JANUARY 15, 2005

Make no bones about it

Rheumatoid arthritis eats away bone

Radiological pictures speak a thousand words — and the news
doesn't bode well for mineral density scores

As the popular childhood song goes, "the toe bone's connected to the foot bone," and so on, but it neglects to mention where the joints fit into the picture. According to research published in the December issue of the Annals of the Rheumatic Diseases, this may be a grave omission. The report links severe rheumatoid arthritis to an increased risk of generalized bone loss.

The study population was 373 middle-aged, mostly female patients who had low to moderate rheumatoid arthritis. They'd been recruited to help evaluate the effects of a gung-ho exercise program vs conventional physical therapy.

Demographic and clinical data such as age, weight and disease severity was collected. Rheumatoid arthritis had been part of the patients' lives for around seven years. The subjects had median scores of 27 for the hands and feet, according to the Larsen scoring system, which uses radiology to determine the extent of bone erosion and joint space narrowing. Eighty-three percent of them had never used corticosteroids, which are confirmed culprits in bone loss.

The mineral density of the patients' bones was assessed using a technique called dual X-ray absorptiometry. Dr M C Lodder of VU University Medical Centre in Amsterdam and colleagues discovered osteoporosis in the neck in 6.5% of the women and in the spine in 12.6% of them. When the researchers took a peek at the bone mass in those locales, a reduced amount of bone was apparent in the neck in almost 19% of the women and in the spine in nearly 21%.

When statistical associations between rheumatoid arthritis and the demographic/clinical data, as well as with the bone mass determinations, were explored, a high Larsen score was found to be strongly associated with a low bone mineral density (BMD) of the hip.

The researchers concluded that there was "an association between high radiological [rheumatoid arthritis] damage and low [BMD] at the hip, which suggests an association between the severity of [rheumatoid arthritis] and the risk for generalized bone loss." Further, according to the researchers, bone loss may occur even in "corticosteroid-naive patients."



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