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ACPA, RF linked with bone loss in patients with early untreated RA
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Anti-citrullinated protein antibodies and high levels of rheumatoid factor were associated with systemic bone loss in patients with early untreated rheumatoid arthritis, according to a recently published study.
In patients with early untreated rheumatoid arthritis, anti-citrullinated protein antibodies (ACPA) have been previously associated with articular bone destruction. In this study, the researchers determined whether ACPA and other autoantibodies were associated with systemic bone loss.
To do this, the investigators measured the systemic bone mineral density (BMD) in the lumbar spine and hip of 155 patients who had early untreated rheumatoid arthritis (RA) for a median duration of 13 weeks. The researchers recorded clinical disease activity, joint damage, ACPA and rheumatoid factor (RF) levels.
They found 25.5% of patients had reduced BMD in the spine and 19.4% had it in the hip. ACPA was associated with a reduced spine Z-score (adjusted odds ratio = 2.76), while only high titres were associated with a reduced hip Z-score (adjusted odds ratio = 2.96). Even at low levels of RF, ACPA was associated with reduced BMD in the spine (adjusted odds ratio = 2.65) and was further increased at higher levels of RF (adjusted odds ratio = 3.38). Conversely, hip Z-scores were reduced only in association with high ACPA and RF (adjusted odds ratio = 4.96).
These findings support the concept that autoimmunity associated with RA may cause bone remodeling, the researchers wrote.
“ACPA-RF-positive patients with early RA should thus be carefully monitored for the development of generalized osteoporosis beyond the assessment of traditional risk factors,” the researchers wrote. – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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