Bone health in rheumatoid arthritis: what can studies of bone microarchitecture tell us?

Abstract

Introduction: Rheumatoid arthritis (RA) is associated with changes in skeletal health, includingincreased risk of fracture. This study used a novel technique, high-resolution quantitative CT (HRpQCT),to assess bone microarchitecture in patients with RA.Methods: There were 59 patients (female: 41; male: 18) with RA recruited. They underwent dual energyX-ray absorptiometry and HRpQCT of the radius and tibia. The questionnaire information includedage, sex, BMI, disease duration, comorbidities, medication use, smoking and alcohol consumption,rheumatoid factor (RF) or cyclic citrullinated peptide (CCP) status, and disease activity. HRpQCTresults were compared with published estimated age and sex-specific values.Results: There were 55 patients (female: 39; male: 16) who had either radial or tibial scans available.The mean age was 55.8 (standard deviation [SD]: 12.6) years and median disease duration was 11.4years (interquartile range [IQR]: 6.3–19.4). Mean BMI was 27.2 (SD: 5.8). Forty-nine (90.7%) participantswere RF or CCP positive, with disease severity ranked as severe in 33 (61.1%) patients and moderate in20 (37.0%). Fifteen participants (27.8%) had previously taken steroids and 47 (85.5%) were receivingtumour necrosis factor inhibitor (TNF-i) medication. Radial trabecular number and density were lowerthan expected, and trabecular separation was greater than expected (p<0.05), though tibial resultswere similar (p<0.10 for trabecular number and separation). No difference in cortical values reachedstatistical significance in this sample. Previous use of steroids was associated with greater radialperiosteal circumference (p<0.05, adjusted for sex) and use of TNF-i agents was associated withlower radial total and trabecular area (p<0.05, adjusted for sex).

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Identifiers

ORCID for Michael Clynes: orcid.org/0000-0001-7597-7658

ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

ORCID for Kate Ward: orcid.org/0000-0001-7034-6750

ORCID for Elaine Dennison: orcid.org/0000-0002-3048-4961

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