| BackgroundRheumatoid arthritis(RA)is a kind of unknown etiology autoimmune disease which characterized by chronic arthromeningitis of inflammatory,bone and joint damage is the main characteristics of disease,chronic arthromeningitis eventually lead to the bone loss/erosion,at the same time also can cause systemic osteoporosis(OP).OP is a systemic osteopenia and bone microstructure degradation associated with reduced bone strength.Increased risk of fractures or osteoporotic fractures(OPF)is the most serious consequences in the OP,hip and spine are common sites and severe OPF,and the incidence of death or disability caused by various complications within 1 year after fracture is significantly increased,making the survival and prognosis of RA patients worse.Obesity has become a global problem,it is due to long-term excess energy intake,more than the body consumption,causing excessive accumulation of body fat to the extent of damage to health.An increasing number of epidemiological studies have shown that obesity,metabolic syndrome,diabetes and bone mineral density(BMD)decrease are associated with OP.In recent years,China has entered an aging society,and many age-related diseases have been paid more and more attention.Sarcopenia originally refers to a lack of muscle.In 1989,Irwin first used to describe Sarcopenia and reduced strength in old age.In 2010,EWGSOP defined it as a disease that can reduce skeletal muscle quality and skeletal muscle strength and function in old people,which mainly emphasizes decreased skeletal muscle mass,or reduced skeletal muscle strength,or reduced skeletal muscle function.Ye ting et al.mentioned that sarcopenia and OP are age-related declines in the quantity and quality of muscles and bones,which have the same pathophysiological basis and have the same adverse effects on the health of the elderly,It is suggested to combine the two as dysmobility syndrome.Currently,most studies have pointed out that the incidence of OP and OPF in patients with RA is significantly higher than that in healthy control group,which is mostly related to age,RA disease activity,local bone erosion,etc.,but the correlation with obesity and motor system disorder syndrome is rarely mentioned.This research aims to study the effect of obesity and dysmobility syndrome on OPF in RA by evaluation of patients with RA disease activity,BMD measurement for determining the occurrence of OP,X ray film examination to make sure the spine OPF,calculation of RA patients with BMI,measuring limb muscle mass and determine the presence of less muscle disease.Obesity and movement disorder syndrome in RA with spinal OPF is the purpose of study and the link between each other is also investigated,as to provide theoretical basis for clinical targeted prevention and control.objectiveTo investigate the effect of obesity and dysmobility syndrome on the occurrence of spinal OPF in patients with RA.MethodThe research objects involved a total of 389 RA patients hospitalized from the Department of Rheumatology,First Affiliated Hospital of Anhui Medical University from January 2015 to December 2017 and 156 age-and sex-matched normal persons(control group).The diagnosis of all RA patients fulfilled tne ACR classification criteria for RA in 1987 and 2009.DEXA method is used to measure BMD of lumbar spine and hip in RA patients and control group,and bioelectrical impedance method is applied to determine skeletal muscle mass of limbs,etc.Meanwhile,the general information of RA patients were also recorded in detail including age,sex,height,weight,clinical and laboratory indicators.Result(1)Occurrences of obesity in RA patients and control group.The comparison of median BMI between 389 patients with RA and 156 normal controls showed that the average BMI of RA patients was lower than that of control group[21.97(19.53-24.75)vs 23.47(21.69-26.03),z=4.401,P<0.0001].There were significant differences in the composition ratio of different BMI groups between the two groups(x~2=13.968,P=0.003).(2)Comparison of BMD and OP among RA patients and control group.BMD of all test sites in RA patients was significantly lower than that in the control group(P<0.0001);The incidence of total OP and all measured OP in RA group was significantly higher than that in control group(P<0.0001).(3)Comparison of the incidence of spinal OPF between RA and normal group.A total of 84 patients with RA developed spinal OPF,with an incidence of 21.6%,the incidence was 3.8%higher than that in the control group(6/156)(x~2=25.439,P<0.0001)?(4)Comparison of the incidence of sarcopenia between RA and control group.The incidence of sarcopenia in 389 RA patients was 54.8%,significantly higher than that in the control group(9.6%,15/156),and the difference between the two groups was statistically significant.According to the composition ratio of the two groups with or without OP and sarcopenia,the incidence of both OP and sarcopenia in the RA group(28.5%)was significantly higher than that in the control group(5.8%),and the difference was statistically significant(x~2=118.110,P<0.0001).(5)Comparison of the incidence of total OP and OP at each measurement site between different BMI groups in RA patients.Comparison of the total OP incidence among RA patients with different BMI groups showed that the difference was statistically significant(x~2=13.080,P=0.042),the incidence of total OP decreased gradually with the increase of BMI(x~2=13.815,P=0.032);In addition to L4,the comparison of OP incidence at all measured sites among RA patients with different BMI groups showed a statistically significant difference(P<0.05-0.0001),the OP incidence of all measured sites(including L4)decreased gradually with the increase of BMI(P<0.05-0.0001).(6)Comparison of the incidence of spinal OPF in RA patients with different BMI groups.Comparison of spinal OPF incidence among RA patients with different BMI groups showed no statistically significant difference(x~2=1.778,P=0.620).(7)Comparison of the incidence of spinal OPF in RA patients with different bone mass groups.Comparison of the incidence of spinal OPF in RA patients with different bone mass(normal bone mass,reduced bone mass,osteoporosis)showed that,the incidence of spinal OPF in each group was statistically significant(x~2=43.373,P<0.0001),and the incidence of spinal OPF increased with the decrease of bone mass(x~2=43.003,P<0.0001),the above statistics were corrected by BMI,and there were still significant differences in the incidence of OPF among the groups(P=0.054 in the wasting group and P<0.05-0.0001 in the other groups),and there was still a trend of gradually increasing the incidence of OPF in the spine with the gradual decrease of bone mass(P=0.053 in the wasting group and P<0.05-0.0001 in the other groups).(8)Comparison of the incidence of spinal OPF in RA patients with and without sarcopenia.The incidence of spinal OPF in RA patients with sarcopenia(27.2%,58/213)was significantly higher than that in RA patients without sarcopenia(14.8%,26/176,x~2=8.833,P=0.003).After adjusting for BMI,when BMI was normal and obese,the incidence of spinal OPF in RA patients in the group with sarcomatosmia was still higher than that in the group without sarcomatosmia,with statistically significant differences(P=0.006 in the normal group,P=0.043 in the obese group,and P>0.05 in the other groups).(9)Synergistic effect of dyskinesia syndrome on the incidence of spinal OPF in RA patients.According to the OP and if there are less muscle disease,all participants were divided into the following four groups:normal,1=no OP also no muscle,less 2=less pure muscle disease,3=pure OP,4=OP and muscle at the same time there is a sport disorder syndrome,less incidence of RA patients with spine OPF comparison between the four groups,according to the difference was statistically significant(x~2=41.078,P<0.0001),and from group 1 to 4 group,the incidence of spinal OPF has a tendency to increased gradually(x~2=43.373,P<0.0001).As mentioned in 2.7 as a result,different bone mass in patients with RA(normal bone mass,bone loss,osteoporosis)grouping spinal incidence of OPF,according to the comparison between each group the difference of incidence of spinal OPF has significant statistical significance(x~2=43.373,P<0.0001),the above statistics using the correction have less muscle disease,according to the results in no muscle,less disease group and have less muscle disease group,different bone mass in patients with RA(normal bone mass,bone loss,osteoporosis)grouping incidence of spinal OPF comparison between all have significant statistical significance(x~2=20.955,P<0.0001;x~2=17.186,P<0.0001),and the incidence of spinal OPF gradually increased with the decrease of bone mass(x~2=18.265,P<0.0001;x~2=17.650,P<0.0001).(10)Comparison of the incidence of spinal OPF between different disease courses and different gender RA patients.There was no significant difference in the incidence of spinal OPF in RA patients with different disease courses and different genders(P>0.05).(11)Comparison of the incidence of spinal OPF in patients with RA with different disease activity levels.RA patients were divided into the following three groups according to different disease activity levels:low disease activity level:DAS28<3.2;moderate disease activity level:3.2?DAS28?5.1;high disease activity level:DAS28>5.1(40.0%,6/15 vs 19.0%,26/137 vs 21.5%,46/214;x~2=3.573,P=0.168).(12)Comparison of disease activity indicators in RA patients with and without spinal OPF group.The average age of RA patients with spinal OPF was higher(P<0.0001),the course of disease was longer(P=0.002),the SMI was lower(P<0.0001),the HAQ was worse(P=0.001),and the ambido Sharp score was higher(P=0.002),the other indicators showed no significant difference between the two groups(P>0.05).Presence of spinal joint function in patients with RA between the OPF groups(?:?:?:?)constitute than comparison(4:40:33:7 vs 39:181:76:8),difference have significant statistical significance(x~2=15.822,P=0.001).(13)Comparison of incidence of obesity,OP,muscular dystrophy,and spinal OPF in RA patients with or without GC.RA patients in the GC group had a higher incidence of sarcomatosis(x~2=7.136,P=0.008),OP(x~2=10.900,P=0.004),and spinal OPF(x~2=20.673,P<0.0001),as shown in figure 20.However,there was no significant difference in BMI composition between RA patients in the GC group or not(32:126:48:15 vs 30:84:44:10,x~2=2.463,P>0.05).(14)Multivariate logistic regression analysis of spinal OPF in RA patients.Advanced age,the presence of GC and OP were risk factors for spinal OPF in RA patients(P<0.01-0.0001),while SMI was a protective factor for spinal OPF in RA patients(P=0.016).conclusion(1)The incidence of sarcopenia,OP and spinal OPF in RA patients was higher than that in the normal control group.(2)Advanced age,the presence of GC and OP were risk factors for spinal OPF in RA patients,while SMI was a protective factor for spinal OPF in RA patients. |
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