Background:Osteoporosis and related fragility fractures are one of the most common complications seen in patients with rheumatoid arthritis (RA) and dramatically affect quality of life.Objective:To evaluate changes in bone mineral density in patients with recent onset rheumatoid arthritis (<1 year) and its correlation if any with a modified DAS-28 score and simple erosion narrowing score (SENS).Methods:This study included 30 patients with recent-onset rheumatoid arthritis fulfilling the new American College of Rheumatology/European League Against Rheumatism diagnostic criteria for rheumatoid arthritis and 20 healthy volunteers as controls. All were subjected to a complete blood count, erythrocyte sedimentation rate, C-reactive protein, liver function tests, renal function tests, rheumatoid factor, and plain x-rays of the hands and feet. Dual-energy x-ray absorptiometry DEXA was used to measure bone mineral density (BMD) of the left proximal femur, lumbar spine (L1–L4), and lower distal radius at the time of recruitment.Results:In the RA patients, 13.3% had osteoporosis, 50% had osteopenia, and 36.7% had normal BMD. The most common site of osteoporosis was the lumbar spine (four patients, 13.3%) followed by the femur (two patients, 6.6%), and forearm (only one patient, 3.3%). There was a significantly higher percentage of osteoporosis among RA males than females and the difference was statistically significant (P = 0.009). Osteoporosis was more common in patients treated with corticosteroids and disease modifying antirheumatic drugs (DMARDs) than in patients treated with only nonsteroidal anti-inflammatory drugs (P = 0.004). Higher disease activity (DAS-28) was found in RA patients with osteoporosis compared to RA patients with normal BMD or osteopenia, but the difference was not statistically significant. Osteoporotic RA patients were found to have a higher SENS score for radiological damage than nonosteoporotic ones.Conclusion:BMD changes do occur in patients with early RA, and are not necessarily correlated with disease activity (DAS-28). However, a significant negative correlation was found between BMD and the score of radiological damage (SENS). Dual energy x-ray absorptiometry is an important investigation to assess BMD in early RA patients.

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BackgroundRheumatoid arthritis(RA) is a disabling autoimmune systemic inflammatory disease. It manifests as peripheral symmetric inflammatory polyarthritis and produces a wide range of extra-articular manifestations. Interstitial lung disease (ILD), a diffuse progressive disease of the lung parenchyma, is the most serious manifestation of RA lung affection, it remains as a significant source of morbidity and mortality.ObjectivesTo evaluate the frequency and pattern of pulmonary affection in a cohort of Egyptian rheumatoid arthritis (RA) patients and the relation to disease activity and severity.MethodsSeventy RA patients who fulfilled 2010 (ACR/EULAR) classification criteria underwent full clinical assessment, plain X ray chest, chest high-resolution computed tomography (HRCT) with assessment of the extent and severity of pulmonary affection by Warrick score. Pulmonary function tests (PFTs) including diffusion lung capacity for carbon monoxide (DLCO) were done. Transthoracic echocardiography to screen for pulmonary hypertension (PH). Assessment of disease activity by DAS28 score and of radiographic joint damage by modified Larsen score.ResultsThe mean age of the patients was 44±10.8 years;females(87.1%) and males (12.9%), mean disease duration 7.3±6 years. PFTs were abnormal in (45.7%) with restrictive pattern in (24.3%) of patients followed by small airway affection in (10%), mixed pattern in (8.6%), the least is the obstructive pattern in (2.8%) of patients. DLCO was abnormal in (72.86%) with mild affection in (48.57%), moderate in (15.7%) and severe affection in (8.6%)of patients. HRCT abnormalities were found in 30 patients (42.85%). Interstitial abnormalities were detected in (35.7%). Septal or reticular lines, ground glass appearance, pleural irregularities and bronchiectasis were the most common findings. Most common HRCT pattern was nonspecific interstitial pneumonia (NSIP) in 12.8% (9/70), usual interstitial pneumonia (UIP) in 7% (5/70), organising pneumonia (OP) in 1.4% (1/70) and indeterminate subtype in 14% (10/70). HRCT total score (Warrick score) was correlated with age, disease activity (DAS ESR 28), ESR, modified Larsen score, FVC, FEV1 and DLCO. Age, dyspnea and DLCO impairment were significant predictors for development of HRCT chest abnormalities. Pulmonary hypertension(sPAP >30 mmHg) was detected in (14%) of patients.ConclusionsPulmonary abnormalities are common in Egyptian RA patients. HRCT and PFTs including DLCO can be used effectively for early diagnosis and monitoring of pulmonary affection in RA patients. DLCO can detect pulmonary abnormalities early in clinically asymptomatic patients. Age, disease activity and severity, PFTs and ESR are correlated with the pulmonary affection in RA. Age, dyspnea and DLCO impairment are significant predictors of pulmonary affection in RA patients. Echocardiography can be used as a screening tool for detection of pulmonary hypertension.Disclosure of InterestNone declared