The Utility of Radiographic Focal Erosions of Hands or Feet in Predicting DXA-defined Osteoporosis of the Hip in Patients with Rheumatoid Arthritis

Author(s): Mohsen H. Elshahaly*, Khaled A. Gad

Journal Name: Current Rheumatology Reviews

Volume 16 , Issue 1 , 2020


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Abstract:

Introduction: Osteoporosis is a common comorbidity in Rheumatoid Arthritis (RA) patients and can result in estimated double risk of pathological fractures. Bone Mineral Density (BMD) is known to decrease with RA because of mechanisms incorporating traditional as well as disease-specific causes. With the advent of newer disease-modifying antirheumatic agents and bone protection medications, it is becoming important to identify those individuals who are at increased risk of developing osteoporosis among RA patients.

Aim: In the current study, we aim to evaluate a multitude of factors including focal erosions on radiographs of hands or feet that can predict osteoporosis in RA patients.

Methods: After obtaining IRB approval, 26 patients (20 females & 6 males) with a median age of 62 years (95% CI: 57.4 - 66.0) were retrospectively identified from a Rheumatology clinic database with an established diagnosis of RA but not taking osteoporosis medications. A detailed assessment was accomplished including evaluating a number of disease-specific variables, hands/feet radiographs and Dual-energy X-ray Absorptiometry (DXA).

Results: The total hip BMD was lower in RA patients with radiographic erosions (0.862 g/cm2 ± 0.17) compared to those patients without erosions (1.011 g/cm2 ± 0.13). On univariate logistic regression, the presence of radiographic erosions predicted osteoporosis of the hip (p = 0.04). ROC curve demonstrated satisfactory performance of erosions in predicting WHO-defined osteoporosis or osteopenia at the hip (AUC = 0.732).

Conclusion: RA patients who show radiographic erosions are more likely to develop hip osteoporosis that may require further intervention.

Keywords: Rheumatoid arthritis, osteoporosis, DEXA, periarticular erosions, BMD, osteopenia.

[1]
Węgierska M, Dura M, Blumfield E, Żuchowski P, Waszczak M, Jeka S. Osteoporosis diagnostics in patients with rheumatoid arthritis. Reumatologia 2016; 54(1): 29-34.
[http://dx.doi.org/10.5114/reum.2016.58759] [PMID: 27407274]
[2]
Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 2000; 43(3): 522-30.
[http://dx.doi.org/10.1002/1529-0131(200003)43:3<522:AID-ANR7>3.0.CO;2-Y] [PMID: 10728744]
[3]
Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK. Reduced bone mineral density in male rheumatoid arthritis patients: frequencies and associations with demographic and disease variables in ninety-four patients in the Oslo County Rheumatoid Arthritis Register. Arthritis Rheum 2000; 43(12): 2776-84.
[http://dx.doi.org/10.1002/1529-0131(200012)43:12<2776:AID-ANR18>3.0.CO;2-N] [PMID: 11145036]
[4]
Combe B, Landewe R, Daien CI, et al. 2016 update of the EULAR recommendations for the management of early arthritis. Ann Rheum Dis 2017; 76(6): 948-59.
[http://dx.doi.org/10.1136/annrheumdis-2016-210602] [PMID: 27979873]
[5]
Lane NE, Lukert B. The science and therapy of glucocorticoid-induced bone loss. Endocrinol Metab Clin North Am 1998; 27(2): 465-83.
[http://dx.doi.org/10.1016/S0889-8529(05)70017-7] [PMID: 9669150]
[6]
Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010; 17(1): 25-54.
[http://dx.doi.org/10.1097/gme.0b013e3181c617e6] [PMID: 20061894]
[7]
Lim LS, Hoeksema LJ, Sherin K. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med 2009; 36(4): 366-75.
[http://dx.doi.org/10.1016/j.amepre.2009.01.013] [PMID: 19285200]
[8]
Amarnath ALD, Franks P, Robbins JA, Xing G, Fenton JJ. Underuse and overuse of osteoporosis screening in a regional health system: a retrospective cohort study 2015.
[http://dx.doi.org/10.1007/s11606-015-3349-8]
[9]
Hoes JN, Bultink IE, Lems WF. Management of osteoporosis in rheumatoid arthritis patients. Expert Opin Pharmacother 2015; 16(4): 559-71.
[http://dx.doi.org/10.1517/14656566.2015.997709] [PMID: 25626121]
[10]
Arain SR, Riaz A, Nazir L, Umer TP, Rasool T. Low bone mineral density among patients with newly diagnosed rheumatoid arthritis. J Ayub Med Coll Abbottabad 2016; 28(1): 175-8.
[PMID: 27323588]
[11]
Furuya T. Calcium and bone metabolism across women’s life stages. Osteoporosis in female patients with rheumatoid arthritis. Clin Calcium 2017; 27(5): 691-8.
[PMID: 28439057]
[12]
Meng J, Li Y, Yuan X, Lu Y. Evaluating osteoporotic fracture risk with the Fracture Risk Assessment Tool in Chinese patients with rheumatoid arthritis. Medicine (Baltimore) 2017; 96(18)e6677
[http://dx.doi.org/10.1097/MD.0000000000006677] [PMID: 28471962]
[13]
Okano T, Inui K, Tada M, et al. High frequency of vertebral fracture and low bone quality in patients with rheumatoid arthritis-Results from TOMORROW study. Mod Rheumatol 2017; 27(3): 398-404.
[http://dx.doi.org/10.1080/14397595.2016.1213943] [PMID: 27484855]
[14]
Edavalath S, Singh A, Soni N, Mohindra N, Kumar S, Misra R. Peripheral blood T helper type 17 frequency shows an inverse correlation with disease activity and magnetic resonance imaging-based osteitis and erosions in disease-modifying anti-rheumatic drug- and steroid-naive established rheumatoid arthritis. Clin Exp Immunol 2016; 186(3): 313-20.
[http://dx.doi.org/10.1111/cei.12860] [PMID: 27568583]
[15]
Eng GP. Optimizing biological treatment in rheumatoid arthritis with the aid of therapeutic drug monitoring. Dan Med J 2016; 63(11): B5311.
[PMID: 27808043]
[16]
Gavrilă BI, Ciofu C, Stoica V. Biomarkers in Rheumatoid Arthritis, what is new? J Med Life 2016; 9(2): 144-8.
[PMID: 27453744]
[17]
Zengin O, Onder ME, Kalem A, et al. New inflammatory markers in early rheumatoid arthritis. Z Rheumatol 2018; 77(2): 144-50.
[PMID: 27604908]
[18]
Zerbini CAF, Clark P, Mendez-Sanchez L, et al. Biologic therapies and bone loss in rheumatoid arthritis. Osteoporos Int 2017; 28(2): 429-46.
[http://dx.doi.org/10.1007/s00198-016-3769-2] [PMID: 27796445]
[19]
Barreira SC, Fonseca JE. The impact of conventional and biological disease modifying antirheumatic drugs on bone biology. rheumatoid arthritis as a case study. Clin Rev Allergy Immunol 2016; 51(1): 100-9.
[http://dx.doi.org/10.1007/s12016-016-8547-6] [PMID: 27166684]
[20]
Tenne M, McGuigan F, Besjakov J, Gerdhem P, Åkesson K. Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women. Osteoporos Int 2013; 24(4): 1419-28.
[http://dx.doi.org/10.1007/s00198-012-2048-0] [PMID: 22733092]
[21]
Vis M, Havaardsholm EA, Haugeberg G, et al. Evaluation of bone mineral density, bone metabolism, osteoprotegerin and receptor activator of the NFkappaB ligand serum levels during treatment with infliximab in patients with rheumatoid arthritis. Ann Rheum Dis 2006; 65(11): 1495-9.
[http://dx.doi.org/10.1136/ard.2005.044198] [PMID: 16606653]
[22]
Sinigaglia L, Nervetti A, Mela Q, et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. J Rheumatol 2000; 27(11): 2582-9.
[PMID: 11093437]
[23]
Solomon DH, Finkelstein JS, Shadick N, et al. The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis. Arthritis Rheum 2009; 60(6): 1624-31.
[http://dx.doi.org/10.1002/art.24551] [PMID: 19479876]
[24]
Adamopoulos IE, Bowman EP. Immune regulation of bone loss by Th17 cells. Arthritis Res Ther 2008; 10(5): 225.
[http://dx.doi.org/10.1186/ar2502] [PMID: 18983698]
[25]
Tanaka Y, Nakayamada S, Okada Y. Osteoblasts and osteoclasts in bone remodeling and inflammation. Curr Drug Targets Inflamm Allergy 2005; 4(3): 325-8.
[http://dx.doi.org/10.2174/1568010054022015] [PMID: 16101541]
[26]
Zhao B, Takami M, Yamada A, et al. Interferon regulatory factor-8 regulates bone metabolism by suppressing osteoclastogenesis. Nat Med 2009; 15(9): 1066-71.
[http://dx.doi.org/10.1038/nm.2007] [PMID: 19718038]
[27]
Bugatti S, Bogliolo L, Montecucco C, Manzo A. B cell autoimmunity and bone damage in rheumatoid arthritis. Reumatismo 2016; 68(3): 117-25.
[http://dx.doi.org/10.4081/reumatismo.2016.914] [PMID: 27981813]
[28]
Perpétuo IP, Caetano-Lopes J, Rodrigues AM, et al. Effect of tumor necrosis factor inhibitor therapy on osteoclasts precursors in rheumatoid arthritis. BioMed Res Int 2017; 20172690402
[http://dx.doi.org/10.1155/2017/2690402] [PMID: 28286757]
[29]
Liu H, Luo T, Tan J, Li M, Guo J. ‘Osteoimmunology’ offers new perspectives for the treatment of pathological bone loss. Curr Pharm Des 2017; 23(41): 6272-8.
[http://dx.doi.org/10.2174/1381612823666170511124459] [PMID: 28494718]
[30]
Deal C. Bone loss in rheumatoid arthritis: systemic, periarticular, and focal. Curr Rheumatol Rep 2012; 14(3): 231-7.
[http://dx.doi.org/10.1007/s11926-012-0253-7] [PMID: 22527950]
[31]
Anandarajah AP, El-Taha M, Peng C. The relationship between focal and generalized bone loss in rheumatoid arthritis. Curr Rheumatol Rev 2016.
[PMID: 27632985]


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Article Details

VOLUME: 16
ISSUE: 1
Year: 2020
Published on: 05 March, 2020
Page: [74 - 78]
Pages: 5
DOI: 10.2174/1573397115666190716120127
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