Association of Low Bone Mineral Density with Anti-Citrullinated Protein Antibody Positivity and Disease Activity in Established Rheumatoid Arthritis: Findings from a US Observational Cohort

Abstract

IntroductionTo assess the relationship between low bone mineral density (BMD), anti-cyclic citrullinated peptide-2 (anti-CCP2) antibodies, and disease activity in patients with established rheumatoid arthritis (RA).MethodsPatients enrolled in a single-center, observational cohort registry of patients with RA. Eligible patients had known BMD, as measured by digital X-ray radiogrammetry (DXR–BMD), and anti-CCP2 antibody measurements at the same time point or within 6 months. Anti-CCP2–immunoglobulin (Ig)G-positive (+) patients (≥ 20 U/mL) were distributed into three equal groups (Gp1–3), representing increasing anti-CCP2 antibody concentrations. Associations between BMD and anti-CCP2 antibody status and titer were explored in multivariate regression analyses controlling for covariates (including age, duration of RA, use of steroids, use of osteoporosis medication). Association between disease activity (DAS28 [CRP] < 2.6) and bone loss was also explored.ResultsA total of 149 patients (all women) were included (47 anti-CCP2 antibody negative [−], 102 anti-CCP2+ [34\titer group]). Mean disease duration was greater in the three anti-CCP2+ groups vs. the anti-CCP2− group. DXR–BMD was lower in the anti-CCP2+ vs. the anti-CCP2− groups (Gp1–3 vs. anti-CCP2−: P < 0.0001 for left and right hands). DXR–BMD decreased with increasing anti-CCP2 titer (P < 0.001 for left and right hands). Patients with low DXR–BMD were less likely to have a DAS28 (CRP) < 2.6 (P = 0.0181).ConclusionAmong patients with established RA, data suggest that anti-CCP2+ patients, particularly those with high anti-CCP2 antibody titers, have lower hand BMD, and patients with lower hand BMD are less likely to have low disease activity.FundingBristol-Myers Squibb.Trial RegistrationClinicaltrials.gov identifier, NCT01793103.Electronic supplementary materialThe online version of this article (10.1007/s12325-017-0657-x) contains supplementary material, which is available to authorized users.

Establishment and verification of an osteoporosis risk model in patients with rheumatoid arthritis: a valuable new model

“…This indicates that there was a correlation between disease activity and bone loss. Bone mineral density loss occurs in the early stage of RA and increases with the increase of disease activity, which is consistent with the research viewpoints of many scholars [ 16 , 17 ]. Research shows that the CRP and ESR values of the osteoporosis groups were higher than the non-osteoporosis group, and there was a moderate correlation with osteoporosis, but CRP and ESR were not independent predictors of osteoporosis; the research of Tomizawa and other scholars also confirm this point [ 18 ].…”

Prevalence and Risk Factors for Bone Loss in Rheumatoid Arthritis Patients from South China: modeled by three methods

“…Sabbagh et al [31] found that the inadequate Vitamin D status has a considerably strong association with disease activity in RA cases, and active RA with anti-CCP positivity was associated with lower BMD [32]. Our nding was similar partially, which indicated the need for proper evaluation of Vitamin D status in these patients to ensure the intake of the recommended amount of Vitamin D, but positive anti-CCP was not associated with bone loss in our study.…”

Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons

“…Regarding this topic, there is evidence that measurement of BMD by dual X-ray radiogrammetry (DXR) at metacarpal diaphysis in the non-dominant hand of RA patients is associated with disease progression, appearance of bone erosions and even, in some studies, with increased mortality (84,85). In addition, DXR is a very sensitive procedure to detect loss of BMD in the hand, which in long-standing RA has been associated with high titers of autoantibodies, mainly ACPA, radiographic progression and the appearance of erosions (86).…”