Original Clinical Papers: Longitudinal Bone Mineral Density Changes in Early Rheumatoid Arthritis

Abstract

A prospective longitudinal study of patients with early RA was performed to examine the influence of disease duration, disease activity and physical activity on bone loss. Sixty-seven patients with non-steroid treated RA of less than 5 yr duration, including 16 patients with disease duration less than 6 months, had BMD measurements of the femoral neck and the lumbar spine over a 12-month period using dual energy X-ray absorptiometry. The BMD changes were compared with values from 72 control patients and were also correlated with serial measurements of disease activity (measured by the Stoke Index) and disability [measured by the Health Assessment Questionnaire (HAQ) score], at 3-monthly intervals over the 12-month period. No significant differences in BMD changes were found between RA patients and controls overall. Patients with disease duration of less than 6 months had significantly greater loss of BMD at the femoral neck (-3.9%, S.E.M. 1.5) than the remainder of the cohort (-0.2%, S.E.M. 0.7) (P = 0.02) and controls (-0.8%, S.E.M. 0.6). Lumbar spine BMD changes correlated with the initial Stoke Index (Rs-0.373, P = 0.01) but not mean Stoke Indices. There was no correlation of BMD changes with age or HAQ scores. These findings suggest that significant bone loss occurs within the first few months of disease in patients with RA.

Longitudinal study of hand bone densitometry in rheumatoid arthritis

“…RA is known to cause a generalized skeletal effect, with bone loss in the femoral neck and lumbar spine (7,8); however, a recent cross-sectional study has shown that changes in hand bone mass are more dramatic than changes at other sites (18), with a reduction in hand bone mineral density of 23%, as compared with 16% at the femoral neck and 11% at the lumbar spine (18). The loss of hand bone mass in patients with RA therefore appears to be a combined result of the generalized plus local effects of the disease.…”

“…Major etiologic factors leading to this bone loss include the direct effect of inflammatory mediators, decrease in physical activity, and corticosteroid treatment (3, 5,6). Recent longitudinal studies have shown significant generalized bone loss within the first few years of disease in patients with RA, which correlated with disease activity (7,8).…”

Measurement of Foot Bone Mineral Density in Rheumatoid Arthritis: Its Application and Clinical Relevance

“…Shenstone et al (29) reported correlation between BMD and HAQ score, and also showed relationship between lumbar BMD and baseline Stoke Index. The BMD loss was found to be higher in femur neck in early stages of the RA regardless of disease activity and functional loss.…”

Avaliação da composição corpórea e densidade mineral óssea em mulheres portadoras de artrite reumatóide

“…As nossas pacientes apresentaram um tempo médio de doença de 7,73 anos. A perda de massa óssea em coluna lombar e fêmur proximal é descrita em estudos longitudinais, porém a sua relação com o tempo de doença é, às vezes, controversa 22,23 . Nos pacientes cujo tempo de doença é maior que 6 a 12 meses, a perda óssea ocorre de forma mais lenta 22 …”