Association between Bone Mineral Density of Femoral Neck and Geriatric Nutritional Risk Index in Rheumatoid Arthritis Patients Treated with Biological Disease-Modifying Anti-Rheumatic Drugs.

Satoshi Nagano,Go Jokoji,Hiroto Tokumoto,Eiji Taketomi,Yasuhiro Ishidou,Nobuhiko Sunahara,Setsuro Komiya,Yoshiya Arishima,Masaki Akimoto,Hideo Ohtsubo,Takao Setoguchi,Hiroyuki Tominaga

doi:10.3390/nu10020234

Satoshi Nagano, Go Jokoji + Show 10 more

Open Access

https://doi.org/10.3390/nu10020234

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Journal: Nutrients	Publication Date: Feb 18, 2018
Citations: 20	License type: CC BY 4.0

Affiliation: Kagoshima University, Kagoshima Medical Center

Abstract

Treatment of rheumatoid arthritis (RA) with biological disease-modifying anti-rheumatic drugs (bDMARDs) induces rapid remission. However, osteoporosis and its management remains a problem. The Geriatric Nutritional Risk Index (GNRI) evaluates the risk of malnutrition-related complications in elderly patients and has been shown to be a significant predictor of many diseases. We evaluated the correlation between GNRI and RA activity. In addition, risk factors for femoral neck bone loss were evaluated in RA patients treated with bDMARDs. We retrospectively examined the medical records of 146 patients with RA, collecting and recording the patients’ demographic and clinical characteristics. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Inverse correlations were observed between GNRI and disease duration, disease activity score-28 joint count serum C-reactive protein (CRP), simple disease activity index, modified health assessment questionnaire score and CRP. GNRI showed correlation with femoral neck BMD and femoral neck BMD ≤ 70% of young adult men (YAM). Multiple regression analysis showed that female sex, increased age and lower GNRI were risk factors for lower BMD of the femoral neck. Multivariate binomial logistic regression analysis showed that female sex (odd ratio: 3.67) and lower GNRI (odd ratio: 0.87) were risk factors for BMD ≤ 70% of YAM. Because the GNRI is a simple method, it might be a simple predictor for RA activity and BMD status in RA patients. Complementary nutritional therapies might improve RA activity and osteoporosis in RA patients who have undergone treatment with bDMARDs.

Highlights

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that promotes joint inflammation and destruction [1]
Patients’ demographic and clinical characteristics were collected from medical records, including sex, age, disease duration, estimated glomerular filtration rate, dose of corticosteroid, Geriatric Nutritional Risk Index (GNRI), disease activity score-28-reactive protein (DAS28-C-reactive protein (CRP)), Simplified Disease
The Japanese Society for Bone and Mineral Research has proposed that primary osteoporosis is diagnosed when bone mineral density (BMD) is ≤ 70% in young adult men (YAM) [26,27,28,29]

Summary

Introduction

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disorder that promotes joint inflammation and destruction [1]. Treatment options for RA have increased rapidly using biological disease-modifying anti-rheumatic drugs (bDMARDs) [2]. RA increases the risk of bone loss and fracture, which are associated with a reduction in quality of life [5]. Poor nutrient status in RA patients is often reported [6], nutrient supplementation should be considered in the management of RA and its co-morbidities [7]. Large-scale literature reviews showed that increased protein intake in the diet is beneficial to bone health and reduces morbidity and mortality [12]. We evaluated the correlation between GNRI and disease activity in the RA patients treated with bDMARDs. In addition, risk factors for femoral neck bone loss were evaluated in the RA patients treated with bDMARDs

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