Romatoid Artritte Hastalık Aktivite Skorları Ile Kemik Mineral Yoğunluğu Arasındaki Ilişki

Year 2014, Volume: 4 Issue: 3, - , 28.06.2014

Mehmet Uçar

Abstract

Romatoid Artritte Hastalık Aktivite Skorları Ile Kemik Mineral Yoğunluğu Arasındaki  Ilişki

Amaç: Çalışmamızda Romatoid Artritli hastalarda hastalık aktivite skorları ile kemik mineral yoğunluğu arasındaki ilişkiyi araştırdık.

 

Metod: Çalışmaya Amerikan Romatizma Birliği (ACR) kriterlerine göre RA tanısı konulan ve kliniğimiz de izlenmekte olan 50 kadın hasta alındı. Olguların demografik özellikleri, şiş ve hassas eklem sayıları, hasta ve doktorun hastalık aktivitesini global değerlendirimi Vizüel ağrı skalası (VAS) ile, laboratuar verilerinden eritrosit sedimantasyon hızı ve

C-reaktif protein ve kemik mineral yoğunluğu düzeyleri kaydedildi. Klinik skorlar olarak Sağlık Değerlendirme Anketi ve  Ritchie artiküler indeksi değerlendirildi. Olguların hastalık aktivite skoru DAS-28 indeksi ile hesaplandı. İstatiksel analizde Graph Pad Prisma V3 paket programı kullanıldı. Verilerin değerlendirilmesinde tanımlayıcı istatiksel metodların (ortalama, standart sapma) yani değişkenlerin birbirleri ile ilişkilerini belirlemede Pearson Korelasyon testi kullanılmıştır.

Bulgular: Lomber KMY skoru ile DAS-28 ve HAQ, RAİ arasında kuvvetli korelasyon saptandı (p<0.001). Ayrıca Lomber total t skoru ile DAS-28 ve HAQ, RAİ arasında kuvvetli korelasyon saptandı (p<0.001) (tablo 3). Femur KMY skoru ve femur total t skoru ile DAS-28 ve HAQ, RAİ arasında herhangi bir korelasyon yoktu (p>0.05).

Sonuçlar: Çalışmanın sonucunda hastalık aktivite parametreleri ile KMY değerleri arasında kuvvetli bir ilişkinin olması özellikle enflamasyonun ağır seyrettiği ve tedaviye rağmen enflamasyonun baskılanamadığı hastalarda osteoporoz ve kırık riski açısından dikkatli olunması gerektiğini bildiririz.

 

Bone Mineral Density Correlation Between Disease Activity Scores In Patients With Rheumatoid Arthritis

 

Objective: In this study we researched for the relationship between  the disease activity scores and the bone mineral density in rheumatoid arthritis patients. 

 

Methods: 50 female patients who were diagnosed as RA according to the American College of Rheumatology (ACR) criteria were included for the study. The demographic characteristics, swollen and tender joint counts, patient and physician disease activity evaluation v(by visual analogue scale:VAS), laboratory data of the erythrocyte sedimentation rate and C-reactive protein and bone mineral density levels were recorded. The clinical parameters was assessed by the Health Assessment Questionnaire and Ritchie articular index. Disease activity scores were calculated by DAS-28 index. Graph Pad Prisma V3 statistical analysis software package was used for statistical analysis. Pearson's correlation test was used for the relationships between  the variables.

Results: RAI, HAQ and DAS-28 scores had a strong correlation with  lumbar BMD (p <0.001). In addition, RAI, HAQ and DAS-28 scores had a strong correlation with total lumbar t score as well (p <0.001) (table 3). There was no correlation between Femur BMD, total hip BMD t scores and DAS-2, HAQ and  RAI scores (p> 0.05).

 

 

Conclusion: We report that there is a strong relation between disease activity parameters and BMD levels in RA patients, and one should bear in mind that especially the patients resistant to the treatment have risk for osteoporosis and fracture. 

Keywords

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References

• KAYNAKLAR
• Schett G: Erosive arthritis. Arthritis Res Ther 2007,9(1):2.
• Goldring SR. Periarticular bone changes in rheumatoid arthritis: pathophysiological implications and clinical utility. Ann Rheum Dis 2009,68(3):297-299.
• Fardellone P, Séjourné A, Paccou J, Goëb V. Bone remodelling markers in rheumatoid arthritis. Mediators Inflamm. 2014;2014:484280
• Aizer J, Reed G, Onofrei A, Harisson MJ. Predictors of bone density testing in patients with rheumatoid arthritis. Rheumatol Int. 2009;29(8): 897–905.
• Stewart A, Mackenzie LM, Black AJ, Reid DM. Predicting erosive disease in rheumatoid arthritis. A longitudinal study of changes in bone density using digital X-ray radiogrammetry: a pilot study. Rheumatology.2004;43(12):1561–1564.
• Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31(3):315–324.
• Van Gestel AM,
• Haagsma CJ, van Riel PLCM. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 1998; 41(10):1845–1850.
• Fries J, Spitz P, Kraines R, Holman H. Measurement of patient outcome in arthritis. Arthritis and Rheumatism 1980;23(2):137-145.
• Kücükdeveci AA, Şahin H, Ataman S, Griffi ths B, Tennant A. Issues in crosscultural validity: example from the adaptation, reliability and validity testing of a Turkish version of the Standford Health Assessment Questionnaire. Arthritis Care Res 2004;51(1):14-19.
• Ritchie DM, Boyle JA, McInnes JM, Jasani MK, Dalakos TG, Grieveson P, Buchanan WW. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968;37(147):393-406.
• -
• Laan RF, van Riel PL, van de Putte LB. Bone mass in patient with rheumatoid arthritis. Ann Rheum Dis 1992;51(6):826–832.
• Shiozawa S, Kuroki Y. Osteoporosis in Rheumatoid Arthritis: A Molecular Biological
• Aspect of Connective Tisue Gene Activation. Tohoku J Exp Med 1994;173(1):189–198.
• Shibuya K, Hagino H, Morio Y, Teshima R. Crosssectional and longitudinal study of osteoporosis in patients with rheumatoid arthritis. Clin Rheumatol 2002; 21(2): 150-158.
• Sinigaglia L, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O, et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 2000;27(11):2582–2589.
• Martin JC, Munro R, Campbell MK, Reid DM. Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol 1997;36(1):43–49.
• Günaydın R, Altınay GK, Kaya T. Romatoid Artritte El Kemik Mineral Yoğunluğu ve Kemik Döngüsünün Biyokimyasal Göstergeleri. Romatizma 2006;21: 45-48
• Deodhar AA, Brabyn J, Jones PW et al. Longitudinal study of hand bone densitometry in rheumatoid arthritis. Arthritis Rheum 1995;38(9):1204-1210.
• -
• Deodhar AA, Brabyn J, Pande I et al. Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker. Ann Rheum Dis 2003;62(8):767-770
• Berglin E, Lorentzon R, Nordmark L et al. Predictors of radiological progression and changes in hand bone density in early rheumatoid artritis. Rheumatology (Oxford) 2003;42(2):268-275
• Dolan AL, Moniz C, Abraha H, Pitt P. Does active reatment of rheumatoid arthritis limit disease-associated bone loss? Rheumatology (Oxford) 2002;41(:1047-1051.
• Hoff M, Haugeberg G, Odegard S, Syversen S, Landewe R, van der Heijde D, Kvien TK: Cortical hand bone loss after 1 year in early rheumatoid arthritis predicts radiographic hand joint damage at 5-year and 10-year follow-up. Ann Rheum Dis 2009,68(3):324-329.
• Wolfe F, Sharp JT: Radiographic outcome of recent-onset rheumatoid arthritis: a 19-year study of radiographic progression. Arthritis Rheum 1998,41(9):1571-1582.
• Akın S, Güleç O, Beyazova M, Korkusuz F. Romatoid artritte el kemik mineral yoğunluğu ve kemik döngüsünün biyokimyasal göstergeleri. Romatizma, 2004;19 (1):1-6
• Hafez EA, Mansour HE, Hamza SH, Moftah SG, Younes TB, Ismail MA. Bone mineral density changes in patients with recent-onset rheumatoid arthritis. Clin Med Insights Arthritis Musculoskelet Disord. 2011;4:87-94
• di Munno O, Mazzantini M, Sinigaglia L, et al. Effect of low dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study. J Rheumatol 2004;31(7):1305–9.
• Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis register. Arthritis Rheum 2000;43(3):522 30.
• Gürsoy S, Adam M. Romatoid artritli olguların fonksiyonel durumu, hastalık süresi, ESH, KMY degerleri, osteokalsin ve CRP düzeyi arasında korelâsyonların varlıgının arastırılması. Romatizma Dergisi 2000;15(3):167–171.
• Gough AK, Lilley J, Eyre S,et al. Generalised bone loss in patients with early rheumatoid arthritis. Lancet 1994;344(8914):23–7.