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International Journal of Osteoporosis and Metabolic Disorders
Year: 2012  |  Volume: 5  |  Issue: 1  |  Page No.: 13 - 24

The Effect of Inflammation on Axial Bone Mass and Bone Turnover in Premenopausal Egyptian Women with Rheumatoid Arthritis

M.A. Mohsen, A.A. Afifi and I. Al-Bagoury    

Abstract: Generalized bone loss in rheumatoid arthritis (RA) is attributable to several possible factors including inflammatory disease itself. This study was performed to investigate the effect of inflammation on bone mineral density (BMD) and bone turnover in premenopausal women with RA. Thirty two consecutive premenopausal non-steroid user RA female patients without functional impairment and 15 healthy controls were studied. Disease activity was scored using the Activity Score of 28 joints (DAS-28). BMD of lumbar spine and femoral neck was assessed by dual energy x-ray absorptiometry. Urinary excretion rates of bone resorption markers, free pyridinoline (f-PYD) and free deoxypyridinoline (f-DPYD) were assayed. Pro-inflammatory cytokines, IL-1, IL-6, TNF-α and C-reactive protein (CRP) were dosed in blood. Significant lower BMD values in lumbar spine and left femoral neck (p<0.01, <0.001, respectively) and significant higher levels of IL1, IL6, TNF-α and CRP were observed in RA patients versus healthy controls. BMD at lumbar spine and left femoral neck was inversely correlated with DAS-28, CRP and TNF-α levels. BMD at femoral neck was inversely correlated with disease duration (r = -0.463). Urinary f-PYD was positively correlated with DAS-28, CRP and IL-6 (r = 0.624, 0.543, 0.657, respectively) while inversely correlated with BMD at femoral neck (r = -0.6826). In conclusion, elevated pro-inflammatory cytokines, high disease activity and less extent disease duration, appear to be critical determinant for much of systemic bone loss in RA. Urinary f-PYD reflects bone resorption more selectively than f-DPYD. Control of biological activity of IL-6 may be a therapeutic approach to control osteoporosis in RA.

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