Osteoporos Sarcopenia.  2020 Jun;6(2):75-81. 10.1016/j.afos.2020.04.002.

Rheumatoid arthritis in tight disease control is no longer risk of bone mineral density loss

• Yoshii I
• Chijiwa T
• Sawada N

• KMID: 2503947
• DOI: http://doi.org/10.1016/j.afos.2020.04.002

Abstract

Objectives
Rheumatoid arthritis (RA) is an independent risk factor of osteoporosis. However, if disease activity is successfully controlled using the treat-to-target (T2T) strategy, the risk of bone mineral density (BMD) loss can be diminished. We evaluated if RA is a risk factor even when the T2T is applied in clinical cases.
Methods
From September 2017 to August 2019, 741 patients were examined using dual-energy X-ray absorptiometry; of these, 279 were diagnosed with RA who attained clinical remission within 6 months (RA-rem) and 53 could not attain clinical remission (RA-nonrem), while 409 were not diagnosed with RA (non-RA). The following characteristics between RA-rem and non-RA were matched using the propensity score matching (PSM) technique: age, sex, past bone fragility fracture experience, osteoporosis drug intervention ratio, glucocorticoid administration ratio, mean dose, Barthel Index score, body mass index, serum-creatinine-to-cystatin C ratio, and the number of comorbidities. The BMDs and changes of the lumbar spine, femoral neck, total hip, and greater trochanter were statistically compared between the RA-rem and the non-RA after PSM, and between RA-nonrem and RA-rem after PSM using the Mann- Whitney U test.
Results
In total, 107 patients of RA-rem and 108 of non-RA were recruited. BMDs and changes of every part demonstrated no significant differences between the 2 groups. BMDs in every part of RA-rem after PSM were significantly greater than those in every part of RA-nonrem, while no significant difference in change during follow-up.
Conclusions
If disease activity is controlled in clinical remission, RA will not contribute to BMD reduction.

Keyword

Rheumatoid arthritis; Osteoporosis; Bone mineral density; Disease activity; Propensity score matching