Fractures In Rheumatoid Arthritis Patients Research Articles

Risk factors for vertebral fracture in rheumatoid arthritis patients using biological disease-modifying anti-rheumatic drugs (cases over 5 years): An observational study.

While biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered beneficial for preventing osteoporosis and bone fracture, it is unclear whether bone loss is involved in the development of vertebral fracture, and few reports have examined the factors related to vertebral fracture in rheumatoid arthritis (RA) patients using bDMARDs. This study aims to identify factors influencing vertebral fracture in RA patients treated with bDMARDs. We retrospectively examined the records of 129 RA patients treated with bDMARDs for over 5 years. The lumbar spine and femoral bone mineral density, Disease Activity Score-28-C-Reactive Protein (DAS28-CRP) value, Simplified Disease Activity Index (SDAI), and modified Health Assessment Questionnaire (mHAQ) score were evaluated. The frequency of new vertebral fracture during the study and their risk factors were investigated. A comparison between the fracture group and the nonfracture group was performed. Multivariate analysis was performed using logistic regression analysis to detect risk factors for new vertebral fracture. The number of patients with new vertebral fracture during follow-up was 15 (11.6%) of the 129 patients in the study. Age and mHAQ score were significantly higher and lumbar spine and femoral neck bone mineral density were significantly lower in the fracture group than the nonfracture group. The risk factors for new vertebral fracture during the disease course were older age and higher mHAQ score indicating no remission over the 5 years of follow-up. In this study, there was no significant difference in disease indices such as the DAS28-CRP value and the SDAI between the fracture and nonfracture groups, suggesting an effective control of RA with bDMARDs. However, age and the mHAQ score, an index of RA dysfunction, were significantly higher in the fracture group. These results suggest that improving functional impairment may be important to prevent vertebral fracture in patients using bDMARDs.

Risk and predictors of fractures in early rheumatoid arthritis – A long term follow up study of an inception cohort

ObjectivesTo examine the risk of fractures in a cohort of patients with newly diagnosed rheumatoid arthritis (RA), compared to the background population, and predictors of fractures detectable early in RA. MethodsAn inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995–2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population. ResultsRA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95 % CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95 % CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures. ConclusionPatients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.

Correlation between Trabecular Bone Score and Homocysteine Level in Rheumatoid Arthritis Patients on Anti-TNF Inhibitors.

Rheumatoid arthritis (RA) is an independent osteoporosis risk factor. Biologic and immunosuppressive treatment, and levels of homocysteine and 25-OH vitamin D may influence the trabecular bone score (TBS) in RA patients. We aimed to compare the effects of biological (b) and conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) on TBS in patients with RA and hyperhomocysteinemia (HHcy) or 25-OH vitamin D deficiency. Patients who had tests conducted for trabecular bone score, bone mineral density (BMD), homocysteine (Hcy) and 25-OH vitamin D at an interval of one year and met the inclusion criteria were enrolled in this retrospective study. Sixty-four patients with RA were enrolled and were divided into the following two groups: the first group (34 patients) had received treatment with bDMARDs and the second group (30 patients) had received csDMARDs. BDMARDs and csDMARDs had a positive influence on TBS and BMD. The best results were observed in the Adalimumab group (p = 0.033). Hyperhomocysteinemia and 25-OH vitamin D deficiency led to lower TBS values. Both bDMARDs and csDMARDs positively affected TBS and BMD in RA patients. High homocysteine serum levels or 25-OH vitamin D deficiency had a negative impact on TBS and BMD after 12 months. Our study aims to show the potential benefits of anti-TNF α drugs on TBS. This impact appears to be strongly associated with serum 25-OH vitamin D and homocysteine levels. Anti-TNF drugs may increase bone mineral density and microstructure. As a result, they may minimize the incidence of fractures in RA patients.

Analyzing the risk of osteoporosis and fracture in rheumatoid arthritis patients who have been treated with various biologics.

Rheumatoid arthritis (RA) is a major risk factor for osteoporosis/osteoporotic fractures. We aimed to elucidate the role of treatment choices among osteoporosis/osteoporotic fractures. We utilized the Chang-Gung Research Database to assess the risks of osteoporosis/osteoporotic fractures among independently treated RA patients, using retrospective time-to-event outcomes analysis. A total of 3509 RA patients with a mean of 63.1 ± 8.6 years were analyzed. Among all, 1300 RA patients (37%) were diagnosed with newly diagnosed osteoporosis. The crude incidence of newly diagnosed osteoporosis was the highest among those treated with other conventional disease-modifying anti-rheumatic drugs (cDMARDs; 74.1 events/1000-PYs, 95%CI 66.0-82.3), followed by those with a non-treatment period (68 events/1000-PYs, 95%CI 63.1-72.9), methotrxate (MTX) monotherapy (60.7 events/1000-PYs, 95%CI 41.2-80.3), MTX plus other cDMARDs (51.9 events/1000-PYs, 95%CI 43.4-60.3), and abatacept/rituximab (48.6 events/1000-PYs, 95%CI 14.9-82.3). The lowest crude incidence was found in patients treated with anti-TNFi biologics (40.4 events/1000-PYs, 95%CI 28.6-52.2) and other biologic disease-modifying anti-rheumatic drugs (bDMARDs; 40.1 events/1000-PYs, 95%CI 8.0-72.1). A total of 270 patients (20.8%) suffered from an incident fracture during follow-ups. The crude incidence of fracture was the highest among those treated with abatacept/rituximab (49.0 events/1000-PYs, 95%CI 6.0-91.9), followed by those with non-treatment periods (24.3 events/1000-PYs, 95%CI 19.3-29.4), other cDMARDs (24.2 events/1000-PYs, 95%CI 18.1-30.2), anti-TNFi biologics (20.2 events/1000-PYs, 95%CI 8.8-31.6). Other bDMARDs (13.3 events/1000-PYs, 95%CI 0-39.2), MTX mono (12.5 events/1000-PYs, 95%CI 0.3-24.8), and MTX plus other cDMARDs (11.4 events/1000-PYs, 95%CI 5.4-17.4) were low incidences. The treatment option has emerged as a critical determinant in the context of future osteoporosis and osteoporotic fracture risks among RA. These findings offer a valuable resource for clinicians, empowering them to tailor bespoke treatment strategies for RA patients, thereby mitigating the potential for future osteoporosis and fractures.

Osteoporosis-related fractures in men and women with established and early rheumatoid arthritis: predictors and risk compared with the general population

ObjectivesTo study the risk of osteoporosis-related fractures in a community-based sample of men and women with rheumatoid arthritis (RA) overall, as well as early (< 1 year of disease duration, follow-up time maximum 10 years) and established (RA diagnosis since ≥ 5 years on July 1, 1997) RA, compared with the general population. To study potential risk factors for fractures in patients with RA from baseline questionnaire data.MethodsA community-based cohort of patients with RA (n = 1928) was studied and compared to matched general population controls. Information on osteoporosis-related fractures (hip, proximal upper arm, distal forearm and vertebral fractures) during the period July 1, 1997 to December 31, 2017 was obtained by linkage to the Swedish National Inpatient Register and the Cause of Death Register. The incidence of fractures was estimated in patients and controls. Cox regression models were used to assess the relation between RA and the risk of fractures and to assess potential predictors of fractures in RA patients. Analyses were stratified by sex, and performed in all patients with RA, and in subsets with early and established RA.ResultsThe overall incidence of osteoporosis-related fractures in the RA cohort was 10.6 per 1000 person-years (95% CI 9.31; 12.0). There was an increased risk of fractures overall in both men (hazard ratio (HR) 1.55, 95% CI 1.03; 2.34) and women (HR 1.52; 95% CI 1.27; 1.83) with RA compared to controls, with significantly increased risk also in the hip. No increased risk of osteoporosis-related fractures overall was seen in patients with early RA (HR 1.01, 95% CI 0.69; 1.49). Higher age, longer duration of RA, higher HAQ scores and higher scores in the visual analogue scale for global health were predictors of fractures.ConclusionBoth men and women with RA were at increased risk of osteoporosis-related fractures. Patients with early RA did not have significantly increased risk during the first 10 years of disease in this study.

High incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis. A case-control study.

To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. Median age of RA patients was 64years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85%, methotrexate; and 40%, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.

Delayed Diagnosis of a Tibial Stress Fracture Associated with Glucocorticoid and Methotrexate Therapy in a Patient with Rheumatoid Arthritis: A Case Report

The risk of stress fractures is associated with rheumatoid arthritis (RA), which can aggravate bone loss. We report the case of a patient who was on long-term medication for RA presenting with lower extremity pain on the left and swelling without trauma. Magnetic resonance imaging and plain radiographs at the previous hospital showed no signs of fracture, but radiographs performed later, revealed a stress fracture of the left distal tibia. The stress fracture may have occurred due to multiple reasons such as long-term use of methotrexate and glucocorticoids, active RA, postmenopausal state, and immobility. Suspicion of a stress fracture should not be ruled out especially in RA patients with persistent pain, even if the radiographical findings are normal. Additional imaging and follow-ups are essential. The patient’s pain was relieved with Korean medicine treatments, which suggests their potential application for stress fractures in RA patients.

Osteosarcopenia synergistically increases the risk of falls in patients with rheumatoid arthritis

ObjectivesOsteosarcopenia is defined as osteoporosis with sarcopenia. The impacts of osteosarcopenia on falls and fractures in rheumatoid arthritis (RA) patients were investigated using 4 years of data from a longitudinal study (CHIKARA study). MethodsThe patients were divided into 4 groups by their baseline status: no sarcopenia and no osteoporosis (SP-OP-); only sarcopenia (SP + OP-); only osteoporosis (SP-OP+); and both sarcopenia and osteoporosis (SP + OP+). Survival rates and Cox hazard ratios were analyzed using falls and fractures as endpoints, adjusted by age, sex, and body mass index. ResultsA total of 100 RA patients (SP-OP-: 44%, SP + OP-: 17%, SP-OP+: 28%, and SP + OP+: 11%) were enrolled; 37 patients had falls, and 19 patients had fractures. The fall-free and fracture-free survival rates were significantly lower in SP + OP+ (36.4%, 54.5%) than in SP-OP- (75.0%, 86.4%). The hazard ratio of falls was significantly increased in SP + OP+, by 3.32-fold (95%CI: 1.01–10.9), whereas in SP + OP- and SP-OP+, there were no differences compared to SP-OP-. ConclusionsThe survival rates with the endpoints of falls and fractures in RA patients with osteosarcopenia were lower during 4-year follow-up. The risk of falls increased with the synergistic effect of osteoporosis and sarcopenia.

A Comparison of the Risk of Fracture in Rheumatoid Arthritis Patients with and without Receiving Chinese Herbal Medicine.

ObjectivePatients with rheumatoid arthritis (RA) often suffer from bone complications due to persistent joint inflammation, especially incident fracture. Nowadays, Chinese herbal medicines (CHMs) have provided safe and effective therapy for treating skeletal conditions, but it is unclear whether CHMs can prevent fracture onset among RA individuals. This study aimed to determine the association between the use of CHMs and the risk of fracture among them.MethodsThis retrospective, population-based study retrieved administrative health data from the Taiwan National Health Insurance (NHI) database to identify patients with newly diagnosed RA between 2000 and 2009. Of the 6178 incident RA patients, 2495 matched pairs of CHMs users and non-CHMs users were identified by propensity score matching. Enrollees with hip fractures prior to RA onset were excluded. Included subjects were followed until the end of 2013. Incidence and adjusted hazard ratios (HR) of new-onset bone fracture in the multivariable Cox proportional hazard model were measured with 95% confidence interval (CI).ResultsFracture incidence was lower in CHMs users than in the comparison cohort (26.91 vs 32.94 per 1000 person-years, respectively), with an adjusted HR of 0.82 (95% CI: 0.73–0.92). Subjects receiving CHMs for more than 2 years had a much lower risk of fracture onset by more than 50%. Some CHMs prescriptions (Yan Hu Suo, Bei Mu, Da Huang, Dang Shen, Fu-Zi, Shu-Jing-Huo-Xue-Tang, Dang-Gui-Nian-Tong-Tang, Jia-Wei-Xiao-Yao-San, Gan-Lu-Yin, and Gui-Zhi-Shao-Yao-Zhi-Mu-Tang) were associated with reduced fracture risk.ConclusionAdding CHMs to routine treatment was found to be related to lower fracture risk in RA patients.

Determination of the accuracy of osteoporotic fractures risk assessment in patients with rheumatoid arthritis using the prognostic model, developed at V.A. Nasonova Research Institute of Rheumatology, and the FRAX algorithm

Objective: comparison of the accuracy of risk assessment of low-energy fractures in patients with rheumatoid arthritis (RA) using the prognostic model developed at V.A. Nasonova Research Institute of Rheumatology, and the Russian model of the FRAX algorithm.Patients and methods. A prospective long-term observational non-interventional study included 70 women aged 40–80 years with a definite diagnosis of RA (ACR, 1987). All patients underwent dual-energy X-ray absorptiometry at baseline and over time; clinical and anamnestic data were analyzed, including information on fractures that occurred during the observation period, confirmed by medical documents.Results and discussion. The sensitivity and specificity of the FRAX algorithm were 67 and 56%, the sensitivity and specificity of the prognostic model of V.A. Nasonova Research Institute of Rheumatology – 78 and 56%, respectively. The diagnostic accuracy of the FRAX algorithm and the predictive model was 58 and 61%, respectively.Conclusion. The predictive model developed at V.A. Nasonova Research Institute of Rheumatology, showed higher diagnostic accuracy and sensitivity, as well as comparable specificity with the FRAX algorithm in assessing fractures in RA patients.

Risk factor analysis of fragility fractures in rheumatoid arthritis: A 3-year longitudinal, real-world, observational, cohort study

ObjectivesTo explore the risk factors for fragility fractures in rheumatoid arthritis (RA) patients using a 3-year longitudinal, observational cohort study.MethodsThis RA registry study included consecutive RA patients in the outpatient clinic of Chang Gung Memorial Hospital since September 1, 2014. The demographics, clinical characteristics, lifestyle, evidence of previous fracture, risk factors according to the Fracture Risk Assessment Tool (FRAX®), and the FRAX score of each participant were recorded. The participants were categorized into the new incident fracture (group A) and no incident fracture (group B) groups based on evidence or absence of new incident fractures and propensity score matching (age and gender, 1:2).ResultsOverall, 477 participants completed the 3-year observation period. After matching, 103 and 206 participants were allocated to groups A and B, respectively. The non-adjusted model revealed, presented as hazard ratio (HR) (95% confidence interval [CI]), that the presence of co-morbidity (1.80 [1.17–2.78], p = 0.008), Health Assessment Questionnaire Disability Index (1.35 [1.07–1.69], p = 0.010), lower baseline hip bone mineral density (0.11 [0.02–0.48], p = 0.004), longer disease duration (1.02 [1.00–1.04], p = 0.026), higher FRAX score of major fracture (1.03 [1.02–1.04], p<0.001) or hip fracture (1.03 [1.02–1.04], p<0.001), and previous fracture history (2.65 [1.79–3.94], p<0.001) were associated with new incident fracture. After adjustment, it was disclosed that a previous fracture is an independent risk factor for fragility fractures in RA patients (2.17 [1.20–3.90], p = 0.010).ConclusionsIn addition to aging and disease-related factors, previous fracture history is the most important risk factor for fragility fractures in RA patients.

POS1108 THE ACCURACY OF OSTEOPOROTIC FRACTURE RISK PREDICTION IN PATIENTS WITH RHEUMATOID ARTHRITIS USING THE PREDICTIVE MODEL DEVELOPED AT V.A. NASONOVA REASEARCH INSTITUTE OF RHEUMATOLOGY (RUSSIA) AND FRACTURE RISK ASSESSMENT TOOL (FRAX)

Background:FRAX is a computer-based algorithm that calculates the 10-year probability of a major osteoporotic fracture and the 10-year probability of hip fracture. However, FRAX has several limitations in assessing the risk of fracture in patients with rheumatoid arthritis (RA).In 2013 V.A. Nasonova Reasearch Institute of Rheumatology (Russia) developed a predictive mathematical model for assessing the risk of osteoporotic fractures in RA, which includes 2 main risk factors: cumulative glucocorticoid dose (GC), decrease in BMD in the femoral neck to osteoporosis, and 2 additional factors: for patients under 65 years of age - the presence of ischemic heart disease, and for people over 65 - a history of gastric ulcer or duodenal ulcer.Objectives:To compare accuracy of osteoporotic fracture risk prediction in patients with RA using the predictive model developed at V.A. Nasonova Reasearch Institute of Rheumatology (IR) and FRAX.Methods:This monocentric (single-center) prospective study included 70 patients with RA, aged 40 to 80 years. The follow-up period - 8.0 ± 1.2 years; mean age at the baseline was 55.4±7.8 years old; the mean disease duration at the baseline - 14,7±10,2 years. All patients retrospectively calculated the 10-year probability of fractures and prognostic model developed by the IR.Results:According to the Fracture Risk Assessment Tool, 32 (46%) patients had a low risk of osteoporotic fractures, 38 (54%) had a high risk. According to the predictive model of IR 33 (47%) patients had a low risk of osteoporotic fractures, 37 (53%) had a high risk. During the follow-up period, osteoporotic fractures were occurred in 18 (26%) patients: 14 (78%) of them had a high risk of fractures according to the predictive IR model, and 13 (72%) patients - according to the Fracture Risk Assessment Tool. Positive and negative predictive value of the Fracture Risk Assessment Tool was 34% and 84%, respectively, of the predictive model of IR - 38% and 88%, respectively. Prognosis of the predictive model of IR in 73% cases coincided with assessing the 10-year probability of fracture.Conclusion:The predictive model developed at V.A. Nasonova Reasearch Institute of Rheumatology (Russia) showed a higher sensitivity and specificity in determining the risk of osteoporotic fractures in RA patients vs FRAX algorithm.Disclosure of Interests:None declared.

Impact of biologic disease-modifying antirheumatic drugs on fracture risk in patients with rheumatoid arthritis: a systematic review and meta-analysis.

This systematic review aimed to assess the impact of biologic disease-modifying antirheumatic drugs (bDMARDs) use on the risk of fracture in rheumatoid arthritis (RA) by conducting a pooled analysis of adjusted outcomes from individual studies. PubMed, Embase, and BioMed Central were searched up to 20th January 2021. Multivariable-adjusted odds ratios (OR) or matched estimates on the impact of bDMARDs on fracture risk were pooled. Nine studies were included. We found no statistically significant difference in the risk of fractures in RA patients using bDMARDs vs. non-users. On sensitivity analysis, we found no change in the significance of the effect size on exclusion of any study. There was no statistically significant difference in fracture risk in studies only on tumor necrosis factor (TNF) inhibitors, as well as those including any bDMARDs. Pooled analysis of only three studies indicated a statistically significant reduction in vertebral fractures in bDMARD users vs. non-users. Within the ambit of several limitations of our review, there seems to be no impact of bDMARDs on the fracture risk in RA patients. Further studies evaluating the type and duration of bDMARD therapy with meticulous adjustment of confounding factors are required to strengthen current evidence.

Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Частота и факторы риска падений у пациентов с ревматоидным артритом

Study Objective: To identify the prevalence and risk factors (RFs) of falls in patients with rheumatoid arthritis (RA). Study Design: A three-year prospective study. Materials and Methods. The study included 122 patients with RA (mean age: 60 [55; 67] years old). We undertook a clinical and laboratory examination and assessed RA, physical activity, and muscle strength in hands. In order to predict falls, we used a multifactorial logistic regression analysis. Study Results. During the prospective observation, 60% of RA patients had falls, and 25% of them had 2 and more falls. The single-factor regressive analysis showed that the prevalence of falls in patients with RA was impacted by the age (p = 0.0041), smoking (p = 0.032), history of falls (p = 0.032), and presence of aseptic joint necrosis (p = 0.046). The RFs were used to construct a prediction model for RA patients with the sensitivity of 74.2% and specificity 83.7%. Conclusion. High prevalence of falls and associated low-energy fractures in RA patients necessitate creation of a strategic prevention program. Our prediction model possesses good prognostic value and can be used to identify a high risk of falls in patients with RA. Keywords: rheumatoid arthritis, falls, risk factors, prevalence of falls.

Relationships of the stand-up time to falls and fractures in patients with rheumatoid arthritis: Results from the CHIKARA study.

Patients with rheumatoid arthritis (RA) have a higher risk of falls and fractures due to muscle weakness and painful joints of the lower extremities. Evaluation of muscle functions is important to predict falls and fractures. The aim was to investigate the relationships of muscle functions with falls and fractures in RA patients. Stand-up muscle power, speed, and stabilizing time were evaluated by a muscle function analyzer in 90 RA patients in the CHIKARA study (UMIN000023744). The relationships of the muscle functions with falls, fractures, body composition, Disease Activity Score of 28 joints - erythrocyte sedimentation rate (DAS28-ESR), modified Health Assessment Questionnaire (mHAQ) scores, Steinbrocker class, stage, sarcopenia, and frailty were investigated in a cross-sectional study. Each parameter of muscle function was related to age, falls, frailty, and the leg muscle score. However, only stabilizing time was related with fractures (r=.217, P=.04). When stabilizing time was≥1.13 and ≥1.36seconds, the odds ratios for falls and fractures were increased 6.2-fold compared to<1.13seconds (95% CI: 1.2-20.1, P=.002) and 11.4-fold compared to <1.36seconds (95% CI: 1.7-92.5, P=.071), respectively. Sarcopenia and skeletal muscle mass were not significantly related to each muscle function. There was a negative correlation between DAS28-ESR and power. Steinbrocker class and mHAQ had negative correlations with power and speed. Sarcopenia and skeletal muscle mass were not adequate indicators of muscle functions in RA patients. Analyzing muscle functions is helpful to predict falls and fractures. Patients with extended stabilizing times should recognize the increased risk of falls and fractures.

Frequency Distribution of Bone Fractures in Rheumatoid Arthritis Patients: ACross-Sectional Study in Police Teaching Hospital, Khartoum 2019

Background: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults. This study reveals the frequency distribution of bone fractures and the most frequent fracture sites in RA patients in Police teaching hospital, Sudan. Materials and method: A cross-sectional study was conducted in Khartoum, Sudan from September 2018 to September 2019. The questionnaire is in form of Multiple choice questions, Composed of Demographic information Regards their (age, sex, Occupation, and social habit), Information about the RA disease (duration, Risk factor, and investigation). Information concerning Bone fracture (if there is any fracture, site, how it detected). Statistical analysis was performed using SPSS, Version 22.0. (IBM, USA). Results: From patients diagnosed with RA, 25% had bone fractures out of 72 RA patients. A 72 rheumatic patients were involved in this crosssectional study, 11 of them (15.3%) were males and 61 (84.7%) were females. the mean of age was 50.6 years (48 years for male, 51years for female). The duration of rheumatoid in the majority of patients (36.1%) was falling between 2-5 years of diagnosis. The most common site of fracture is hip (36.9%) following by carpal bones (26.3%), then spinal vertebrae (10.5%). Conclusion: 25% of RA patients experienced bone fractures because of falling the most common site of bone fractures in RA patients is hip bone. Physicians should know the association between RA, bone fractures, and corticosteroid use to decrease bone fracture incidence. Also, investigations such as bone loss measurement should be done routinely to any RA patient.

Comparison of outcomes after reverse shoulder arthroplasty in patients with rheumatoid arthritis and cuff tear arthropathy

Background The reverse shoulder arthroplasty (RSA) was originally designed for cuff tear arthropathy (CTA). Over time, the indications have expanded to rheumatoid arthritis (RA). This study aimed to compare the outcomes of RSA in patients with RA and CTA to determine if there is any impact on clinical and radiographic outcomes. Methods In this retrospective comparative study (performed from August 2010 to March 2017), 61 shoulders from 59 consecutive patients (RA group: 24 patients [26 shoulders], CTA group: 35 patients [35 shoulders]) who underwent primary RSA, were included. The average follow-up period was 31 months (range, 24-64 months). Patients were assessed with the use of the visual analog scale pain score, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, the Single Assessment Numeric Evaluation score, range of motion (ROM), and imaging studies included the β angle, glenoid component superior tilt, and scapular notching. Results The clinical results improved significantly in both groups, but there was no statistically significant difference between the RA group and the CTA group. Significant intergroup differences were observed regarding the β angle (73° ± 11° for the RA group vs. 85° ± 8° for the CTA group; P Conclusion Compared with CTA patients, RA patients achieved similar clinical outcomes following RSA. However, surgeons should pay attention to the positioning of the glenoid component during the surgery and the risk of intraoperative fractures in RA patients.

Frequency distribution of bone fractures in rheumatoid arthritis patients: A cross-sectional study in police teaching hospital 2020

Background: Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis in adults. This study reveals the frequency distribution of bone fractures and the most frequent fracture sites in RA patients in Police teaching hospital. Materials and Method: A cross-sectional study, a health facility-based was conducted in Khartoum, Sudan from January 2019 to January 2020. The questionnaire is in form of Multiple-choice questions, Composed of Demographic information Regards their (age, sex, Occupation, and social habit), Information about the RA disease (duration, Risk factor, and investigation). Information concerning Bone fracture (if there is any fracture, site, how it detected). Statistical analysis was performed using SPSS, Version 22.0. (IBM, USA). Results: From patients diagnosed with RA, 25% had bone fractures out of 72 RA patients. A 72 rheumatic patients were involved in this cross-sectional study, 11 of them (15.3%) were males and 61 (84.7%) were females. the mean of age was 50.6 years (48 years for male, 51years for female). The duration of rheumatoid in the majority of patients (36.1%) was falling between 2-5 years of diagnosis. The most common site of fracture is hip (36.9%) following by carpal bones (26.3%), then spinal vertebrae (10.5%), and talus bone (10.5%). Conclusion:25% of RA patients experienced bone fractures, the most common site of bone fractures in RA patients is hip bone following by carpal bones. Physicians should know the association between RA and bone fractures to decrease the bone fracture incidence. Also, investigations such as bone loss measurement should be done routinely to any patients with RA.

Zoledronic acid ameliorates the effects of secondary osteoporosis in rheumatoid arthritis patients

BackgroundSecondary osteoporosis may occur in patients with rheumatoid arthritis (RA), causing irreversible joint damage and disability. Bisphosphonates, the recently developed bone resorption inhibitors, have demonstrated significant therapeutic effects on senile and postmenopausal osteoporosis. This study evaluated the efficacy and safety of zoledronic acid (ZOL), with or without methotrexate (MTX), for the prevention and treatment of bone destruction in RA patients.MethodsWe recruited 66 RA patients with symptoms of secondary osteoporosis. They were randomized into three treatment groups—combined treatment with MTX and ZOL, ZOL monotherapy, or MTX monotherapy—in two consecutive 6-month periods. The participants were followed for 12 months. At the end of each treatment period, improvement in disease activity, bone destruction, and fracture risk were evaluated.ResultsCombined treatment with ZOL and MTX had significantly better clinical efficacy compared with either ZOL or MTX monotherapy (P < 0.05). The combination significantly improved the lumbar spine and hip BMD and reduced FRAX scores, suggesting that ZOL combined with MTX reduces bone loss and risk of hip fracture in RA patients with secondary osteoporosis.ConclusionZOL has a synergistic effect when combined with MTX, inhibiting RA disease activity, reducing fracture risk, and improving quality of life in RA patients with secondary osteoporosis.Trial registrationChinese Clinical Trial Registry, ChiCTR1800019290. Registered 3 November 2018–Retrospective registered, http://www.chictr.org.cn/showproj.aspx?proj = 31758