone BMD of femur(femur neck，Ward area，greatertrochanter) and lumbar spine2-4(L2-4) by Dual-Energy X-ray Absorptiometry（DEXA）was measured in56patients with RA, and all the clinical and laboratoryfactors of RA were recorded in details，such as functional status，X-ray status andassessed by Sharp’ method，the number of tender or swollen joints and DSA28score，platelets（PLT）、C-reactive protein(CRP)、erythrocyte sedimentation rate(ESR)、rheumatoid factor(RF)、 anti-keratin anti-body(AKA)、 cyclic citrullinatedpeptides(CCP)、calcium(Ca)、phosphorus(P)，and C-terminal Telopeptides of Type Icollagen（CTX）、N-terminal procollagen I propeptides（PINP），N-end of osteocalcin（N-MID）、25（OH）D3were also measured the meantime. Results：The incidentrates of normal BMD，low BM and osteoporosis are21.43％，32.14％，46.43％respectively in56RA patients，which indicate the significant low BM in RA patients；there are significant differences in OP and non-OP group in terms of age(P＜0.05)，course of disease(P＜0.05)，β-CTX（P＜0.05），25（OH）D3（P＜0.05），functionalstatus（P＜0.05），X-ray status （P＜0.05）、bone erosion（P＜0.01）、bone narrow（P＜0.01）、Sharp score（P＜0.01）and there are no significant differences on thenumber joint tenderness，swollen joint、DSA28score and RF、AKA、CCP、ESR、CRP、 Ca、 P in RA patients． There is significant difference in the incidentrates(X~2=8.184， P=0.004， OR=5.492)， spine and femur BMDs(P=0.000) ofglucocorticoid and non-glucocorticoid groups of RA patients．The incident rate of OPin small-dosed-glucocorticoid group is higher than non-small-dosed-glucocorticoidgroup(X~2=5.384，P=0.020，OR=5.625)，long-term group is higher than short-term group(X~2=6.348，P=0.012，OR=6.800)．There is no significant differences indisease-Modifying anti-rheumatic drugs（DMARDs）-group and non-DMARDs-group in terms of OP(X~2=0.919，P=0.338)．Conclusion Multi-location BM lost andosteoporosis are more pronounced in RA patients，and there is correlation relationshipwith the patients’ age、history、β-CTX、25（OH）D3、functional status、X-ray status、bone erosion and narrow， and glucocorticoid administration， and there is nosignificant relationship with DMARDs administration．In our study，we suggest that，the diagnosis of RA should be combined with BMD testing and Bone metabolic-indexmeasuring，in order to come out with BMC and bone metabolism，and osteoporosisshould be early detected、early prevent and early treat during the RA patients．...