Correlation between osteoporosis and bone erosionin in patients with early rheumatoid arthritis
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摘要: 目的 探讨早期类风湿性关节炎(RA)中骨质疏松(OP)与骨侵蚀的特点。 方法 收集安徽医科大学第一附属医院427例RA患者,其中早期RA(病程≤1年)139例,非早期RA 288例,427例RA患者均测其股骨和腰椎部骨密度(BMD),早期RA患者行双手X线摄片并进行分期,记录RA患者各临床指标和服用糖皮质激素(GC)等情况。收集158例正常人作为对照组。 结果 对照组OP发生率为13.9%,早期RA组为23.5%,非早期RA组为35.4%(χ2=24.84,P<0.001)。3组间各部位BMD均呈逐渐下降趋势且有统计学意义(P<0.05)。早期RA中OP组较无OP组有更高的年龄(P<0.05),而在GC的使用、RF、ESR、CRP、DAS28积分等指标的比较上差别无统计学意义(P>0.05)。早期RA中总股骨区、各腰椎部位BMD均与双手X线分期呈负相关(P<0.05),L3及L2~4部位BMD还与抗CCP呈负相关(P<0.05)。早期RA中骨侵蚀的发生率为13.7%,低于早期RA中OP的发生率(χ2=4.18,P=0.041)。早期RA中发生OP患者的平均病程为(0.59±0.35)年,短于发生骨侵蚀的平均病程(0.82±0.29)年(t=2.46,P=0.018)。 结论 早期RA即出现明显的OP,其发生率高于骨侵蚀,且早于骨侵蚀的发生,因此要重视OP在早期RA中的意义。Abstract: Objective To investigate the characteristics of osteoporosis(OP) and bone erosion in patients with early rheumatoidarthritis(RA). Methods A total of 427 patients with RA(including 139 early RA with disease duration less than 1 year and 288 non-early RA ).BMD of proximal femur and lumbar vertebrae were measured by dual energy X-ray absorptiometry(DEXA).The assessment of bone erosion by examination of hands X-ray in all early RA patients,meanwhile,clinical index and the treatment with glucocorticoid(GC) were recorded.Data of 158 normal people were collected as control group. Results The prevalence of OP in early RA and non-early RA were 23.5%,35.4%,while in control group was 13.9%(χ2=24.84,P<0.001).BMD sat different positions were decreased in all three groups(P<0.05).In the early RA,patients with OP had elder age as compared with the group without OP(P<0.05).There were no significant difference regarding the use of GC,RF,ESR,CRP and DAS28 scores between OP group and non-OP gorup(P>0.05).The BMD of total femoral area and lumbar spine were negatively correlated with the X-ray stage(P<0.05).The BMD of L2 and L2~4 were also negatively correlated with anti-CCP(P<0.05).The percentage of bone erosion was 13.7%,which was lower than that of OP(χ2=4.18,P=0.041) in the early RA.The average disease duration of early RA patients with OP was shorter than that in early RA patients with bone erosion(0.59±0.35 yr vs. 0.82±0.29 yr,t=2.46,P=0.018). Conclusion The patients with early RA show obvious OP which occurs earlier than bone erosion,and the incidence of OP is higher than bone erosion.We should pay more attentions to the occurrence of OP in early RA.
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Key words:
- Early rheumatoid arthritis /
- Osteoporosis /
- Bone erosion
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