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Reduced Bone Mineral Density in Early Rheumatoid Arthritis Is Associated with Radiological Joint Damage At Baseline and After 2 Years in Women
KRISTINA FORSLIND, CATHARINA KELLER, BJÖRN SVENSSON, and INGIÄLD HAFSTRÖM for the BARFOT Study Group
ABSTRACT.
Methods. BMD at lumbar spine and hip was measured in 204 patients with recent RA at presentation. At baseline and after 2 years, radiographs of hands and forefeet were evaluated according to the Larsen method. At the same time-points, Disease Activity Score (DAS 28) and functional disability (the Stanford Health Assessment Questionnaire, HAQ) were assessed. Results. The 134 women and 70 men had a mean age of 55 and 61 years, respectively. Reduced bone mass (RBM, Z score £ 1.0 SD) in at least one site was found in 46.0% of women and 62.5% of men. T and Z scores correlated significantly with Larsen scores both at baseline and after 2 years for the total patient cohort. Calculated separately for the sexes, significant correlations were found only for women. Women but not men with reduced bone mass and osteoporosis had higher Larsen scores at baseline and after 2 years than those without. From a stepwise multiple logistic regression analysis Z score trochanter and baseline C-reactive protein were selected as independent predictors of joint damage, measured as proportion over the median Larsen scores. This model could explain about 25% of the "variance" in outcome (Nagelkerke R2 = 0.27). Conclusion. Reduced BMD at onset of RA in women was associated with a higher Larsen score at baseline and after 2 years, indicating that the development of reduced bone mass and joint destruction in RA may have a common pathophysiological mechanism. (J Rheumatol 2003;30:2590-6) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Rheumatology Section, Department of Medicine, Helsingborg's lasarett, Helsingborg; and the Rheumatology Department, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden. Supported by grants from The Swedish Rheumatism Association, King Gustaf V 80 Year Foundation, Ugglas Foundation, Börje Dahlins Foundation, and the Gorthon Foundation in Helsingborg. K. Forslind, MD; C. Keller, MD; B. Svensson, MD, Assistant Professor, Rheumatology Section, Department of Medicine, Helsingborg's lasarett; I. Hafström, MD, Assistant Professor, Rheumatology Department, Karolinska Institutet, Huddinge University Hospital. Address reprint requests to Dr. I. Hafström, Rheumatology Department, R92, Huddinge University Hospital, 141 86 Stockholm, Sweden. E-mail: ingiald.hafstrom@hs.se Submitted October 9, 2002; revision accepted May 6, 2003. |