Bone Mineral Density in Female Patients with Rheumatoid Arthritis in Relation to Anti-Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor

Abstract

Background: Rheumatoid arthritis (RA) is an autoimmune disorder associated with a chronic inflammation, which can cause joint damage and extra-articular complications. Anti-citrullinated protein antibody (ACPA) positivity is accompanied by poor prognosis in RA, and testing for ACPA has become traditional practice in the context of RA diagnosis.Objective: The aim of the study was to estimate the prevalence of low bone mineral density (BMD) among female patients with RA using dual energy x-ray absorptiometry (DEXA), and to study the correlation between BMD & levels of anti-cyclic citrullinated peptide (anti-CCP) and RF in the studied cases. Patients and methods: The present study was a cross-section descriptive study that was conducted on eighty female patients with RA. All patients were subjected to assessment to the levels of anti-CCP and RF using ELISA. BMD was measured by DEXA. Results: Osteopenia and Osteoporosis at lumbar spine, femoral neck and distal end of radius showed statistically significant increase in +ve anti-CCP patients when compared to -ve anti-CCP patients. BMD at the lumbar spine, femoral neck and lower end of radius showed statistically significant decrease in +ve anti-CCP patients when compared to -ve anti-CCP patients. History of fragility fracture showed statistically significant increase in RA patients with +ve RF when compared to -ve RF patients. Conclusion: Bone loss and fragility fracture are common in RA and increased in seropositive RA, post-menopausal state and corticosteroids use. The presence of ACPA and RF are strongly predictive for the development of osteoporosis and erosions in RA patients. It would be a more appropriate approach to carefully monitor osteoporosis in seropositive RA.