Generalised bone loss in patients with early rheumatoid arthritis.
Abstract
Generalised osteoporosis is a feature of established rheumatoid arthritis but whether this is a consequence of treatment, immobility, or disease activity has been unclear. We estimated bone mineral density by dual energy x-ray absorptiometry on 148 patients with early rheumatoid arthritis before treatment with corticosteroids or disease-modifying drugs and 730 normal controls. Scans were done at 12-month intervals in patients and at 0 and 12 months on 50 of the controls matched for menopausal status. At presentation, bone mineral density of patients did not differ from controls. However, patients with disease for less than 6 months had significantly higher spinal bone mineral density than those of longer duration. Over the next 12 months, bone mineral density loss was greater in patients with rheumatoid arthritis compared with controls; significantly so for early disease (eg, -2.4 [0.8] vs -0.6 [0.4] g/cm2, p < 0.05 in the spine and -4.3 [0.8] vs -0.4 [0.5] g/cm2, p < 0.001 in the trochanter). For the lumbar spine, only disease activity was significantly associated with this bone mineral density loss. For patients with active disease over 2 years, mean bone mineral density loss at each site was between 5.5 and 10% (p < 0.01 compared to patients with inactive disease). Suppression of disease activity stabilised this bone loss. In patients with rheumatoid arthritis significant amounts of generalised skeletal bone were lost early in the disease and the loss was associated with disease activity. These findings have implications for the management of patients with rheumatoid arthritis and possibly other inflammatory diseases.
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Rheumatoid arthritis is characterized by multiple forms of osteoclast-mediated bone loss, including focal bone erosions at the bone-pannus junction, subchondral bone loss adjacent to inflamed joints, and generalized systemic bone loss.
“multiple forms of osteoclast-mediated bone loss that are characteristic of the disease, including focal bone erosions at the bone-pannus junction of inflamed joints, subchondral (periarticular) bone loss adjacent to inflamed joints, and generalized systemic bone loss (223-227).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [224]
Systemic bone loss and increased fracture risk are important components of RA.
“In addition to focal bone erosions and periarticular bone loss, systemic bone loss and increased fracture risk are important components of RA (224, 239, 420 -422).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [224]
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- Authors
- GOUGH, A.
- Affiliations
- University of Birmingham (GB)
- Corresponding author
- GOUGH, A
- ORCID
- GOUGH, A
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 1994-07
- Volume
- 344
- Issue
- 8914
- Pages
- 23-27
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2086103128
- Cited by
- 630
- References
- 27
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 11 · 2023: 6 · 2022: 9 · 2021: 16 · 2020: 19 · 2019: 17 · 2018: 11 · 2017: 18 · 2016: 15 · 2015: 30 · 2014: 36 · 2013: 24 · 2012: 42
- FWCI
- 15.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- rheumatoid arthritis, early rheumatoid arthritis, bone mineral density, bone loss, osteoporosis, disease activity, disease duration, spinal bone mineral density, disease-modifying drugs, corticosteroids, immobility
- MeSH terms
- Arthritis, Rheumatoid, Female, Humans, Longitudinal Studies, Male, Osteoporosis, Prospective Studies, Absorptiometry, Photon, Bone Density, Premenopause, Postmenopause
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