Bone Mineral Density in Rheumatoid Arthritis Patients with Positive Anti-Cyclic Citrullinated Peptide in Egypt

Abstract

R heumatoid arthritis (RA) is a systemic and chronic inflammatory disease that has been associated with disability, the existence of comorbidities and decreased life expectancy in which osteoporosis is recognized as a major source of morbidity. Bone damage in early and even recent-onset RA has been attributed to anti- citrullinated peptide antibodies (ACPAs), which form years before arthritis and clinical symptoms start to emerge and is highly specific for RA. The aim of this study was to assess the effect of ACPA on BMD in a cohort of Egyptian patients with rheumatoid arthritis. This study was carried out on 50 patients with RA within 1 year symptoms who satisfied the 2010 ACR/ EULAR classification of RA. Patients were divided into two groups: 25 were ACPA negative (Group A) and 25 were ACPA positive (Group B). All participating patients were less than 50 years and all females were premenopausal. Patients previously diagnosed with osteoporosis or those receiving anti- osteoporotic medication, smokers and alcohol consumers and those with metabolic bone diseases or other co-existing rheumatological autoimmune diseases were excluded from the study. Thorough clinical examination with special emphasis on joint examination and assessment of DAS28-CRP, VAS and HAQ. laboratory investigations including CBC, ESR, CRP, RF and ACPA and DEXA scan of proximal femur and lumbar spine was carried out to all patients. In the present study, the age of our patients ranged from 22 to 50 years with mean 37 ± 7y for ACPA negative and 41.3 ± 8y for ACPA positive where ninety percent of the our studied patients were females, from which 44% were ACPA negative and 46% were ACPA positive. The mean of disease duration was 7.4 and 7.6 among the two groups respectively. There was no statistically significant difference between the two groups as regards the age, sex or disease duration. In addition, ACPA titre was not correlated with age or disease duration. There was no statistically significant difference between the two groups regarding types of drug intake or drug use duration (p>0.05). There was no statistically significant difference in BMI between the two groups (p=0.65). It was not correlated with ACPA but Z-score at lumbar spine and femoral neck showed significant positive correlation with weight and BMI (p < 0.05), suggesting a protective effect of weight on BMD.