Paraarticular Trabecular Bone Loss at the Ultradistal Radius and Increased Arterial Stiffening in Postmenopausal Patients with Rheumatoid Arthritis

KAZUMASA TANAKA, MASAAKI INABA, HITOSHI GOTO, MAYUMI NAGATA-SAKURAI, SHINREI SAKAI, SHINSUKE YAMADA, MISAKO UEDA, EIJI ISHIMURA, and YOSHIKI NISHIZAWA

ABSTRACT.

Objective. We recently reported enhanced arterial thickening in patients with rheumatoid arthritis (RA) and the importance of increased bone resorption in this process. Our aim was to examine whether arterial stiffening, another aspect of atherosclerosis, is also increased in patients with RA, and to determine if it is an important risk factor.

Methods. The subjects were 47 patients with RA and 49 healthy controls, all postmenopausal women. Subjects having risk factors for atherosclerosis were excluded. Femoral-ankle (fa) pulse wave velocity (PWV) and brachial-ankle (ba) PWV were measured in all patients using a waveform analyzer. Bone mineral density (BMD) at the ultradistal radius was assessed by peripheral quantitative computed tomography. Inflammation markers (C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, platelet count) and bone resorption markers (urinary excretion of deoxypyridinoline and N-terminal telopeptide) were also measured.

Results. The median values of faPWV and baPWV in RA patients were 1124 cm/s [interquartile range (IQR) 1040–1175] and 1539 cm/s (IQR 1297–1738), respectively, which were significantly greater than the respective values of 982 cm/s (IQR 819–1054; p < 0.001) and 1322 cm/s (IQR 1112–1398; p = 0.004) in controls. In multiple regression analysis, the presence of RA emerged as an independent factor associated with the greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. In RA patients alone, BMD in the trabecular bone component, but not for the total bone (cortical plus trabecular), at the ultradistal radius correlated significantly with both faPWV and baPWV. Multiple regression analysis showed that trabecular BMD at the distal radius was a significant factor independently associated with greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. None of the measured inflammation markers or bone resorption markers correlated with either faPWV or baPWV in patients with RA.

Conclusion. Patients with RA show increased arterial stiffening, in addition to the arterial thickening we have previously reported, supporting the notion of enhanced atherosclerosis in RA patients. Paraarticular bone loss in the trabecular bone component at the ultradistal radius is a factor significantly associated with increased arterial stiffening in RA patients. (J Rheumatol 2006;33:652–8)

Key Indexing Terms:

ATHEROSCLEROSIS
RHEUMATOID ARTHRITIS
ARTERIAL STIFFENING
PULSE WAVE VELOCITY
PARAARTICULAR OSTEOPOROSIS

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From the Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, and Senboku Second Hospital, Osaka, Japan.

Supported in part by a grant-in-aid from Health Science Research, Ministry of Health and Welfare of Japan.

K. Tanaka, MD, Research Associate; M. Inaba, MD, PhD, Associate Professor; H. Goto, MD, PhD, Lecturer; M. Nagata-Sakurai, MD, PhD, Research Associate; S. Sakai, MD; S. Yamada, MD, Graduate Student; M. Ueda, MD, PhD; E. Ishimura, MD, PhD, Associate Professor; Y. Nishizawa, MD, PhD, Professor.

Address reprint requests to Dr. M. Inaba, Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. E-mail: inaba-m@med.osaka-cu.ac.jp

Accepted for publication November 23, 2005.

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