الفهرس 
RHEUMATOID ARTHRITISOnly 14 pages are availabe for public view
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Abstract
Rheumatoid arthritis (RA) is a systemic and chronic inflammatory disease that has been associated with disability, the existence of comorbidities, and decreased life expectancy in which osteoporosis is recognized as a major source of morbidity in rheumatoid arthritis (RA).
The present study was designed to evaluate the change in BMD in patients with recent onset RA<1year as well as the effect of inflammation, mobility, and the use of drugs such as steroids and DMARDS on this change.
Our study included 30 patients with recent onset RA (<1year) fulfilling the ACR diagnostic criteria for RA and 20 normal individuals as controls.
All included patients were subjected to full history taking with special emphasis on: age, sex, disease duration, drugs intake (steroids, NSAIDS, and DMARDS), history of smoking and menopausal state in women. Through clinical examination with special emphasis on joint examination, laboratory investigations including complete blood count, ESR, CRP, liver function tests, renal function tests, RF, plain X-rays on both hands and feet and DEXA was used to measure BMD of the proximal femur, lumbar spine (L1-L4) and lower radius at the time of recruitment.
In the present study the age of our patients ranged from 23-54 years, we found that RA affects females more than males with female to male ratio 2:1. Out of the 30 patients included in the study, 3 patients (16.6%) were in remission, 1 patient (3.3%) was in a state of mild disease activity, 17 patients (56.6%) were in a state of moderate disease activity and 7 patients (23.3%) were in a state of severe disease activity according to DAS28.
In this study, we found that RF was positive in 23 patients (76.6%) and negative in 7 patients (23%).
Regarding CRP as a marker of inflammation we found that the incidence of osteoporosis was statistically significant higher in CRP positive than in CRP negative RA patients.
Our results showed that 13.3% of the patients with RA had osteoporosis, 50% had osteopenia, and 36.7% had normal BMD. The most common site for osteoporosis was the lumbar spine (4 patients (13.3%)) followed by the Lt femur (2 patients (6.6%)), followed by the Lt forearm (only 1 patient (3.3%)).
We reported that there was a higher percentage of osteoporosis among males compared to females and the difference was statistically highly significant (P=0.009). Also in our results, we found higher percentage of osteoporosis among patients treated with corticosteroids and DMARD compared to patients treated with NSAIDs (p=0.004).
Disability and physical activity as measured by Health assessment questionnaire (HAQ) showed more disability among cases with osteoporosis compared to patients with osteopenia or normal BMD.
Disease activity as measured by DAS 28 showed higher score among patients with osteoporosis compared to normal or osteopenic patients but the difference wasn’t significant statistically.
Moreover, radiological joint damage assessment by using Van Heijdi modification of sharp method showed that there was higher SENS score among patients with osteoporosis.
So reduced BMD can be used to predict future joint damage. The occurrence of osteoporosis was statistically significantly increased among CRP positive patients when compared to patients who were CRP negative. Higher percentage of osteoporosis among patients treated with corticosteroids or DMARD compared to patients treated with NSAIDs only.