Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis

BMC Musculoskeletal Disorders

W F Lems⁴  C F Allaart¹  T W J Huizinga¹  P J S M Kerstens⁵  W M de Beus³  J H L M van Groenendael²  M van den Broek¹  Linda Dirven¹ 

[1] Department of Rheumatology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands;Franciscus Hospital, Roosendaal, the Netherlands;MCH Haaglanden, Leidschendam, the Netherlands;VUMC, Amsterdam, the Netherlands;Jan van Breemen Research Institute

[2]  Reade, Amsterdam, the Netherlands

关键词: Treatment strategy;    Disease activity;    Functional ability;    Bone mineral density;    Vertebral fractures;    Rheumatoid arthritis;   

Others  :  1149227
DOI  :  10.1186/1471-2474-13-125

 received in 2012-02-29, accepted in 2012-07-05,  发布年份 2012

【 摘 要 】

Objective

To determine the prevalence of vertebral fractures (VFs) after 5 years of disease activity score (DAS)-steered treatment in patients with early rheumatoid arthritis (RA) and to investigate the association of VFs with disease activity, functional ability and bone mineral density (BMD) over time.

Methods

Five-year radiographs of the spine of 275 patients in the BeSt study, a randomized trial comparing four treatment strategies, were used. Treatment was DAS-steered (DAS ≤ 2.4). A height reduction >20% in one vertebra was defined a vertebral fracture. With linear mixed models, DAS and Health Assessment Questionnaire (HAQ) scores over 5 years were compared for patients with and without VFs. With generalized estimating equations the association between BMD and VFs was determined.

Results

VFs were observed in 41/275 patients (15%). No difference in prevalence was found when stratified for gender, prednisone use and menopausal status. Disease activity over time was higher in patients with VFs, mean difference 0.20 (95% CI: 0.05-0.36), and also HAQ scores were higher, independent of disease activity, with a mean difference of 0.12 (95% CI: 0.02-0.2). Age was associated with VFs (OR 1.06, 95% CI: 1.02-1.09), mean BMD in spine and hip over time were not (OR 95% CI, 0.99: 0.78-1.25 and 0.94: 0.65-1.36, respectively).

Conclusion

After 5 years of DAS-steered treatment, 15% of these RA patients had VFs. Higher age was associated with the presence of VFs, mean BMD in hip and spine were not. Patients with VFs have greater functional disability over time and a higher disease activity, suggesting that VFs may be prevented by optimal disease activity suppression.

【 授权许可】

   
2012 Dirven et al.; licensee BioMed Central Ltd.

【 图 表 】

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