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Objective:To investigate the synergistic effect of sarcopenia and osteoporosis on the occurrence of spinal osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods:A total of 389 hospitalized RA patients and 156 age and sex-matched normal subjects (control group) were recruited. Dual energy X-ray absorptiometry (DEXA) method was used to measure bone mineral density (BMD) of lumbar spine and hip, and bioelectrical impedance method was applied to determine skeletal muscle mass of limbs. X-ray examination of spin was conducted and spinal OPF was diagnosed according to semi-quality method. Student's t test was used for comparison of measurement date between the two groups, χ2 test was used for comparison of intergroup rates, and Logistic Regression(Backward LR) method was used for multivariate Regression analysis of binomial classification data. Results:BMD of all test sites in RA patients was significantly lower than that in the control group ( P<0.01). The incidence of total OP in RA group was significantly higher than that in the control group [(32.9% vs 12.8%), χ2=22.706, P<0.01]. A total of 84 patients with RA developed spinal OPF, with an incidence of 21.6% which was higher than that in the control group [(3.8%), χ2=25.439, P<0.01]. The incidence of sarcopenia in RA was 54.8%, significantly higher than that in the control group [(9.6%), χ2=93.241, P<0.01]. The incidence of sarcopenia combined with osteoporosis in RA group (28.5%) was significantly higher than that in the control group [(5.8%), χ2=118.110, P<0.01]. Comparison of the incidence of spinal OPF in RA patients among groups with different bone mass (normal bone mass, osteopenia, osteoporosis) showed that the incidence of spinal OPF among these groups was statistically different ( χ2=43.373, P<0.01), and the incidence of spinal OPF increased along with the decrease of bone mass ( χ2=43.003, P<0.01). The incidence of spinal OPF in RA patients with sarcopenia (27.2%, 58/213) was significantly higher than that in RA patients without sarcopenia [(14.8%, 26/176), χ2=8.833, P=0.003]. All participants were divided into three groups: group 1=no OP and sarcopenia, group 2=with sarcopenia or OP, group 3=both sarcopenia and OP. Difference of incidence of spine OPF in RA patients among three groups was statistically significant ( χ2=33.832, P<0.01), and the incidence of spinal OPF raised gradually in group 1 and 3, ( χ2=37.164, P<0.01). Incidences of sarcopenia, OP and spinal OPF in RA treated with glucocorticoid (GC) were higher than those in RA without GC ( P<0.05, P<0.01). Results of logistic regression showed advanced age[ OR(95% CI)=1.069(1.038, 1.101), P<0.01], usage of GC [ OR(95% CI)=3.169(1.679, 5.984), P<0.01] and sarcopenia combined with OP [ OR(95% CI)=2.113(1.430, 3.124), P<0.01] were risk factors for spinal OPF in RA patients. Conclusion:Incidences of sarcopenia, OP and spinal OPF in RA patients are higher than that in normal controls. Sarcopenia and OP have a synergistic effect on spinal OPF in RA patients.
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Objective:To explore the clinical value of sarcopenia and vitamin D deficiency on gluco-corticoid induced osteoporosis (GIOP) in patients with rheumatoid arthritis (RA).Methods:Three hundred and eleven patients with RA from January 2017 to December 2018 were enrolled in the study. One hundred and fifty-eight sex, age-matched normal subjects were recruited as control group. Clinical and laboratory features, daily dosage and treatment duration of glucocorticoid (GC) were recorded in detail. Skeletal muscle mass was measured by biological electrical impedance. Serum levels of 25-hydroxy vitamin D [25(OH)D] were examined using electro-chemiluminescence. Bone mineral density (BMD) at total hip and lumbar vertebra were detected by dual energy X-ray absorptiometry (DEXA). Numerical data and categorical data comparisons were analyzed using χ2 test, non-parametric test, Logistic regression analysis test. Results:① The prevalence of osteoporosis (OP) in RA patients was 33.4%(104/311), which was higher than that in the control group 12.7%(20/158)( χ2=23.267, P<0.01). Percentage of GC taking in 311 RA patients was 56.6%(176/311), and the prevalence of GIOP was 40.9%(72/176). The prevalence of sarcopenia in RA patients was 61.7%(192/311), which was higher than that in the control group [9.0%(14/156), χ2=117.310, P<0.01]. The prevalence of vitamin D deficiency in RA patients was 81.7%(254/311), which was higher than that in control group [38.0%(60/158), χ2=90.415, P<0.01]. ② The prevalence of OP in RA without sarcopenia was 17.6% (21/119), which was lower than that in patients with sarcopenia [43.2%(83/192), χ2=21.601, P<0.01]. In condition without GC, the prevalence of OP in RA without sarcopenia was 9.8%(6/61), which was significantly lower than that in patients with sarcopenia [35.1%(26/74), χ2=11.834, P<0.01]. Under circumstances with GC, the prevalence of OP in RA without sarcopenia (25.9%, 15/58), which was significantly lower than that in patients with sarcopenia (48.3%, 57/118, χ2=8.103, P<0.01). ③ No matter whether existing vitamin D deficiency or not, the prevalence of OP in RA without GC was 23.7%(32/135), which was significantly lower than that in patients with GC [40.9%(72/176), χ2=10.161, P<0.01]. In patients without vitamin D deficiency, the prevalence of OP in RA without GC was 21.4%(6/28), which was similar to that in patients with GC [31.0%(9/29), χ2=0.678, P>0.05]. In the case of vitamin D deficiency, the prevalence of OP in RA without GC was 24.3%(24/107), which was significantly lower than that in patients with GC [42.9% (63/147), χ2=9.370 2, P<0.01]. ④ In RA patients with GC, age( t=5.313, P<0.01), Sharp score ( Z=2.999, P<0.01), disease duration ( Z=2.141, P<0.05) and treatment duration of GC ( Z=2.460, P<0.05) were higher in group with GIOP than that in group without GIOP, while erythrocyte sedimentation rate (ESR)( Z=2.262, P<0.05), C-reactive protein levels (CRP) ( Z=2.551, P<0.05) and body mass index (BMI) ( t=2.425, P<0.05) were lower and the composition ratio of X-ray staging was worse ( χ2=12.484, P<0.01).⑤ Logistic regression analysis (LR Backward) showed that female gender [ OR(95% CI)=14.240(3.878, 52.288), P<0.01], age [ OR(95% CI)=1.079(1.042, 1.118), P<0.01] and sarcopenia [ OR(95% CI)=2.470(1.192, 5.120), P<0.05] were the risk factors for GIOP in RA patients. Conclusion:The proportion of treatment with GC in RA patients is very high (about 60%), and the prevalence of GIOP is 40.9%, which is closely related to sarcopenia and vitamin D deficiency.
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Objective@#To investigate factors affecting X-ray structure of the spine in patients with ankylosing spondylitis (AS).@*Methods@#A total of 206 AS patients were recruited. Clinical and laboratory parameters in AS patients were recorded in detail. Disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp)], X-ray structural damage index-modified stoke ankylosing spondylitis spine score (mSASSS) and grading results of radiographic examination of sacroiliac joint were calculated. Statistical analysis using Statistical Package form Soci-science(SPSS) 17.0 Chi-square test, rank test, Logistics regression analysis and other statistical methods were used. Differences of mSASSS levels, spine involvement (mSASSS>0) and rates of bone bridge formation were compared between different groups.@*Results@#Incidences of spine involvement (100%) and bone bridge formation(65.2%) in AS patients ≥40 years old were significantly higher than those in AS patients <40 years old (90.6%、31.9%)(χ2=4.651, P=0.031; χ2=16.647, P<0.01), and the level of mSASSS was also higher (Z=5.575, P<0.01). In AS patients with BMI ≥24 kg/m2, disease duration ≥5 years (49.2%, 50.4%), rates of bone bridge formation was significantly higher than those in AS with BMI <24 kg/m2, but the disease duration (34.5%, 19.7%)(χ2=4.014, P=0.045; χ2=18.173, P=0.03), and mSASSS values were significantly higher (Z=2.281, P=0.023, Z=4.828, P<0.01). Bone bridge formation rate in smoking patients (50.6%) was significantly higher than that in non-smoking patients (31.0%) (χ2=7.346, P=0.007) and mSASSS value was significantly higher (Z=2.045, P=0.041). Bone bridge formation rates in AS with high-ESR and high-CRP(48.6%, 49.0%) were significantly higher than those in patients with normal-ESR and normal-CRP(25.6%, 28.9%)(χ2=10.784, P=0.001; χ2=8.102, P=0.004) and mSASSS value was clearly higher(Z=2.379, P<0.01; Z=3.112, P<0.01). Bone bridge formation rate in AS with BASDAI≥4 or ASDAScrp≥2.1 groups (52.8%, 46.4%) were significantly higher than that in AS with BASDAI<4 or ASDAScrp<2.1 groups (34.2%, 30.7%) (χ2=5.681, P=0.017; χ2=4.646, P=0.031) and mSASSS values were significantly higher (Z=3.887, P<0.01; Z=3.895, P=0.004). Rates of bone bridge formation among different X-ray grading of sacroiliac joint (10.8%, 35.6%, 60.3%) and MRI findings (33.3%, 50.0%, 15.4%) differed with each other (χ2=25.714, P<0.01; χ2=6.855, P=0.032). Logistics regression analysis showed that BMI [OR(95%CI)=1.145(1.037, 1.265), P<0.01], disease duration [OR(95%CI)=1.144(1.055, 1.239), P<0.01], smoking [OR(95%CI)=2.832(1.343, 5.969), P<0.01] and sacroiliac joint X-ray staging [OR(95%CI)=2.584(1.337, 4.997), P<0.01] were risk factors for the bone bridge formation in spine of AS.@*Conclusion@#Spinal involvement in AS is related to disease activity. Bone bridge formation correlateswith disease duration, BMI and disease-status, especially with smoking.
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Objective To explore the prevalence and reference value of disease features of patients with spondyloarthritis. Methods Spondyioarthritis features and laboratory indexes and radiographic indexes of 505 patients with spondyloarthritis (SpA) including 353 patients with ankylosing spondylitis (AS), 62 patients with non-radiographic axial spondyloarthritis (nr-axSpA) and 90 patients with peripheral spondyloarthritis (pSpA) were recorded. One-way analysis of variance, Kruskal-Wallis test, x2-test, Logistic regression were used for statistical analysis. Results Sex ratio ( x2=20.673, P<0.01), age ( x2=22.258, P<0.01), disease duration ( x2=76.052, P<0.01) were different among AS, nr-axSpA and pSpA. Besides, Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAScrp), erythrocyte sedimentation rate (ESR), C-reactionprotein (CRP) and Bath ankylosing spondylitis functional index (BASFI)were different among SpA subgroups ( x2/F=13.196-40.028, P<0.01). Prevalence of inflammatory back pain, peripheral arthritis, preceding infection, positive human lymphocyte antigen (HLA)-B27 and elevated CRP were different among SpA subgroups ( x2=11.416, 32.657, P<0.01). Prevalence of dactylitis in SpA with positive HLA-B27 was lower than that in SpA with negative HLA-B27 ( x2=5.414, P=0.02). Prevalence of enthesitis and dactylitis in SpA patients with peripheral arthritis was higher than that in SpA without peripheral arthritis involvement ( x2=7.177, 14.428, P<0.01). Prevalence of good response to Non-steroid anti-inflammatory drugs. (NSAIDs) in patients with anterior uveitis involvement was higher than SpA without anterior uveitis involvement ( x2=4.578, P=0.032). SpA patients were stratified by total number of SpA features into 4 subgroups (n≤1, n=2, n=3, n≥4). Prevalence of inflammatory back pain, positive HLA-B27, good response to NSAIDs were the top three in all subgroups. Inflammatory back pain and HLA-B27 (+) were risk factors for axSpA (OR=3.254, 3.323, P<0.01). Peripheral arthritis, dactylitis, and preceding infection were risk factors for pSpA (OR=3.759, 4.134, 17.044, P<0.01). Conclusion Inflammatory back pain, HLA-B27 (+) and good response to NSAIDs should be emphasized for the diagnosis of SpA. Inflammatory back pain and HLA-B27(+) always means axSpA. Peripheral arthritis, dactylitis and preceding infection always indicates pSpA.
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Objective To explore the serum levels of fibroblast growth factor 23 (FGF23) in patients with rheumatoid arthritis (RA) and to investigate the relationship between FGF23 and RA disease activity and the occurrence of osteoporosis (OP).Methods Serum levels of FGF23 from 174 cases of patients with RA and 88 normal subjects were detected by enzyme linked immunosorbent assay (ELISA).Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.All the clinical and laboratory indexes of RA patients were recorded in details,disease activity score (DAS28) and health assess questionnaire (HAQ) were also calculated in the meantime.Radiographic changes in both hands of RA patients were assessed by Sharp's method.T test,nonparametric test,x2 test,correlation analysis and Logistic regressive analysis were used for statistical analysis.Results Serum levels of FGF3 [145.46(67.67,245.93) pg/ml] in RA patients were higher than the control group [32.64(12.34,44.70) pg/ml,Z=11.416,P＜0.01].The positive rate of serum levels of FGF23 (≥71.95 pg/ml) in RA was 74.7％(130/174),while the positive rate in control was 4.5％(4/88,x2=115.16,P＜0.01).The threshold of FGF23 serum levels for diagnosing RA was 48.56 pg/ml (AUC=0.932,Youden index=0.743,P＜0.01,sensitivity 89.1％,specificity 85.2％).In RA patients with serum FGF23 ≥48.56 pg/ml,compared with negative FGF23 group,VAS,HAQ,number of joint swelling and BMD at femoral neck,Ward,GT,Total hip,L4 and L1-4 were significantly higher in FGF23 positive group (P＜0.05).Linear correlation analysis found that in RA patients with serum FGF23 ≥48.56 pg/ml,anti-CCP was negatively correlated with serum FGF23 levels (r=-0.171,P=0.035).And DAS28 was positively correlated with serum FGF23 (r=0.163,P=0.045).BMD at femoral neck,Ward,GT,Total hip,L4 and L1-4 were negatively correlated with serum FGF23 (P＜0.05).Results of logistic regression analysis showed that sex (OR=8.518,95％CI (2.636,27.522),P＜0.01,age [OR=1.129,95％CI (1.079,1.180),P＜0.01] and Sharp score [OR=1.008,95％CI(1.003,1.013),P=0.001]were risk factors for OP in RA patients.BMI[OR=0.801,95％CI(0.707,0.909),P=0.001] was a protective factor for OP in RA patients.Conclusion Serum FGF23 level is significantly higher in RA patients.Meanwhile,the serum FGF23 level correlates with RA disease activity and BMD.
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Objective To investigate the value of serum levels of peroxisome proliferater-activated receptor (PPAR)γin patients with rheumatoid arthritis (RA) and to explore the associations between serum PPARγwith disease activity of RA and RA-associated osteoporosis (OP).Methods One hundred and one cases of hospitalized patients with RA were enrolled.A total of 88 normal subjects during the same period were recruited as the control group.Levels of serum PPARγwere detected by enzyme linked immunosorbent assay (ELISA).Bone mineral density (BMD) was measured by dual energy X-ray absortiometry.All the clinical and laboratory indexes of RA patients were recorded in detail.T-test (or t'-test) was used for comparison of measurement data between the two groups,non-parametric test was applied for skewed distribution data.Comparison of incidence was analyzed with x2 test,correlation analysis was represented ascorrelation coefficient (r).Results Binary logistic regression analysis was used for multivariate regression analysis.Serum levels of PPARγ(3.38/4.00 ng/ml) in RA patients were higher than thosein normal subjects (2.63/1.76) ng/ml (Z=3.204,P=0.001).The positive rate of serum levels of PPARγin RA was 35.6％ (36/101),while the positive rate in the controls was (2.3％,2/88,x2=32.602,P＜0.01).The incidence of OP in RA was 34.7％(35/101;while the levels of serum PPARγ in RA without OP at femur area (femoral neck,total hip) and lumbar spine (L1,L1-4) were higher than that in RA with OP (P＜0.05).Serum levels of PPARγ between groups with different disease activity had no significant difference (P＞0.05).Serum levels of PPARγ in RA with negative RF or negative anti-CCP were higher than thosetin the RA group with positive RF or positive anti-CCP(P＜0.05).Serum levels of PPARγ in RA were negatively correlated with serum RF,anti-CCP,hemoglobin (P ＜0.05-0.001),and positively correlated with erythrocyte sedimentation rate,platelet,BMD at sites of femur neck andWard (P＜0.05-0.001).Results of binary logistic regression analysis showed that levels of serum PPARγwere protective factors in RA for OP at femurneck [OR=0.577,P=0.005,95％CI (0.394-0.846)],and total hip [OR=0.754,P=0.033,95％CI (0.581-0.978)].Condusion Serum levels of PPARγ in patients with RA are significantly increased,and negatively correlate with autoantibodies.Serum levels of PPARγare protective factors for OP in RA.
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Objective To investigate the prevalence of balance deficiency and falls in patients with rheumatoid arthritis (RA),and to explore the effect of above factors on osteoporotic fracture (OPF).Methods A total of 386 patients with RA and 158 age,gender-matched normal subjects from Jan 2013 to Oct.2015 were recruited.Antero-posterior and lateral X-rays scanning of vertebral column (T5-L5) were conducted for each individual,and semi-quantity method was used as the standard for determining vertebral OPF.Falls in 296 RA were recorded in details.The balance ability of 263 cases were measured by Berg balance scale.Statistical analysis was performed with ttest and Chi-square text and logistic regression analysis.Results ① The prevalence of vertebral OPF in RA was 17.4％(67/386),which was 4.5 times the prevalence of the control group (6/158,3.8％) (x2=17.743,P＜0.01).The occurrence rate of falls in RA was 20.3％ during the last year (60/296).② Compared to RA without OPF,patients with OPF had lower Berg balance score (43±14 vs 33±15,t=4.150,P＜0.01).Patients with falls also had lower Berg balance scale scorethan that in RA without falls (31± 16 vs 41±14,t=4.373,P＜0.01).③ The prevalence of falls during the last year in RA with vertebral OPF was 39.2％ (20/51),which was higher than that in RA without OPF (15.7％,22/140) (x2=12.036,P=0.01).The prevalence of falls during the last year in RA with Berg balance scale score ＜40 was 32.5％,which was higher than that in patients with Berg balance scale score≥40 (P＜0.01).Incidence of Berg balance scale score ＜40 in patients with OPF (68.8％,33/48) was higher than that in group without OPF (29.7％,35/118) (x2=21.558,P＜0.01).④ Logistic regression analysis found that age [OR=1.064,P=0.001,95％CI (1.025,1.103)] and falls [OR=2.735,P=0.021,95％CI(1.168,6.407)] were risk factors for OPF in RA patients,while Berg balance scale score [OR=0.957,P=0.016,95％CI (0.924,0.992)] was negatively correlated with spinal OPF in RA patients.Conclusion Falls and decreased balance capacity in RA are closely correlated with OPF in RA.
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Objective To explore the changes of serum vitamin D binding protein (VDBP) levels in patients with rheumatoid arthritis (RA) and the clinical significance of association between serum VDBP with secondary osteoporosis (OP) in RA.Methods One hundred and sixty patients with RA were enrolled in the study.Eighty-three normal subjects were recruited as the control group.The concentration of serum VDBP was determined by enzyme-linked immuno sorbent assay (ELISA),and bone mineral density (BMD) was measured by dual energy X-ray absorptiometry.Clinical and laboratory indexes of RA patients were recorded in detail and disease activity (DAS28) score,health assessment questionnaire (HAQ) and Sharp score according to X-ray examination of both hands were calculated simultaneously.The t test was used to compare the metrological data between the two groups,and the x2 test was used to compare the intergroup rate.The correlation analysis was tested by Pearson correlation analysis,the ROC curve was used to analyze the threshold of the serum VDBP,and the multivariate logistic regression analysis was used for multivariate analysis.Results ① Serum levels of VDBP in RA patients were higher than that in control group [(414±12) ng/ml vs (79±12) ng/ml,t=20.082,P＜0.01].Positive rate of serum levels of VDBP was 67.0％(118/176) in RA patients,which was higher than that in the control group (4.8％)(x2 =87.651,P＜0.01).② The threshold of serum VDBP levels for diagnosing RA was 193.74 ng/ml (AUC=0.943,Youden index=0.796,P＜0.01).③ DAS28 sore in group with positive VDBP was significantly higher than that in group with negative VDBP (P9=0.025).There was significant difference regarding on the incidence of OP in female RA patients between groups with positive and negative VDBP [41.9％(54/129) vs 31.8％(14/44),x2=4.325,P=0.038].④ Linear correlation analysis found that DAS28in RA patients was positively correlated with serum VDBP levels (r=0.252,P=0.019).And anti-CCP was negatively correlated with serum VDBP levels (r=-0.150,P=0.049).⑤ Results of logistic regression analysis showed that sex [OR=9.841,95％CI (1.349,71.810),P=0.024],age [OR=1.154,95 ％CI (1.069,1.245),P＜0.01] and Sharp score [OR=1.102,95％CI (1.002,1.021),P=0.018] were risk factors for OP in RA patients.Conclusion Serum VDBP levels are significantly higher in patients with RA.Meanwhile,serum VDBP levels are correlated with disease activity and secondary OP in RA.
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Objective To explore the value of patient global assessment (PGA) on evaluating disease activity in patients with axial spondyloarthritis (SpA),Methods A total of 222 patients with axial SpA were recruited.Scores of PGA,disease activity index [Bath ankylosing spondylitis disease activity index (BASDAI),ankylosing spondylitis disease activity score (ASDAS)crp] and spondyloarthritis research consortium of Canada (SPARCC) were calculated.Differences of PGA scores between different disease activity groups in axial SpA were compared and correlations between different disease activity index with PGA scores were analyzed.Statistical analyses were performed using Statistical Product and Service Solutions (SPSS) software (version 17.0).Comparison of frequency among different groups was performed by x2 test.Rank-sum test was used to compare the median of measurement data in different groups when the data were skewed in distribution.Cut-off value of PGA for assessing disease activity in axial SpA was calculated by ROC curve.Results Medians of PGA score in groups with BASDAI remission[3(1,4) vs 5(4,7)] and ASDAScrp remission [1(1,2) vs 4(2,5)] were lower than that in disease activity group (P＜0.01).BASDAI scores [1.80(1.20,2.90) vs 3.40(2.28,4.63) vs 5.15 (4.08,5.88)] and ASDAScrp scores [2.19(1.34,2.76) vs 2.86(2.08,3.54) vs 4.08(2.96,4.41)] were significant different among PGA groups (≤3,4-6 and ≥7) (P＜0.01).Differences of SPARCC scores [6.00(0,18.00) vs 7.50(3.75,18.00) vs 18.50(6.75,24.50)] were statistically significant among PGA groups (Z=7.427,P=0.037).Erythrocyte sedimentation rate (ESR) [12.00(5.00,23.00) mm/1 h vs 19.50(7.00,44.50) mm/1 h vs 18.00(7.75,54.75) mm/1 h],C-reactive protein (CRP) [7.85(2.37,22.49) mg/L vs 10.07(3.02,28.51) mg/L vs 21.28(7.14,37.74) mg/L] and Bath ankylosing spondylitis functional index (BASFI) [0.70(0.10,1.30) vs 2.25(0.60,3.30) vs 2.85(0.83,6.53)] were also different among PGA groups (P＜0.01,separately).Proportion of axial SpA patients in BASDAI disease activity group or ASDAScrp higher disease activity group were different among PGA groups (P＜0.01,separately),while represented as positive correlations (P＜0.01,separately).Correlation analyses revealed that PGA was positively correlated with ASDAScrp (r=0.694),BASDAI(r=0.616),SPARCC (r=0.271),ESR (r=0.288),CRP(r=0.215),occipital wall distance (r=0.196),finger-floor distance (r=0.385) and negatively correlated with Sschober's test (r=-0.195) (P＜0.05).Receiver operator characteristic (ROC) curve analysis found that PGA-BASDAI AUC was 0.813,the cut off value of PGA was 3.5 and PGA-ASDAScrp AUC was 0.860,the cut off value of PGA was 2.5.Conclusion PGA has good correlations with the disease activity indexes in axial SpA patients.It can also reflect the degree of inflammation in iconography.PGA may reflect disease activity especially when the value of PGA is around 3.
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Objective To investigate the effect of sarcopenia and vitamin D deficiency on osteoporosis (OP) in patients with rheumatoid arthritis (RA).Methods Six hundred and forty-eight patients with RA were enrolled into the study,while 158 normal subjects were recruited as the control group.Bone mineral density (BMD) at total hip and lumbar vertebra 2-4 were measured by dual energy X-ray absorptiometry (DEXA),limbs skeletal muscle mass was determined in 267 patients with RA and 156 normal subjects by bioelectrical impedance method.Serum 25-hydroxy vitamin D [25(OH)D] levels were determined by electrochemiluminescence in 234 RA patients and 68 normal subjects.Clinical and laboratory features,daily dosage and duration of glucocorticoid (GC) were recorded.Numerical data and categorical data comparisons were analyzed using t test,x2 test,linear correlation analysis,single factor analysis of variance test and Logistic regression analysis test.Results ① Incidence of OP in RA (37.8％,245/648) was significantly higher than that in the controls (13.9％,22/158)(x2=32.712,P＜0.01).Incidence of sarcopenia was evidently higher in RA,compared with normal subjects [55.8％(149/267),9.0％(14/156),x2=91.176,P＜0.01].Percentage of sarcopenia was higher in RA with OP compared with RA without OP group [76.6％(49/64),39.3％(35/89),x2=20.848,P＜0.01].②Compared to control group,serum 25 (OH)D levels were significantly lower in RA group [(13.4±9.7) ng/ml,(22.4±6.3) ng/ml,t=9.063,P＜0.01].Rate of vitamin D deficiency iu RA was also higher than that in controls [80.8％(189/234),36.8％(25/68),x2=49.412,P＜0.01].③The differences of serum 25 (OH)D levels among different bone metabolic state groups at lumbar vertebra in RA (normal bone mass,osteopenia,OP) were statistically significant (F=6.263,P=0.003),whichrepresented a clearly decreasing trend along with the decreasing of serum 25 (OH)D levels (P=0.001).④Linear correlation analysis found that skeletal muscle mass indexes at limbs in RA were positively correlated with BMD and serum 25 (OH)D levels (P＜0.05).⑥Logistic Regression analysis revealed that sarcopenia (OR=4.373,P=0.002),age (OR=1.083,P=0.001) and duration of disease (OR=1.074,P=0.029) were the risk factors for occurrence of OP in patients with RA.Conclusion Sarcopenia generally exists in patients with RA,which is correlated with decreasing of serum 25 (OH)D levels,and also is the risk factor for the occurring of OP in RA.
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Objective To analyze and compare the clinical and laboratory features between patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (nr-axSpA).Methods One hundred and forty-one patients with AS and 73 cases with nr-axSpA were recruited.Clinical and laboratory indexes of individuals were recorded in detail,Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS) crp were calculated.Spondyloarthritis research consortium of Canada (SPARCC) score standard was used to evaluate the degree of bone marrow edema in sacr-oiliac joint under magnetic resonance imaging scanning.T test,rank test and x2 test were used for statistical analysis.Results The average age of patients with AS was obviously higher than that of patients with nr-axSpA (t=4.962,P＜0.01).Patients with AS were more often male,and those with nr-axSpA were more often female (82.0％ of the AS patients were men and 49.3％ of the nr-axSpA patients were men (x2=24.079,P＜0.01).Disease duration of AS was significantly longer than that of the nr-axSpA (Z=6.396,P＜0.01).The incidence of human leukocyte antigen (HLA)-B27 positive in AS was 89.4％,which was similar to that in patients with nr-axSpA (84.9％) (x2=0.884,P＞0.05).21.6％ (21 cases) of patients with AS had peripheral swollen joints,which was higher than that in nr-axSpA (2.2％,x2=8.861,P=0.003).Forty cases in AS had tender joints (41.2％),only 6 patients in nr-axSpA had tender joints (13.3％,x2=11.458,P＜0.01).Serum erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) levels in patients with AS were clearly higher than those in nr-axSpA (P＜0.01) patients.In AS,the patient global assessment (PGA),BASDAI and ASDAScrp value was significantly higher than that in nr-axSpA (P＜0.01).There were no differences in SPARCC score or incidence of bone marrow edema in sacroiliac joint in magnetic resonance imaging scanning between AS and nr-axSpA (P＞0.05).Percentage of patients with occipit-to-wall distance higher than 0 cm in AS was higher than that in nr-axSpA,and the mean distance of fingers to ground in AS was also higher than that in nr-axSpA (x2=19.844,P＜0.01;Z=5.724,P＜0.01).Chest expansion degree and Schboer's test in AS was much lower than that in nr-axSpA,respectively (Z=3.083,P=0.002;Z=5.103,P＜0.01).BASFI in AS was higher than that in nr-axSpA (Z=5.840,P＜0.01).The ratio of joint function in AS was obviously worse than that in nr-axSpA (x2=1 1.369,P=0.01).Conclusion Compared to patients with nr-axSpA,AS patients are male predominant,and have severer inflammation in clinical and laboratory findings and are worse in functional status.
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Objective To investigate the current situation in Chinese rheumatologic physicians' clinical diagnosis and evaluation of Takayasu's arteritis (TA).Methods Nineteen rheumatology experts and three vascular surgery specialists in China were invited to make the nationwide investigation for the first time about the diagnosis and disease activity evaluation of TA in China,through the questionnaire survey on the internet.Weighted average was used to calculate the average scores of corresponding problems.Results Chinese experts mainly adopted 1990 American College of Rheumatology (ACR) classification criteria for clinical diagnosis of TA.In details,symptoms of age,limb claudication and amaurosis,signs including pulselessness or pulse weakening,vascular bruits,increasing bilateral pulse pressure and hypertension and acute phase reactants (APR) were critical to the clinical diagnosis of TA.Besides,noninvasive imaging examinations,such as computed tomography angiography (CTA),magnetic resonance angiography (MRA),vascular ultrasonography,and positron emission tomography (PET) were also of great importance.In the aspect of disease activity assessment,Chinese experts mainly used Kerr scoring tool.APR and noninvasive radiological examinations were considered with vital value.Some TA patients with carotid artery involvement were recommended using vascular ultrasonography,while others with pulmonary artery and thoracic/abdominal aorta trunk involvement were preferred CTA other than MRA.Conclusions APR and noninvasive imaging examinations were thought with great help to make clinical diagnosis and evaluation of TA for Chinese physicians.
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Objective To investigate the prevalence of balance capacity declining and sarcopenia in patients with rheumatoid arthritis (RA),and to explore the effect of balance capacity declining and sarcopenia on spinal osteoporotic fracture (OPF)in RA. Methods A total of 963 hospitalized patients with RA and 158 age, gender-matched normal subjects from Jan. 2013 to Oct. 2015 were recruited from department of Rheumatology and Immunology, the first affiliated hospital of Anhui Medical University. Anteroposterior and lateral X-ray scanning of vertebral column(T5-L5)was conducted for every individual and semi-quantity method were used as the standard for determining vertebral OPF. Two hundred and sixty-seven RA patients and 156 control individuals were measured by bioelectrical impedance method for detecting skeletal muscle mass. Berg balance scale method was used to determine the balance capacity in RA patients. Statistical analyses were performed using statistical product and service solutions (SPSS) software (Version 17.0). Comparison of frequency among different groups was used by x2test. Ranksum test was used to compare the median of measurement data in different groups when the data were skewed in distribution. Linear correlation between two indicators was represented with correlation coefficient. Multivariate regression was analyzed by binary logistic Regression(Backward LR). Results ①The prevalence of vertebral OPF in RA was 15.1%(141/936), which was higher than that in the control group (6/158, 3.8%) ( x2=18.658, P<0.01). The incidence of sarcopenia in RA patients was 55.8%(149/267), which was significantly higher than that in control group (9.0%, 14/156) ( x2=91.176, P<0.01).②Compared to RA without spinal OPF, skeletal muscle mass of general body and every part of extremities were apparently decreased in RA with spinal OPF (P<0.05). Berg balance scale score in RA with spinal OPF (33±15) was lower than that in RA without spinal OPF (43 ±14) (t=4.150, P<0.01). ③Berg balance scale score in RA patients with sarcopenia was lower than that in RA without sarcopenia (37±14 vs 43±13, t=3.524, P=0.001) and the proportion of Berg balance scale score ≤40 in RA with sarcopenia was higher than that in RA without sarcopenia (50.8%,65/128 vs 29.9%,32/107, x2=10.477, P=0.001).Skeletal muscle mass of general body(18±4 vs 20±5,t=3.563,P<0.01)and every part of extremities in RA patients with Berg balance scale score ≤40 also were significantly reduced than that in RA group with Berg balance scale score >40(P<0.05). ④ Linear correlation analysis found that Berg balance scale score was positively correlated with skeletal muscle index (SMI)(r=0.299, P<0.01), skeletal muscle mass of general body (r=0.251, P<0.01), muscle mass of right upper limb (r=0.225, P<0.01), muscle mass of left upper limb (r=0.221,P<0.01).muscle mass of trunk(r=0.230,P<0.01),muscle mass of right lower limb(r=0.228, P<0.01), muscle mass of left lower limb (r=0.245, P<0.01) in RA. ⑤Logistic regression analysis (LR Backward) discovered that age (OR=1.075, P=0.002, 95%CI (1.028,1.124)] was the risk factor for spinal OPF in RA patients, while skeletal muscle mass index (SMI) [OR=0.649, P=0.020, 95% CI (0.451, 0.933)] and Berg balance scale score [OR=0.957, P=0.016, 95%CI (0.924, 0.992)] were protective factors for the occurrence of spinal OPF in RA. Conclusion Sarcopeniaand balance capacity declining are probably correlated with spinal OPF in RA.
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Objective This study aimed to investigate whether the copy numbers of the CCL3L1 (Chemokine C-C-Motif Ligand 3 Like Protein 1) gene were associated with susceptibility to ankylosing spondylitis (AS). Methods A total of 806 Chinese individuals including 405 AS patients and 401 healthy controls were enrolled. The CCL3L1 gene copy number was measured by a custom-by-design Multiplex AccuCopyTM Kit based on a multiplex fluorescence competitive polymerase chain reaction (PCR) principle, and 50 samples were randomly selected using the fluorescent quantitative PCR method to verify copy number. Main statistical method was t test, chi-square test and logistic regression model. Results There were no statistically significant differences between the case group and control group in age and gender ( t=1.77, P=0.076, χ2=1.14, P=0.289). The copy number of CCL3L1 gene ranged from 0 to 13 in both AS patients and the controls. After copy numbers were classified into 3 categories by 3, we did not find significant difference between the two groups ( χ2=0.591, P=0.669). And regression analyses also did not support the hypothesis that CCL3L1 gene copy number variation (CNV) could be an impact factor to the severity or function indexes of AS patients ( χ2=0.341, P=0.804 and χ2=0.472, P=0.774, respectively). Conclusion We suggest that the copy number of the CCL3L1 gene does not have a role in the susceptibility and the severity or function to AS.
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Rheumatoid arthritis is a autoimmune diseases characterized as joint chronic synovitis, and is accompanied with systemic damage.Osteoporotic fracture is one of the common complications of rheumatoid arthritis, which may decrease quality of life, and even increase the mortality of patients.Variety of factors may be associated with the occurrence of osteoporotic fractures in rheumatoid arthritis patients.In this article, through the literature review we discuss the risk factors of osteoporotic fracture, including vitamin D deficiency, lower limb muscle strength and balance ability in rheumatoid arthritis patients.
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Objective To investigate the relationship between complement C3 level and the degree of disease activity in patients with systemic lupus erythematosus(SLE).Methods A total of 1 012 patients with SLE were enrolled in this study from January 2006 to December 2013 at department of rheumatology and immunology,the first affiliated hospital of Anhui medical university.Serum complement C3 level was detected by rate erythenephelometry assay.The relationship between reduction of complement C3 and SLE was analyzed.Results Serum complement C3 clearly decreased in 782 patients,accounted for 77.27％.There were significant differences concerning serum complement C3 level among different groups of disease activity (F =131.275,P＜0.01).The low serum complement C3 level was correlated with the high degree of disease activity (r =-0.517,P ＜0.01).Patients with SLE had a severe disease activity (SLE disease activity index ≥ 15) when the level of serum complement C3 was less than 0.57 g/L.Serum complement C3 levels were positively correlated with serum complement C4 (r =0.845,P ＜ 0.01),peripheral blood leukocyte count (r =0.115,P ＜ 0.01),hemoglobin (r =0.069,P ＜ 0.01),platelet count (r =0.177,P ＜0.01) and albumin level (r =0.091,P ＜ 0.01).There was also a negative association of serum complement C3 with 24 h urinary protein (r =-0.228,P ＜ 0.01).101 patients whose average level of serum complement C3 was(0.48 ±0.26)g/L,were treated with glucocorticoid pulse therapy as high degree of disease activity.Conclusions There is a close relationship between serum complement C3 level and the degree of disease activity in SLE.Serum complement C3 less than 0.57 g/L might be seen in SLE with severe disease activity.
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Objective To investigate the clinical value of serum 14-3-3η protein levels in patients with rheumatoid arthritis (RA) and secondary osteoporosis (OP). Methods 259 RA patients and 80 healthy controls were recruited. Serum 14-3-3η levels were determined by ELISA and bone mineral density (BMD) were detected by the DEXA. Results Firstly, the levels and the positive rate of serum 14-3-3η protein were significantly high-er in RA patients than healthy controls (P < 0.000 1). Secondly, ROC curve revealed that the sensitivity of 14-3-3η protein for diagnosis of early RA was 91.7% and its specificity was 99.6% when the cut-off point was 0.879 ng/mL (AUC = 0.917, P < 0.000 1). Finally, 14-3-3η protein concentrations revealed significant differ-ence among the groups of bone mass normal, osteopenia and osteoporosis in early RA (χ2=7.974, P = 0.019). Conclusion Serum 14-3-3η protein levels increase significantly in RA , especially in early RA , which is relat-ed to clinical symptoms and osteoporosis.
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Objective To investigate the clinical significance of anti-nuclear envelope protein antibody (gp210),anti-soluble acid resistant nucleoprotein (sp100) and anti-mitochondrial antibody M2 subtype (AMA-M2) in sjogren syndrome (SS) and primary biliary cirrhosis (PBC).Methods A total of 241 hospitalized patients diagnosed with connective tissue disease (CTD) were recruited.Anti-gp210,anti-sp100 and AMA-M2 were detected by indirect immunofluorescence.Results (1) Positive rate of AMA-M2,anti-sp100 and antigp210 in 241 cases CTD patient were 10.4％ (25/241),3.3％ (8/241) and 2.9％ (7/241) respectively.(2) There were 16 cases with SS,5 cases with SS-PBC overlap syndrome and 17 cases with PBC in 241 patients with CTD.Distinction among groups of PBC,SS,SS overlapping PBC of positive incidence of AMA-M2 antibody (x2 =6.584,P =0.03) and anti-gp210 (x2 =8.735,P ＜ 0.01) were significantly different,while there was no apparent difference about positive rate of anti-sp100 among the three groups (x2 =3.343,P =0.18).(3) Positive expression of either antibody of anti-gp210 or anti-sp100 in the three groups of SS,SS overlapping PBC,PBC were 3 cases,4 cases,4 cases respectively.The positive rates of any of three autoantibodies in three groups of were 8 cases,5 cases,13 cases respectively.(4) There were significant difference in terms of serum ALB(t =3.858,P＜0.000 1),TSB(t =5.473,P＜0.000 1),ALT(t =2.235,P=0.026),AKP(t =3.141,P =0.002) and γ-GT (t =2.317,P =0.021) in liver damaged patients of all CTD between AMA-M2 positive and negative patients (P ＜ 0.05).However,serum TSB in anti-sp100 positive and negative patients were differed (t =7.892,P ＜ 0.000 1).Serum AKP was different between anti-gp210 positive and negative patients (t =2.451,P =0.015).Conclusion Positive rate of anti-gp210,anti-sp100 and AMA-M2 are the highest in patients with SS overlap of the PBC among CTD patients.Combined detection can improve the sensitivity of diagnosis.Antisp100 and anti-gp210 are valuable for the diagnosis of SS-PBC overlaps syndrome with negative AMA-M2.
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Objective To investigate the value of serum receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegrin (OPG) ratio in osteoporotic fracture (OPF) of patients with rheumatoid arthritis (RA).Methods Three hundred and eighty four RA patients with mean age of (49 ± 14) y (16-82) admitted in the First Affiliated Hospital of Anhui Medical University from 2010 to 2013 and 158 sex-and age-matched healthy subjects were enrolled in the study.OPF was diagnosed by X-ray examination and BMDs of femur and lumbar spine 2-4 (L2-4) were measured by dual energy X-ray absorptiometry.Levels of RANKL and OPG in the peripheral blood of 220 RA patients and 100 normal subjects were detected by ELISA method.Results Eighty-two cases of OPF was diagnosed in 384 RA patients (21.35％),the rate was higher than that in controls (3.80％,6/158,x2 =25.371,P ＜0.01).The peripheral blood levels of RANKL (0.150 ± 0.143 vs.0.101 ± 0.066,t =4.178,P ＜ 0.01),OPG (0.457 ± 0.293 vs.0.359 ±0.216,t=3.347,P=0.001) and ratio of RANKL/OPG (0.41 ±0.35 vs.0.34±0.20,t =2.111,P=0.036) in RA patients were significantly higher than those in control group.In comparison with normal controls,BMDs of all detected regions in RA were decreased significantly (P ＜0.01).The incidence of osteoporosis in RA (121/327,37％) was higher than that in normal controls (22/158,13.92％) (x2 =27.291,P ＜ 0.01).RA patients with OPF had higher age (t =4.377,P ＜ 0.01),longer duration of disease (t =2.612,P =0.009),higher RANKL level (t =3.554,P =0.001),higher RANKL/OPG ratio (t =2.651,P =0.010),higher health assessment questionnaires (HAQ) score (t =2.418,P =0.016),lower serum calcium level (t =2.183,P =0.030),lower hemoglobin level (t =2.125,P =0.036),higher Sharp score in hands X-ray examination (t =2.747,P =0.007),worse X-ray stage (x2 =7.856,P =0.049),higher glucocorticoid utilization rate (x2 =9.066,P =0.003) and higher incidence of osteoporosis (x2 =38.186,P ＜ 0.01),compared with patients without OPF.RA patients taking corticosteroids had higher incidence of osteoporosis (x2 =7.489,P =0.006) and higher incidence of OPF (x2 =9.066,P =0.003).Logistic regression analysis showed that age (OR =1.029,P =0.039,95％ CI:1.001-1.057)and the occurrence of osteoporosis (OR =3.159,P =0.001,95％ CI:1.562-6.385),RANKL/OPG ratio (OR =3.516,P =0.013,95 ％ CI:1.305-9.647) were risk factors for RA patients with OPF.Conclusion A higher incidence of OPF is prevalent in RA patients,and age,osteoporosis,taking glucocorticoids and RANKL/OPG ratio are risk factors for OPF in RA patients.
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Objective To explore the effect of vitamin D deficiency and falls on osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods A total of 852 patients with RA were recruited, anteroposterior and lateral X-rays examination of vertebral column were conducted for every patient.Serum 25-hydroxy vitamin D [25(OH)D] levels and bone mineral density (BMD) of all the vertebrae of lumbar were exam-ined.Clinical and laboratory index of patients were recorded in details meanwhile.Data of 156 normal subjects during the same period were collected as the control group.Numerical data and categorical data comparisons were analyzed using t test, x2 test, single factor analysis of variance test, linear correlation and Logistic regression analysis test.Results ① The prevalence of vertebral OPF in RA was 16.1％(137/852).Compared to RA without OPF, patients with OPF had lower serum 25(OH)D levels [(14±4) ng/ml vs (18±7) ng/ml, t=2.898, P=0.004].② The occurrence rate of falls in RA patients was 19.7％(36/183).Patients with falls had lower serum 25(OH)D levels [(14±4) ng/ml vs (18±6) ng/ml, t=2.854, P=0.005].③ The prevalence of falls in RA with vertebral OPF was higher than that in RA without OPF (38.1％ vs 14.2％,x2=11.708, P=0.001).④ Linear correlation analysis found that serum levels of 25 (OH)D was positively correlated with total lumbar region BMD in RA patients.⑤ Logistic regression analysis revealed that age [OR=1.124, P=0.002, 95％CI: (1.045, 1.209)]and usage of glucocorticostroid (GC) [OR=6.724, P=0.031,95％CI: (1.196, 37.813)] were the risk factors for occurrence of OPF in RA, while serum 25 (OH) D level [OR=0.850, P=0.046, 95％CI: (0.725, 0.997)] was the protective factor.Conclusion Spinal OPF in patients with RA is clearly related with vitamin deficiency, falls and usage of GC.