Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis

Abstract

ObjectiveTo determine the prevalence of vertebral fractures (VFs) after 5 years of disease activity score (DAS)-steered treatment in patients with early rheumatoid arthritis (RA) and to investigate the association of VFs with disease activity, functional ability and bone mineral density (BMD) over time.MethodsFive-year radiographs of the spine of 275 patients in the BeSt study, a randomized trial comparing four treatment strategies, were used. Treatment was DAS-steered (DAS ≤ 2.4). A height reduction >20% in one vertebra was defined a vertebral fracture. With linear mixed models, DAS and Health Assessment Questionnaire (HAQ) scores over 5 years were compared for patients with and without VFs. With generalized estimating equations the association between BMD and VFs was determined.ResultsVFs were observed in 41/275 patients (15%). No difference in prevalence was found when stratified for gender, prednisone use and menopausal status. Disease activity over time was higher in patients with VFs, mean difference 0.20 (95% CI: 0.05-0.36), and also HAQ scores were higher, independent of disease activity, with a mean difference of 0.12 (95% CI: 0.02-0.2). Age was associated with VFs (OR 1.06, 95% CI: 1.02-1.09), mean BMD in spine and hip over time were not (OR 95% CI, 0.99: 0.78-1.25 and 0.94: 0.65-1.36, respectively).ConclusionAfter 5 years of DAS-steered treatment, 15% of these RA patients had VFs. Higher age was associated with the presence of VFs, mean BMD in hip and spine were not. Patients with VFs have greater functional disability over time and a higher disease activity, suggesting that VFs may be prevented by optimal disease activity suppression.

Differences in bone structure between rheumatoid arthritis and psoriatic arthritis patients relative to autoantibody positivity

“…For instance, it was stunning that despite the well-described negative effects of glucocorticoids on the skeleton,37 the use of low-dose glucocorticoids (5 mg prednisolone or less) positively rather than negatively influenced Tb.N. However, the most likely explanation for this finding is the anti-inflammatory effect of low-dose glucocorticoids, which counteracts inflammation-dependent bone loss and beneficially influences bone quality, as previously demonstrated by others 12 38…”

“…Even minor chronic increases of inflammatory activity can trigger systemic bone loss 10. Bone mineral density (BMD) is significantly decreased in RA patients compared to controls11 and the risk of fracture is increased at vertebral12 and peripheral skeletal sites 13. High disease activity is an independent predictor of bone loss in RA 14.…”

Osteoporotic Fracture Risk in Rheumatoid Arthritis

“…The underlying reasons for the increased fracture risk in RA are complex. These may include chronic inflammation, increased disease activity, impaired physical activity and an increased risk of falling [20,21]. The various risk factors for osteoporosis are history of fracture, gender, age, family history of osteoporosis, estrogen deficiency, low calcium intake, vitamin D deficiency, use of corticosteroids, smoking and alcohol consumption [22] but the present study focused on the diseasespecific risk factors associated with RA like age, sex, disability, previous non-vertebral fracture, disease duration, active disease and use of glucocorticoids.…”

Decreased Quantity and Quality of the Periarticular and Nonperiarticular Bone in Patients With Rheumatoid Arthritis: A Cross-Sectional HR-pQCT Study

“…Together, these factors result in rapid loss of bone mass at periarticular and nonperiarticular sites including the femoral head and the spine . In addition, RA is considered an independent risk factor for secondary osteoporosis and osteoporosis‐related vertebral and nonvertebral fractures, which is also reflected by its inclusion into the fracture risk assessment tool (FRAX) …”