Introduction. Low-energy fractures in patients with rheumatoid arthritis (RA) occur more often than in the general population, reduce the quality and life expectancy of patients. Establishment of predictors of fractures will allow to personalize treatment and preventive measures.Aim. To study the frequency, structure, predictors of new and repeated low-energy fractures that occurred in patients with RA during long-term prospective follow-up.Materials and methods. 123 women with RA, aged 63.7 ± 8.3 years, were included in an open, prospective, non-interventional study, the follow-up period was 9.4 ± 1.8 years. Initially and in dynamics, laboratory and X-ray examinations were performed (X-ray morphometry of the spine, X-ray densitometry of the lumbar spine (L1-4) and femoral neck (SB)).Results. During the follow-up period, 101 low-energy fractures occurred in 63 (51%) patients: in 33 (52%) people – for the first time, in 25 (48%) – again. Two or more fractures occurred in 25 (39%) patients. There were 32 (32%) peripheral fractures, 69 (68%) vertebral fractures. A direct relationship was established between fractures and a longer duration of RA course (r = 0.231, p < 0.05), with X-ray stage of RA at baseline (r = 0.280, p < 0.05) and over time (r = 0.819, p < 0.05), intake of glucocorticoids (GC) initially (r = 0.202, p < 0.05) and over time (r = 0.308, p < 0.05), cumulative dose of GC initially (r = 0.239, p < 0.05) and over time (r = 0.268, p < 0.05), duration of GC use (r = 0.270, p < 0.05), history of low-energy fractures (r = 0.291, p < 0.05), and feedback with OP in SB (r = -0.190, p < 0.05).Conclusions. А high frequency of repeated and first-time low-energy fractures was established in patients with RA, among which fractures of the vertebrae, distal forearm, humerus and lower leg bones predominated. Fracture predictors: GC intake, history of low-energy fractures, baseline radiological stage of RA. A mathematical model for assessing the risk of fractures with good predictive ability has been developed.
Patients' adherence to drug therapy, medical support and implementation of the doctor's recommendations for lifestyle changes can affect the effectiveness of therapy and quality of life in patients with rheumatoid arthritis (RA).Objective: to analyze adherence to treatment, medical support and implementation of recommendations for changing the lifestyle in RA patients, including those with and without low-energy bone fractures.Patients and methods. The study included 88 women with a definite diagnosis of RA. All patients were followed up for a long time (on average 8.45±1.34 years) at V.A. Nasonova Research Institute of Rheumatology. All patients underwent clinical, radiological and laboratory examinations, and a questionnaire for the quantitative assessment of adherence to treatment was completed.Results and discussion. The integral indicator of adherence to treatment in 30 (34%) patients corresponded to a low level, in 51 (58%) – to an average level, and in 7 (8%) – to a high level. Low adherence to medical support was more often determined in patients with anxiety (p=0.02) and depression (p=0.04). The intake of oral glucocorticoids (GC) was associated with a high adherence to drug therapy (p=0.01). Adherence rates in the group of RA patients with and without bone fractures did not differ significantly. Functional disorders and the severity of radiological changes also did not differ significantly in patients with different levels of adherence.Conclusion. Patients with RA had predominantly an average level of adherence to drug therapy, medical support, and a low level of adherence to recommendations for lifestyle changes. Oral GC were associated with high adherence to drug therapy, while low adherence to medical support was associated with anxiety and depression. Treatment adherence rates in the group of RA patients with and without bone fractures did not differ.
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