Document Type : Original Article

Authors

1 Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

2 Clinical Research Development Unit, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

3 Department of Community Medicine, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

4 Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

5 Department of internal Medicine,school of medicine, AliIbn Abi Talib hospital, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.

10.32592/RR.2024.9.1.26

Abstract

Rheumatoid arthritis (RA) can affect bone density. Given the significant risk of low bone mass density (BMD) in RA patients, the present study aims to investigate the BMD in these patients. The present cross-sectional study included 415 RA patients from the Rafsanjan Rheumatology Clinic. The patients were included in the study by census based on the inclusion criteria, which included a physician's diagnosis of RA according to the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria, at least three months of disease history, and age between of 35 and 70 years. The BMD was measured using the dual-energy x-ray absorptiometry method in both the hip and the spine, and the RA severity was determined using the disease activity score-28 (DAS-28) index. The mean age of RA patients was 56.49 ± 11.73 years, with females accounting for 86.7% (300 people). The frequency of osteoporosis was 7.5% (26 people), and osteopenia was 43.6% (151 people) based on hip bone density, and 33% (137 people) and 38.1% (158 people) based on spine density, respectively. Age, fracture history, and DAS-28 score increased the probability of developing osteopenia or osteoporosis based on hip and spine bone density. According to the findings of a study in RA patients, increasing age, history of bone fracture, and DAS-28 score increase the probability of osteopenia or osteoporosis. Therefore, it is advised to pay close attention to the mentioned factors to prevent complications in these patients.

Keywords

Main Subjects

1.Jameson JL, Kasper DL, Fauci AS, Hauser SL, LongoDL, Loscalzo J. Harrison's principles of internalmedicine: McGraw-Hill education; 2018.
2.Gulati M, Farah Z, Mouyis M. Clinical features ofrheumatoid arthritis. Medicine 2018;46(4):211-5.
3.de la Vega M, da Silveira de Carvalho HM, VenturaRíos L, Goycochea Robles MV, Casado GC. Theimportance of rheumatology biologic registries in Latin
America.
Rheumatol Inter 2013; 33(4):827-35. doi: 10.1007/s00296-012-2610-2.
4.Almutairi K, Nossent J, Preen D, Keen H, Inderjeeth C.The global prevalence of rheumatoid arthritis: a meta-analysis based on a systematic review. RheumatolInter 2021; 41(5):863-77. doi: 10.1007/s00296-020-04731-0.
5.Davatchi F, Sandoughi M, Moghimi N, Jamshidi AR,Tehrani Banihashemi A, Zakeri Z, et al. Epidemiologyof rheumatic diseases in Iran from analysis of fourCOPCORD studies. IJRD 2016;19(11):1056-62.
6.
Lin Y-J, Anzaghe M, Schülke S. Update on thepathomechanism, diagnosis, and treatment options forrheumatoid arthritis. Cells 2020;9(4):880. doi: 10.3390/cells9040880.
7.Durán J, Massardo L, Llanos C, Iacobelli S, Burgos PI,Cisternas M, et al. The Prevalence of RheumatoidArthritis in Chile: A Nationwide Study Performed asPart of the National Health Survey. J Rheumatol 2020;47(7):951-958. doi: 10.3899/ jrheum.190396.
8.Aletaha D, Smolen JS. Diagnosis and management ofrheumatoid arthritis: a review. JAMA. 2018; 320(13):1360-72. doi: 10.1001/jama.2018.13103.
9.Kim D-H, Lim H, Chang S, Kim J-N, Roh Y-K, ChoiM-K. Association between body fat and bone mineraldensity in normal-weight middle-aged Koreans. KoreanJ Fam Med 2019; 40(2):100-105. doi: 10.4082/kjfm.17.0082.
10.Rotta D, Fassio A, Rossini M, Giollo A, Viapiana O,Orsolini G, et al. Osteoporosis in inflammatoryarthritides: new perspective on pathogenesis andtreatment. Front Med (Lausanne) 2020; 7:613720. doi:10.3389/fmed.2020.613720.
11.American College of Rheumatology Subcommittee onRheumatoid Arthritis Guidelines. Guidelines for themanagement of rheumatoid arthritis: 2002 Update.Arthritis Rheum 2002; 46(2):328-46. doi: 10.1002/art.10148.
12.Choi ST, Kwon S-R, Jung J-Y, Kim H-A, Kim S-S,Kim SH, et al. Prevalence and fracture risk ofosteoporosis in patients with rheumatoid arthritis: amulticenter comparative study of the FRAX and WHOcriteria. J Clin Med 2018; 7(12):507. doi: 10.3390/jcm7120507.
13.Lee SG, Park YE, Park SH, Kim TK, Choi HJ, Lee SJ,et al. Increased frequency of osteoporosis and BMDbelow the expected range for age among S outh K oreanwomen with rheumatoid arthritis. Int J Rheum Dis2012; 15(3):289-96. doi: 10.1111/j.1756-185X.2012.01729.x.
14.Curtis JR, Johnson SR, Anthony DD, Arasaratnam RJ,Baden LR, Bass AR, et al. American College ofRheumatology guidance for COVID‐19 vaccination inpatients with rheumatic and musculoskeletal diseases version 3.Arthritis Rheumatol 2021; 73(10):e60-e75. doi: 10.1002/art.41928.
15.Owlia M, Rezvani-Nejad S, Soleymani H.Interrelationship Between Radiographic Findings ofHands and Bone Mineral Density in Patients WithRheumatoid Arthritis. JSSUc2008; 16(2):44-8.
16.Wells G, Becker J, Teng J, Dougados M, Schiff M,Smolen J, et al. Validation of the 28-joint DiseaseActivity Score (DAS28) and European League AgainstRheumatism response criteria based on C-reactiveprotein against disease progression in patients withrheumatoid arthritis and comparison with the DAS28based on erythrocyte sedimentation rate. Ann RheumDis 2009; 68(6):954-60. doi: 10.1136/ard.2007.084459.
16.Cheng H. A simple, easy-to-use spreadsheet for automatic scoring of the International Physical Activity Questionnaire (IPAQ). ResearchGate. 2016.
17.Ladyzhenskaia O, Solonnikov V, Ural'tseva N. Linearand quasi-linear equations of parabolic type. USA:American Mathematical Soc; 1988.
18.Hardcastle SA, Dieppe P, Gregson CL, Davey Smith G,Tobias JH. Osteoarthritis and bone mineral density: arestrong bones bad for joints? Bonekey Rep 2015; 4:624.doi: 10.1038/bonekey.2014.119..
19.Hussain SM, Cicuttini FM, Alyousef B, Wang Y.Female hormonal factors and osteoarthritis of the knee,hip and hand: a narrative review. Climacteric 2018;21(2):132-139. doi: 10.1080/13697137.2017.1421926.
20.Lee JH, Sung YK, Choi CB, Cho SK, Bang SY, ChoeJY, et al. The frequency of and risk factors forosteoporosis in Korean patients with rheumatoidarthritis. BMC Musculoskelet Disord 2016; 17:98. doi:10.1186/s12891-016-0952-8.
21.Fahimfar N, Gharibzadeh S, Khashayar P, Rajabian R,Ranjbar Omrani G, Bahrami A, et al. IranianMulticenter Osteoporosis Studies (IMOS) during lastdecade: rationale, main findings, lessons learned andthe way forward. J Diabetes Metab Disord 2023. doi:10.1007/s40200-020-00600-6.
22.Aghaei M, Sedighi S, Behnam Pour N, Hezar Khani S,Jamshir M, Agh A, et al. Prevalence and risk factors ofosteoporosis in postmenopausal women withrheumatoid arthritis: a brief report. Tehran UniversityMedical Journal. 2012; 70(7):447-51.
23.Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK.Bone mineral density and frequency of osteoporosis infemale patients with rheumatoid arthritis: results from394 patients in the Oslo County Rheumatoid Arthritisregister. Arthritis Rheum 2000; 43(3):522-30. doi: 10.1002/1529-0131(200003)43:3<522::AID-ANR7>3.0.CO;2-Y.
24.Güler-Yüksel M, Bijsterbosch J, Goekoop-RuitermanY, Breedveld F, Allaart C, de Vries-Bouwstra J, et al.
Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis. Ann Rheum Dis 2007; 66(11):1508-12. doi: 10.1136/ard.2007.070839.
25.Michel B, Bloch D, Fries J. Predictors of fractures inearly rheumatoid arthritis. J Rheumatol 1991;18(6):804-8.
26.Aghaei M, Sedighi S, Behnam pour N, Hezar Khani S,Hashemizadeh P, Shirashiani M, et al.—the study ofbone mineral density in postmenopausal women withrheumatoid arthritis Sciences. Journal of ShahrekordUuniversity of Medical 2013;15(2):53-60.
27.Jang S-N, Choi Y-H, Choi M-G, Kang S-H, Jeong J-Y,Choi Y-J, et al. Prevalence and associated factors ofosteoporosis among postmenopausal women inChuncheon: Hallym Aging Study (HAS). Journal ofPreventive Medicine Public Health. 2006; 39(5):389-96.
28.Larijani MB, Soltani AAF, Pazhouhi M, Bastan HaghMH, Mirfeizi SZ, Dashti R, et al. Bone mineral densityvariations in 20-69 year population of Tehran/Iran.Iranian South Medical Journal. 2002;5(1):41-9.
29.Larijani B, Moayyeri A, Keshtkar AA, Hossein-NezhadA, Soltani A, Bahrami A, et al. Peak bone mass ofIranian population: The Iranian multicenterosteoporosis study. Journal of Clinical Densitometry.2006;9(3):367-74.
30.Yavari P. Epidemiology Textbook of PrevalentDiseases in Iran. 1, editor. Tehran: GAPnashr; 2016.
31.Sagayama H, Kondo E, Tanabe Y, Ohnishi T, YamadaY, Takahashi H. Bone mineral density in male weight-classified athletes is higher than that in male endurance-athletes and non-athletes. Clin Nutr ESPEN 2020;36:106-110. doi: 10.1016/j.clnesp.2020.01.008.
32.Codrea CI, Croitoru A-M, Baciu CC, Melinescu A,Ficai D, Fruth V, et al. Advances in osteoporotic bonetissue engineering. J Clin Med 2021; 10(2):253. doi:10.3390/jcm10020253.
33.Whyte MP, Mumm S. Heritable disorders of theRANKL/OPG/RANK signaling pathway. Journal OfMusculoskeletal Neuronal Interactions. 2004;4(3):254.
34.Boyle WJ, Simonet WS, Lacey DL. Osteoclastdifferentiation and activation. Nature 2003;423(6937):337-42.
35.Edwards BJ, Bunta AD, Simonelli C, Bolander M,Fitzpatrick LA. Prior fractures are common in patientswith subsequent hip fractures. Clin Orthop Relat Res2007; 461:226-30. doi: 10.1097/BLO.0b013e 3180534269.
36.Solomon D, Polinski J, Truppo C, Egan C, Jan S, PatelM, et al. Access to bone mineral density testing inpatients at risk for osteoporosis. Osteoporosisinternational 2006;17(12):1749-54.
37.Kopiczko A, Adamczyk JG, Gryko K, Popowczak M.Bone mineral density in elite masters athletes: the effect of body composition and long-term exercise. Eur Rev Aging Phys Act 2021; 18(1):7. doi: 10.1186/s11556-021-00262-0.
38.Aboarrage Junior AM, Teixeira CVLS, Dos Santos RN,Machado AF, Evangelista AL, Rica RL, et al. A high-intensity jump-based aquatic exercise programimproves bone mineral density and functional fitness inpostmenopausal women. Rejuvenation Res 2018;21(6):535-540. doi: 10.1089/rej.2018.2069.
39.Greco EA, Pietschmann P, Migliaccio S. Osteoporosisand sarcopenia increase frailty syndrome in the elderly.Front Endocrinol 2019; 10:255. doi: 10.3389/ fendo.2019.00255.
40.Machida S, Booth FW. Insulin-like growth factor 1 andmuscle growth: implication for satellite cellproliferation. Proc Nutr Soc 2004; 63(2):337-40. doi:10.1079/PNS2004354.