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Investigating the relationship between disease severity and low bone density in patients with axial spondyloarthropathy
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Nazanin Biazar1    , Zahra Shariati2 , Shima MosalaNejad3 , Mehdi Afkar4 , Basim Nikta1 |
1- Internal Medicine Resident, Department of Internal medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
2- Internal Medicine Specialist, Department of Internal medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran , shariatisima872@gmail.com
3- Internal Medicine Specialist, Department of Internal medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
4- Community Medicine Specialist, Department of Community Medicine, Faculty of Medicine, Tehran Medical Sciences Islamic Azad University, Tehran, Iran |
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Abstract: (523 Views) |
Background: Osteoporosis is a well-known problem in patients with spondyloarthropathy that may begin even in the early stages of the disease and cause debilitating complications. The aim of this study was to investigate the relationship between disease severity and low bone density in patients with axial spondyloarthropathy.
Materials and methods: In this study, 65 patients with axial spondyloarthropathy were included in the study, and the data including age, gender, BMI, CRP, 25(OH) vit.D, HLAB27, MRI of the sacroiliac joint and bilateral hip, disease duration, disease activity and the last BMD test was extracted from their records and analyzed with statistical software.
Results: Mean (and standard deviation) age, BMI, the duration of the disease, CRP, and ASDAS- CRP were 37.5±5/9 years, 24.7±1.8 kg/m2, 73.9±33.5 months, 14.2±3.2, and 2.2±0.5, respectively. 21.5% of patients had osteoporosis, 90/8% were HLAB27 positive, 78.5% had sacroiliac joint involvement and 66.2% had vitamin D deficiency. Gender (p=0.75), age (p=0.11), involvement of sacroiliac joints (p=0.13) and positive HLAB27 (p=0.75) were not significantly different in patients with and without osteoporosis. While, vitamin D deficiency (p<0.001), BMI (p<0.001), disease duration (p=0.01), CRP (p<0.001), and disease activity (p=0.004) were significantly higher in patients with osteoporosis.
Conclusion: The results of this study showed that disease activity, CRP, disease duration, BMI and vitamin D level are related to osteoporosis in these patients. Therefore, patients who have these risk factors should be prioritized to check bone density.
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| Keywords: Axial spondyloarthropathy, Osteoporosis, Vitamin D. |
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Full-Text [PDF 1418 kb]
(193 Downloads)
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Semi-pilot: Survey/Cross Sectional/Descriptive |
Subject:
Romatology
Received: 2023/12/19 | Accepted: 2024/02/14 | Published: 2024/11/30
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1. Vencevičienė L, Butrimienė I, Vencevičius R, Sadauskienė E, Kasiulevičius V, Šapoka V. Factors associated with bone mineral density loss in patients with spondyloarthropathies: A 4-year follow-up study. Medicina 2015;51:272-79. [ DOI:10.1016/j.medici.2015.08.001] 2. Liu H, Chen J, Zhuang XJ, Chen LC. Disease progression associated with low bone mass in axial spondyloarthropathy patients. Arch Osteoporos 2021;16:65. [ DOI:10.1007/s11657-021-00928-3] 3. Carette S, Graham D, Little H, Rubenstein J, Rosen P. The natural disease course of ankylosing spondylitis. Arthritis Rheum 1983;26:186-90. [ DOI:10.1002/art.1780260210] 4. Tan S, Wang R, Ward MM. Syndesmophyte growth in ankylosing spondylitis. Curr Opin Rheumatol 2015;27:326-32. [ DOI:10.1097/BOR.0000000000000179] 5. Gran JT, Skomsvoll JF. The outcome of ankylosing spondylitis: a study of 100 patients. Br J Rheumatol 1997;36:766-71. [ DOI:10.1093/rheumatology/36.7.766] 6. Zilber K, Gorenberg M, Rimar D, Boulman N, Kaly L, Rozenbaum M, et al. Radionuclide Methods in the Diagnosis of Sacroiliitis in Patients with Spondyloarthritis: An Update. Rambam Maimonides Med J 2016;7:e0037. [ DOI:10.5041/RMMJ.10264] 7. Melchior J, Azraq Y, Chary-Valckenaere I, Rat A-C, Reignac M, Texeira P, et al. Radiography, abdominal CT and MRI compared with sacroiliac joint CT in diagnosis of structural sacroiliitis. Europ j radiol 2017;95:169-76. [ DOI:10.1016/j.ejrad.2017.08.004] 8. Reid IR. Vitamin D effect on bone mineral density and fractures. Endocrinol Metabol Clin 2017;46:935-45. [ DOI:10.1016/j.ecl.2017.07.005] 9. Kriegel MA, Manson JE, Costenbader KH, editors. Does vitamin D affect risk of developing autoimmune disease?: a systematic review. Semin Arthritis Rheum 2011;40512-531. 10. Bikle DD. Vitamin D metabolism, mechanism of action, and clinical applications. Chemist Biol 2014;21:319-29. [ DOI:10.1016/j.chembiol.2013.12.016] 11. Vargas-Alarcón G, Londono J, Hernandez-Pacheco G, Pacheco-Tena C, Castillo E, Cardiel M, et al. Effect of HLA-B and HLA-DR genes on susceptibility to and severity of spondyloarthropathies in Mexican patients. Ann Rheum Dis 2002;61:714-7. [ DOI:10.1136/ard.61.8.714] 12. Khan MA. HLA-B27 and its subtypes in world populations. Curr Opin Rheumatol 1995;7:263-9. [ DOI:10.1097/00002281-199507000-00001] 13. de Castro JL. The pathogenetic role of HLA-B27 in chronic arthritis. Curr Opin Rheumatol 1998;10:59-66. [ DOI:10.1016/S0952-7915(98)80033-2] 14. Nicknam MH, Ganjalikhani Hakemi M, Jamshidi AR, Khosravi F, Amirkhani A, Narouinejad M, et al. Association between HLA-b27 antigen and ankylosing spondylitis in Iranian patients. Hakim Res J 2005;8:29-34. [In Persian] 15. Donnelly S, Doyle D, Denton A, Rolfe I, McCloskey E, Spector T. Bone mineral density and vertebral compression fracture rates in ankylosing spondylitis. Ann Rheum Dis 1994;53:117-21. [ DOI:10.1136/ard.53.2.117] 16. Singh A, Bronson W, Walker SE, Allen SH. Relative value of femoral and lumbar bone mineral density assessments in patients with ankylosing spondylitis. Southern Med J 1995;88:939-43. [ DOI:10.1097/00007611-199509000-00010] 17. Briot K, Etcheto A, Miceli-Richard C, Dougados M, Roux C. Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis: results from the prospective DESIR cohort. Rheumatology (Oxford) 2016;55:335-42. [ DOI:10.1093/rheumatology/kev332] 18. Ulu MA, Çevik R, Dilek B. Comparison of PA spine, lateral spine, and femoral BMD measurements to determine bone loss in ankylosing spondylitis. Rheumatol Int 2013;33:1705-11. [ DOI:10.1007/s00296-012-2632-9] 19. Lange U, Kluge A, Strunk J, Teichmann J, Bachmann G. Ankylosing spondylitis and bone mineral density-what is the ideal tool for measurement? Rheumatol Int 2005;26:115-20. [ DOI:10.1007/s00296-004-0515-4] 20. Karberg K, Zochling J, Sieper J, Felsenberg D, Braun J. Bone loss is detected more frequently in patients with ankylosing spondylitis with syndesmophytes. Rheumatol Int 2005;32:1290-8. 21. Briot K, Durnez A, Paternotte S, Miceli-Richard C, Dougados M, Roux C. Bone oedema on MRI is highly associated with low bone mineral density in patients with early inflammatory back pain: results from the DESIR cohort. Ann Rheum Dis 2013;72:1914-9. [ DOI:10.1136/annrheumdis-2012-201845] 22. Akgöl G, Kamanlı A, Ozgocmen S. Evidence for inflammation-induced bone loss in non-radiographic axial spondyloarthritis. Rheumatology (Oxford) 2014;53:497-501. [ DOI:10.1093/rheumatology/ket385] 23. Mullaji A, Upadhyay S, Ho E. Bone mineral density in ankylosing spondylitis. DEXA comparison of control subjects with mild and advanced cases. J Bone Joint Surg Bri 1994;76:660-5. [ DOI:10.1302/0301-620X.76B4.8027159] 24. Baek H, Kang S, Lee Y, Shin K, Lee E, Yoo C, et al. Osteopenia in men with mild and severe ankylosing spondylitis. Rheumatol Int 2005;26:30-4. [ DOI:10.1007/s00296-004-0516-3] 25. Obermayer-Pietsch BM, Lange U, Tauber G, Frühauf G, Fahrleitner A, Dobnig H, et al. Vitamin D receptor initiation codon polymorphism, bone density and inflammatory activity of patients with ankylosing spondylitis. Osteoporos Int 2003;14:995-1000. [ DOI:10.1007/s00198-003-1501-5] 26. Kim H-R, Kim H-Y, Lee S-H. Elevated serum levels of soluble receptor activator of nuclear factors-κB ligand (sRANKL) and reduced bone mineral density in patients with ankylosing spondylitis (AS). Rheumatology (Oxford) 2006;45:1197-200. [ DOI:10.1093/rheumatology/kel072] 27. Mermerci Başkan B, Pekin Doğan Y, Sivas F, Bodur H, Özoran K. The relation between osteoporosis and vitamin D levels and disease activity in ankylosing spondylitis. Rheumatol Int 2010;30:375-81. [ DOI:10.1007/s00296-009-0975-7] 28. Grazio S, Kusić Z, Cvijetić S, Grubišić F, Balenović A, Nemčić T, et al. Relationship of bone mineral density with disease activity and functional ability in patients with ankylosing spondylitis: a cross-sectional study. Rheumatol Int 2012;32:2801-8. [ DOI:10.1007/s00296-011-2066-9] 29. Jun J-B, Joo K-B, Her M-Y, Kim T-H, Bae S-C, Yoo D-H, et al. Femoral bone mineral density is associated with vertebral fractures in patients with ankylosing spondylitis: a cross-sectional study. J Rheumatol 2006;33:1637-41. 30. Vasdev V, Bhakuni D, Garg MK, Narayanan K, Jain R, Chadha D. Bone mineral density in young males with ankylosing spondylitis. Int J Rhe Dis 2011;14:68-73. [ DOI:10.1111/j.1756-185X.2010.01577.x] 31. Toussirot E, Michel F, Wendling D. Bone density, ultrasound measurements and body composition in early ankylosing spondylitis. Rheumatology (Oxford) 2001;40:882-8. [ DOI:10.1093/rheumatology/40.8.882] 32. Speden DJ, Calin AI, Ring FJ, Bhalla AK. Bone mineral density, calcaneal ultrasound, and bone turnover markers in women with ankylosing spondylitis. J Rheumatol 2002;29:516-21. 33. Prieto-Alhambra D, Muñoz-Ortego J, De Vries F, Vosse D, Arden N, Bowness P, et al. Ankylosing spondylitis confers substantially increased risk of clinical spine fractures: a nationwide case-control study. Osteoporosis Int 2015;26:85-91. [ DOI:10.1007/s00198-014-2939-3] 34. Kang KY, Lee KY, Kwok S-K, Ju JH, Park K-S, Hong YS, et al. The change of bone mineral density according to treatment agents in patients with ankylosing spondylitis. Joint Bone Spine 2011;78:188-93. [ DOI:10.1016/j.jbspin.2010.05.010] 35. Briot K, Garnero P, Le Henanff A, Dougados M, Roux C. Body weight, body composition, and bone turnover changes in patients with spondyloarthropathy receiving anti-tumour necrosis factor α treatment. Ann Rheum Dis 2005;64:1137-40. [ DOI:10.1136/ard.2004.028670] 36. Allali F, Breban M, Porcher R, Maillefert J, Dougados M, Roux C. Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor α. Ann Rheum Dis 2003;62:347-9. [ DOI:10.1136/ard.62.4.347] 37. Briot K, Gossec L, Kolta S, Dougados M, Roux C. Prospective assessment of body weight, body composition, and bone density changes in patients with spondyloarthropathy receiving anti-tumor necrosis factor-alpha treatment. J Rheumatol 2008;35:855-61. 38. Kirveskari J, Kellner H, Wuorela M, Soini H, Frankenberger B, Leirisalo-Repo M, et al. False-negative serological HLA-B27 typing results may be due to altered antigenic epitopes and can be detected by polymerase chain reaction. Br J Rheumatol 1997;36:185-9. [ DOI:10.1093/rheumatology/36.2.185] 39. Kelley WN, Harris ED, Ruddy S, Sledge CB, Eds. Textbook of rheumatology. 3rd ed. Philadelphia: WB Saunders; 1989. P.2144. 40. Ren E, Koh W, Sim D, Boey M, Wee G, Chan S. Possible protective role of HLA‐B* 2706 for ankylosing spondylitis. Tissue Antigens 1997;49:67-9. [ DOI:10.1111/j.1399-0039.1997.tb02713.x] 41. González S, Martínez-Borra J, López-Larrea C. Immunogenetics, HLA-B27 and spondyloarthropathies. Curr Opin Rheumatol 1999;11:257-64. [ DOI:10.1097/00002281-199907000-00006] 42. Braun J, Bollow M, Remlinger G, Eggens U, Rudwaleit M, Distler A, Sieper J. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 1998;41:58-67.
https://doi.org/10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G [ DOI:10.1002/1529-0131(199801)41:13.0.CO;2-G] 43. Brown M, Wordsworth P. Predisposing factors to spondyloarthropathies. Curr Opinin Rheumatol 1997;9:306-14. [ DOI:10.1097/00002281-199707000-00006] |
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Biazar N, Shariati Z, MosalaNejad S, Afkar M, Nikta B. Investigating the relationship between disease severity and low bone density in patients with axial spondyloarthropathy. MEDICAL SCIENCES 2024; 34 (4) :420-430 URL: http://tmuj.iautmu.ac.ir/article-1-2202-en.html
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