Evaluation of systemic and localized bone involvement in premenopausal women with long-standing rheumatoid arthritis

Author(s)

Mariana Ortega Perez

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2021-05-03

Examining board members

Rosa Maria Rodrigues Pereira; Manoel Barros Bértolo; Ivânio Alves Pereira; Vera Lucia Szejnfeld

• Advisor: Rosa Maria Rodrigues Pereira

Abstract

Introduction: two patterns of bone involvement are described in rheumatoid arthritis (RA), systemic and localized. Systemic bone involvement is characterized by generalized bone mass loss, osteoporosis and increased risk of fractures, while localized bone involvement by periarticular osteopenia, bone cysts and bone erosions. High resolution peripheral quantitative computed tomography (HR-pQCT) is an imaging methodology capable of evaluating volumetric bone mineral density and bone microarchitecture at the distal radius and tibia, and localized periarticular lesions, catabolic (erosion) and anabolic (osteophytes) in inflammatory arthropathies. Objectives: to evaluate premenopausal women with long-standing RA and to explore the relationship between parameters of systemic and localized bone involvement assessed simultaneously using HR-pQCT. Methods: eighty consecutive RA premenopausal women were evaluated. Volumetric bone mineral density (vBMD), microarchitecture and finite element analysis were performed using HR-pQCT at the distal radius and tibia and compared with parameters from 160 female healthy controls matched by age and body mass index. Localized bone involvement was also assessed using HRpQCT in the 2nd and 3rd metacarpophalangeal and 2nd and 3rd proximal interphalangeal joints to identify erosions and osteophytes. Results: the mean age of patients was 39.4 ± 6.7 years, and the disease duration was 9.8 ± 5.3 years. Bone erosions were found in 75% of patients, and osteophytes were found in 41.3%, both of which were mainly located in the metacarpophalangeal head. An association between erosion and osteophyte was observed (p = 0.001). RA patients had impaired trabecular, cortical and bone strength parameters compared with healthy controls at the radius and tibia (p < 0.05). Comparing patients with and without erosions, at the radius and tibia, a lower cortical vBMD (radius: 980 ± 72 mgHA/cm3 versus 1021 ± 47 mgHA/cm3 , p = 0.03; and tibia: 978 ± 34 mgHA/cm3 versus 1003 ± 34 mgHA/cm3 , p = 0.04, respectively) and higher cortical porosity (radius: 2.8 ± 2.5% versus 1.8 ± 1.6%, p = 0.04; and tibia: 3.7 ± 1.6% versus 2.7 ± 1.6%, p=0.01, respectively) were observed in patients with erosion. At the radius, osteophyte volume was positively correlated with trabecular vBMD (0.392, p = 0.02), trabecular number (0.381, p = 0.03) and stiffness (0.411, p = 0.02), and negatively correlated with trabecular separation (-0.364, p = 0.04). Conclusion: this study showed that premenopausal women with long-standing RA had systemic bone fragility at peripheral sites. It was observed that erosions were associated with cortical bone fragility at the radius and tibia, and osteophytes correlated with repair of trabecular bone at the radius. (AU)

• FAPESP's process: 18/05596-2 - Evaluation of bone parameters obtained by histomorphometry, HR-pQCT and trabecular bone score in patients with Rheumatoid Arthritis
• Grantee: Mariana Ortega Perez
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)