Cartilage and bone loss in premenopausal women with rheumatoid arthritis: Radiological and laboratory assessments

Abstract

IntroductionTo investigate the radiological and laboratory features of bone and cartilage losses in premenopausal women with rheumatoid arthritis (RA).MethodsThis case–control study is the continuation of a study that was conducted on 48 women with RA and 48 matched healthy volunteers. All RA patients were previously subjected to clinical examination, disease activity assessment using the 28‐joint Disease Activity Score (DAS28) and Clinical Disease Activity Index (CDAI), serological tests, dual‐energy X‐ray absorptiometry measuring bone mineral density (BMD), and plain X‐ray of both hands. Added to these, matrix metalloproteinase 3 (MMP‐3) and cartilage oligomeric matrix protein (COMP) were measured by enzyme‐linked immunosorbent assay.ResultsThere were statistically significant differences between patients and controls regarding COMP and MMP‐3, being higher in patients (p < .001). COMP and MMP‐3 have significant positive correlation with serum levels of anti‐cyclic citrullinated peptide (anti‐CCP) and anti‐carbamylated protein (anti‐CarP). The original Sharp erosion score was positively correlated with the serum level of the studied antibodies and disease duration, but no significant correlation was found with either COMP, MMP‐3, or DAS‐28. Spine BMD and Z score were negatively correlated with disease activity and anti‐CarP. There were significant positive relationhsips between indices of local cartilage and bone loss and the indices of systemic bone loss. MMP‐3 had no correlation with indices of local cartilage and bone loss and disease activity scores.ConclusionsThe pathogenic mechanism of hand joint damage involved the three studied autoantibodies namely, rheumatoid factor, anti‐CCP and anti‐CarP antibodies. Anti‐CarP antibody was involved in the reduction of BMD of the spine. The association between systemic osteoporosis and hand joint damage pointed to a common pathogenic mechanism.

Analyzing the risk of osteoporosis and fracture in rheumatoid arthritis patients who have been treated with various biologics

“…Although our study has encountered certain limitations, such as incomplete data, 15,16 missing the real osteoporosis dual‐energy X‐ray absorptiometry (DEXA) scan data, detailed fracture data, several other confounding factors like patients' lifestyle, genetic predisposition, 34 other comorbidities 35 of osteoporotic fracture, and the disease activity index of RA, besides, the instances of follow‐up loss within the multifaceted care network of CGMH, and the influence of individual treatment preferences (e.g., a predilection for oral medications over subcutaneous injections, among others), our research effectively mirrors the real‐world implications of RA treatments concerning both osteoporosis and osteoporotic fractures. Besides, severe RA treatments (e.g., biologics) may reflect more severe RA, but because we do not have the severity of RA (e.g., Disease Activity Score‐28 for rheumatoid arthritis [DAS28]) nor the treatment compliance, 36 it is possible that the results of this study will be interfered with by the severity of RA and treatment compliance.…”