Loss of cortical bone from the metacarpal diaphysis in patients with rheumatoid arthritis: Independent effects of systemic inflammation and glucocorticoids

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Abstract

Objective. To identify factors associated with the loss of cortical diaphyseal bone over time in patients with rheumatoid arthritis (RA). Methods. We measured the combined cortical thickness (CCT) of the second metacarpal bone from digitized hand radiographs in an RA cohort. We estimated the rate of loss of CCT, and tested the effect of factors that could accelerate the rate. Results. We studied 649 patients, who had 2990 hand radiographs. The median interval between the first and last followup radiograph was 2 years (range 0 to 23 yrs). The mean CCT at baseline was 4.04 mm (standard deviation 1.18). CCT loss was greatest during the earliest observation stages, following a square-root function of time at a rate of 0.393 mm/year 1/2 (95% CI 0.360, 0.423). Patients with a mean erythrocyte sedimentation rate (ESR) < 30 mm/h lost CCT at a rate of 0.303 mm/year 1/2 (95% CI 0.247, 0.358); those with a mean ESR > 30 and ≤ 60 mm/h lost CCT at 0.395 mm/year 1/2 (95% CI 0.345, 0.446); and those with ESR > 60 mm/h lost CCT at 0.554 mm/year 1/2 (95% CI 0.480, 0.628). Patients who received a cumulative dose of glucocorticoids ≥ 11.7 g lost CCT at 0.659 mm/year 1/2 (95% CI 0.577, 0.742), compared to 0.361 mm/year 1/2 (0.323, 0.401) in patients who did not receive glucocorticoids. In a multivariable model, the effect of the ESR and cumulative glucocorticoids was independent of age at RA onset, RA duration, sex, ethnic group, body mass index, presence of rheumatoid nodules, rheumatoid factor, and the HLA-DRB1 shared epitope. Conclusion. Early rapid loss of cortical diaphyseal bone occurs in patients with RA, followed by gradual slowing. Systemic inflammation and glucocorticoids seem to accelerate bone loss independently of other risk factors. Cortical diaphyseal bone may be an important target of the disease process in RA.

Original languageEnglish (US)
Pages (from-to)508-516
Number of pages9
JournalJournal of Rheumatology
Volume33
Issue number3
StatePublished - Mar 2006

Fingerprint

Diaphyses
Metacarpal Bones
Glucocorticoids
Rheumatoid Arthritis
Inflammation
Blood Sedimentation
Rheumatoid Nodule
Hand Bones
HLA-DRB1 Chains
Rheumatoid Factor
Ethnic Groups
Cortical Bone
Epitopes
Body Mass Index
Hand
Observation
Bone and Bones
N-(3-N-(benzyloxycarbonyl)amino-1-carboxypropyl)leucyl-O-methyltyrosine N-methylamide

Keywords

  • Bone diaphysis
  • Bone turnover
  • Cortical bone
  • Inflammatory markers
  • Osteoporosis
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

@article{a04a646d15de4904aec75ce2a1f6c739,
title = "Loss of cortical bone from the metacarpal diaphysis in patients with rheumatoid arthritis: Independent effects of systemic inflammation and glucocorticoids",
abstract = "Objective. To identify factors associated with the loss of cortical diaphyseal bone over time in patients with rheumatoid arthritis (RA). Methods. We measured the combined cortical thickness (CCT) of the second metacarpal bone from digitized hand radiographs in an RA cohort. We estimated the rate of loss of CCT, and tested the effect of factors that could accelerate the rate. Results. We studied 649 patients, who had 2990 hand radiographs. The median interval between the first and last followup radiograph was 2 years (range 0 to 23 yrs). The mean CCT at baseline was 4.04 mm (standard deviation 1.18). CCT loss was greatest during the earliest observation stages, following a square-root function of time at a rate of 0.393 mm/year 1/2 (95{\%} CI 0.360, 0.423). Patients with a mean erythrocyte sedimentation rate (ESR) < 30 mm/h lost CCT at a rate of 0.303 mm/year 1/2 (95{\%} CI 0.247, 0.358); those with a mean ESR > 30 and ≤ 60 mm/h lost CCT at 0.395 mm/year 1/2 (95{\%} CI 0.345, 0.446); and those with ESR > 60 mm/h lost CCT at 0.554 mm/year 1/2 (95{\%} CI 0.480, 0.628). Patients who received a cumulative dose of glucocorticoids ≥ 11.7 g lost CCT at 0.659 mm/year 1/2 (95{\%} CI 0.577, 0.742), compared to 0.361 mm/year 1/2 (0.323, 0.401) in patients who did not receive glucocorticoids. In a multivariable model, the effect of the ESR and cumulative glucocorticoids was independent of age at RA onset, RA duration, sex, ethnic group, body mass index, presence of rheumatoid nodules, rheumatoid factor, and the HLA-DRB1 shared epitope. Conclusion. Early rapid loss of cortical diaphyseal bone occurs in patients with RA, followed by gradual slowing. Systemic inflammation and glucocorticoids seem to accelerate bone loss independently of other risk factors. Cortical diaphyseal bone may be an important target of the disease process in RA.",
keywords = "Bone diaphysis, Bone turnover, Cortical bone, Inflammatory markers, Osteoporosis, Rheumatoid arthritis",
author = "Rold{\'a}n, {Jos{\'e} F.} and {Del Rincon}, Inmaculada and Agustin Escalante",
year = "2006",
month = "3",
language = "English (US)",
volume = "33",
pages = "508--516",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology",
number = "3",

}

TY - JOUR

T1 - Loss of cortical bone from the metacarpal diaphysis in patients with rheumatoid arthritis

T2 - Independent effects of systemic inflammation and glucocorticoids

AU - Roldán, José F.

AU - Del Rincon, Inmaculada

AU - Escalante, Agustin

PY - 2006/3

Y1 - 2006/3

N2 - Objective. To identify factors associated with the loss of cortical diaphyseal bone over time in patients with rheumatoid arthritis (RA). Methods. We measured the combined cortical thickness (CCT) of the second metacarpal bone from digitized hand radiographs in an RA cohort. We estimated the rate of loss of CCT, and tested the effect of factors that could accelerate the rate. Results. We studied 649 patients, who had 2990 hand radiographs. The median interval between the first and last followup radiograph was 2 years (range 0 to 23 yrs). The mean CCT at baseline was 4.04 mm (standard deviation 1.18). CCT loss was greatest during the earliest observation stages, following a square-root function of time at a rate of 0.393 mm/year 1/2 (95% CI 0.360, 0.423). Patients with a mean erythrocyte sedimentation rate (ESR) < 30 mm/h lost CCT at a rate of 0.303 mm/year 1/2 (95% CI 0.247, 0.358); those with a mean ESR > 30 and ≤ 60 mm/h lost CCT at 0.395 mm/year 1/2 (95% CI 0.345, 0.446); and those with ESR > 60 mm/h lost CCT at 0.554 mm/year 1/2 (95% CI 0.480, 0.628). Patients who received a cumulative dose of glucocorticoids ≥ 11.7 g lost CCT at 0.659 mm/year 1/2 (95% CI 0.577, 0.742), compared to 0.361 mm/year 1/2 (0.323, 0.401) in patients who did not receive glucocorticoids. In a multivariable model, the effect of the ESR and cumulative glucocorticoids was independent of age at RA onset, RA duration, sex, ethnic group, body mass index, presence of rheumatoid nodules, rheumatoid factor, and the HLA-DRB1 shared epitope. Conclusion. Early rapid loss of cortical diaphyseal bone occurs in patients with RA, followed by gradual slowing. Systemic inflammation and glucocorticoids seem to accelerate bone loss independently of other risk factors. Cortical diaphyseal bone may be an important target of the disease process in RA.

AB - Objective. To identify factors associated with the loss of cortical diaphyseal bone over time in patients with rheumatoid arthritis (RA). Methods. We measured the combined cortical thickness (CCT) of the second metacarpal bone from digitized hand radiographs in an RA cohort. We estimated the rate of loss of CCT, and tested the effect of factors that could accelerate the rate. Results. We studied 649 patients, who had 2990 hand radiographs. The median interval between the first and last followup radiograph was 2 years (range 0 to 23 yrs). The mean CCT at baseline was 4.04 mm (standard deviation 1.18). CCT loss was greatest during the earliest observation stages, following a square-root function of time at a rate of 0.393 mm/year 1/2 (95% CI 0.360, 0.423). Patients with a mean erythrocyte sedimentation rate (ESR) < 30 mm/h lost CCT at a rate of 0.303 mm/year 1/2 (95% CI 0.247, 0.358); those with a mean ESR > 30 and ≤ 60 mm/h lost CCT at 0.395 mm/year 1/2 (95% CI 0.345, 0.446); and those with ESR > 60 mm/h lost CCT at 0.554 mm/year 1/2 (95% CI 0.480, 0.628). Patients who received a cumulative dose of glucocorticoids ≥ 11.7 g lost CCT at 0.659 mm/year 1/2 (95% CI 0.577, 0.742), compared to 0.361 mm/year 1/2 (0.323, 0.401) in patients who did not receive glucocorticoids. In a multivariable model, the effect of the ESR and cumulative glucocorticoids was independent of age at RA onset, RA duration, sex, ethnic group, body mass index, presence of rheumatoid nodules, rheumatoid factor, and the HLA-DRB1 shared epitope. Conclusion. Early rapid loss of cortical diaphyseal bone occurs in patients with RA, followed by gradual slowing. Systemic inflammation and glucocorticoids seem to accelerate bone loss independently of other risk factors. Cortical diaphyseal bone may be an important target of the disease process in RA.

KW - Bone diaphysis

KW - Bone turnover

KW - Cortical bone

KW - Inflammatory markers

KW - Osteoporosis

KW - Rheumatoid arthritis

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