The Clinical Study On Bone Mineral Density In Female Patients With Rheumatoid Arthritis

Objection:To investigate the changes of bone mineral density in female patients with rheumatoid arthritis,and relationship with the clinical data and laboratory indexes.Method: Two hundred and thirteen female patients with rheumatoid arthritis(RA) were recruited from Septemper 2013 to November 2014 in our hospital,who were diagnosed as having RA as defined by 2009 ACR/EULAR criteria, aged from 40 to80 years were qualified into the study. Through dual-energy X-ray absorptiometry(DEXA), bone mineral density measurements of the lumbar spine(L1-L4) and left femoral neck and total hip were executed. The clinical information and blood samples of all the patients were collected, such as age, body mass index, swollen joint counts and tender joint counts, the 28-joint Disease Activity Score,use of glucocorticoid and methotrexate or not, rheumatoid factor, cyclic citrullinated peptides, erythrocyte sedimentation rate(ESR), C-reactive protein, platelets,tartrate-resistant acid phosphatase(TRACP-5b), bone alkaline phosphates(BAP) were measured the meantime.The level of interleukin-6 and 25 hydroxy vitamin D in the peripheral blood of 80 RA patients(including 30 with osteoporosis,30 with osteopenia,20 with nomal).Result:1.There were statistical significance differences on age(P=0.000),disease duration(P=0.002),tender joint counts(P=0.040),DAS28(P=0.021) between OP and non-OP group in RA patients,while other clinical and laboratory parameters(ESR,P=0.059, CRP, P=0.061,swollen joint counts P=0.074,platelets,P=0.105;patients self-assessment,P=0.216; BMI,P=0.407)between the two groups had no obvious discrepancy.2.Analysis of binary logistic regression was executed to explore that age(OR=1.079,P=0.000,95%CI:1.047~1.111]、disease duration(OR=1.004,P=0.011,95%CI:1.001~1.008)、TJC(OR=1.054,P=0.049,95%CI:1.000~1.110)、DAS28(OR=1.350,P=0.035,95%CI:1.021~1.784)were risk factors for BMD in RA patients.3.There was significance difference in the occurrence rate of glucocorticoid andnon-glucocorticoid groups of RA patients(χ2=5.215,P=0.022),but different result was observed between MTX-group and non-MTX-group(χ2=1.773,P=0.183).4.Pearson correlation analysis displayed that the lumbar spine BMD and femoral neck BMD were negative correlated with BAP(r=-0.172,P=0.041;r=-0.197,0.019),TRACP were negative correlated with BMD of the lumbar spine(L1-L4), femoral neck and total hip,plasma levels of BAP,TRACP were higher in OP group than in non-OP group(P=0.040、0.015).5.Plasma levels of 25 OHD was postively related with BMD of lumbar spine(r=0.237,P=0.034),IL-6 were negative correlated with BMD of the lumbar spine,femoral neck and total hip(r=-0.374、-0.289、-0.382,P<0.05),25 OHD,IL-6 levels were different distribution between osteoporosis,osteopenia and the nomal groups in RA patients.In futher pairwise comparison,it was found that IL-6 levels increased with BMD decreased(P<0.017),compared to nomal group,plasma levels of 25 OHD was lower in osteoporosis or osteopenia group(P=0.010,0.007),there was no statistically significant difference between osteoporosis group and osteopenia group.6.Plasma 25 OHD level had no obvious correlation with disease activity indexes such as ESR,CRP,DAS28,however,IL-6 levels was postive correlation with CRP(P=0.009).Conclusion:1.OP was more prevalent in female patients with RA, the BMD were negatively correlated with age, disease duration, tender joint counts, DAS28, IL-6 levels;respectively, lumbar spine BMD was positively correlated with 25 OHD.2.Both BAP and TRACP-5b in peripheral level were respectively negative related with lumbar spine BMD, femoral neck BMD, total hip BMD.