Assessment of vertebral fractures occurred

in patients with rheumatoid arthritiscorrelation with disease activity score

University of Medicine and Pharmacy of Craiova

Background

rheumatoid arthritis (RA)-the most common

chronic autoimmune disease
debilitating phenotype
major economic impact
affects approximately 1% of the population
worldwide*

*Kotake S. Nihon Naika Gakkai Zasshi [Rheumatoid arthritis and osteoporosis]. 2005; 94(4):649-655
University of Medicine and Pharmacy of Craiova

Background
osteoporosis is the main complication of RA

patients are at high risk of fractures

special attention -osteoporosis related

vertebral fractures -consequences:
recurrences, chronic back pain,
kyphosis and functional impairment.

Roux C. Osteoporosis in inammatory joint diseases. Osteoporos Int 2011; 22(2):421-433

University of Medicine and Pharmacy of Craiova

Aim

The main objective was to study the

frequency of vertebral fractures in
patients with RA, and the relationship
with the disease activity score and the
functional status
University of Medicine and Pharmacy of Craiova

Material and Methods

Location: Rheumatology Clinic, Emergency
County Hospital, Craiova

Time period: october 2011-august 2012

125 patients, diagnosed with AR by 1987 ACR

chriteria

University of Medicine and Pharmacy of Craiova

Material and Methods

Bone mineral density lumbar spine and total hipDXA technology
Diagnosis

T-score*

Normal

-1.0

Low bone mass

(osteopenia)

Between -1.0 and

-2.5

Osteoporosis

-2.5

Severe
(established)
osteoporosis

-2.5 and
fragility fracture

*Adapted for clinical use from the World Health Organization:

http://www.shef.ac.uk/FRAX/pdfs/WHO_Technical_Report.pdf
University of Medicine and Pharmacy of Craiova

Material and Methods

Fracturar risk-FRAX algorithm, introduced
by WHO task force in 2008, which estimates
the 10-year probability of hip fracture and
major osteoporotic fracture

*WHO Fractureosteoporotic fracture Risk Assessment Tool (FRAX).

http://www.shef.ac.uk/FRAX (Accessed on June 05, 2012).
University of Medicine and Pharmacy of Craiova

Material and Methods

Vertebral fractures were diagnosed using the
Genant method

University of Medicine and Pharmacy of Craiova

Material and Methods

Disease activity score-DAS28(4v) defines a

High activity for values>5.1
Moderate activity 3.2-5.1
Low activity 2.6-3.1
Remission <2.6

University of Medicine and Pharmacy of Craiova

Results
Osteoporosis - 21.6% patients, both for
lumbar spine and total hip
Osteoporosis- 38.5% for one site
Osteopenia-32%

University of Medicine and Pharmacy of Craiova

Results
Mean value-DAS28(4v) -4.78

University of Medicine and Pharmacy of Craiova

Results
FRAX-4.716.03% (min 0, max 37)hip and
11,968.18% (min 1.7%, max 46%) for a
major osteoporotic fracture
50
40
30

Mean

IC
95%

DS

Median

Min

Max

20
10

FRAX-major
osteoporotic
fracture (%)

11.96

10.5113.41

8.1
8

1.7

46

FRAX-hip (%)

4.71

3.655.78

6.0
3

2.3

37

University of Medicine and Pharmacy of Craiova

Results
29.6% (37)-vertebral fractures
9 patients2 fractures
Location -

9
6
4
1

T10,T12, L1
T11, L2
L3
T8,T9

Grade -67.56%-1

-40.45%-2

-13.51% grade 3
University of Medicine and Pharmacy of Craiova

Results
48 osteoporosis-20 VF
40 osteopenia-4VF
RR 6.64 (%)

University of Medicine and Pharmacy of Craiova

Results
54% DAS28(4v)>5,1-at least one VF
15.78% moderate activity score-at least one
VF
10
8
6
4
2
0

University of Medicine and Pharmacy of Craiova

p<0.0001

Results

DAS28(4v)
r

0.482

<0.0001

IC95%

0.33-0.60

r2

0.233

University of Medicine and Pharmacy of Craiova

Conclusions

Our research was based on highly significant

items as the assessment of BMD-a
noninvasive, accessible and reliable method,
that has a possitive correlation with the
fracturar risk, established by the results of
several multicentric studies worldwide

University of Medicine and Pharmacy of Craiova

Conclusions

The relevancy of the study arises from the

necesity of an early diagnosis of osteoporosis
, due to the fact that over 1/3 of the patients
with AR and osteoporosis have at least one
asymptomatic vertebral deformity, inducing
a late therapuetic intervention
Using FRAX algorithm we found a high 10
year risk both for a major osteoporotic and
hip fracture
University of Medicine and Pharmacy of Craiova

Conclusions
Establishing the profile of vertebral fractures
we found a significant percentage among the
AR patients, fact that testifies the risk of
functional impairment and disability, added
to the underlying disability of the disease
itself, in the absence of a quick therapeutic
action

University of Medicine and Pharmacy of Craiova

Conclusions

AR may be an independent factor for the

development of osteoporosis and vertebral
fractures, and the risk increases with the
disease duration and severe course of the
disease

University of Medicine and Pharmacy of Craiova

Medicine is a science of
uncertainty and an art of
probability
William Osler
Thank you!
University of Medicine and Pharmacy of Craiova