Relationship between Disease Activity and Calcium Levels with Bone Mineral Density in Rheumatoid Arthritis Patients

Authors

  • Nur Handy Megawanto Universitas Brawijaya
  • Bagus Putu Putra Suryana Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya—dr. Saiful Anwar General Hospital, Malang, Indonesia
  • Rulli Rosandi Division of Endocrinology Metabolic and Diabetes, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya —dr. Saiful Anwar General Hospital, Malang, Indonesia

DOI:

https://doi.org/10.21776/ub.crjim.2021.002.01.2

Keywords:

Artritis reumatoid, Disease activity, BMD, Calcium.

Abstract

Background: Arthritis rheumatoid (AR) is a chronic inflammatory disease that mainly affects the joints. Decreased bone mass and osteoporosis are its complications. Several factors such as dietary calcium, disease activity, physical activity, vitamin D levels, steroids can affect bone mineral density values. Aim: The purpose of this study was to determine the relationship between disease activity, calcium levels and bone mineral densitometry in patients with arthritis rheumatoid. Methods: 23 AR patients based on the 2010 ACR criteria including the inclusion criteria with a cross sectional study approach that had bone mineral densitometry (BMD) data for the last 1 year. Blood samples were also taken to check the total calcium level, the characteristics of the baseline data were collected, and the disease activity was examined using the DAS 28 LED. The relationship between these factors and the bone mass density was analyzed using the Spearman test. The analysis result was considered significant if p <0.05. Results: The results showed that the basic characteristics of the subjects were 45,87 years old, body mass index 24,51 kg / m2, duration of illness 3,96 years, steroid dose 3,48 mg, disease activity 4.35 (moderate disease activity), anti CCP 333,87 U / ml, rheumatoid factor (RF) 10,18 IU / ml, methotrexate 12,17 mg, leflunomide 20 mg. There was no significant relationship between serum calcium levels and disease activity with BMD. However, there was a significant relationship between age and BMI with BMD in the femur neck (p = 0,043), lumbar 3 (p = 0,017) and lumbar 4 (p = 0,048). Conclusion: There is no relationship between disease activity and calcium levels with bone mass density values in AR patients except for age and BMI.

Author Biography

Nur Handy Megawanto, Universitas Brawijaya

Resident of Internal Medicine Faculty of Medicine Universitas Brawijaya

References

Alam JI, Jantan, and Bukhari SNA. Rheumatoid arthritis: Recent advances on its etiology, role of cytokines and pharmacotherapy. Biomed Pharmacother, 2017. 92: p. 615-633. [DOI: 10.1016/j.biopha.2017.05.055 ]

Aletaha D and Smolen JS. Diagnosis and management of rheumatoid arthritis: A review. JAMA, 2018. 320(13): p. 1360-1372. [DOI: 10.1001/jama.2018.13103 ]

Amarasekara DS, Yu J, and Rho J. Bone loss triggered by the cytokine network in inflammatory autoimmune diseases. J Immunol Res, 2015. 2015: p. 12. [DOI: 10.1155/2015/832127 ]

Lau CS, et al. 2018 Update of the APLAR recommendations for treatment of rheumatoid arthritis. Int J Rheum Dis, 2019. 22(3): p. 357-375. [DOI: 10.1111/1756-185X.13513 ]

Deal C. Bone loss in rheumatoid arthritis: systemic, periarticular, and focal. Curr Rheumatol Rep, 2012. 14(3): p. 231-237.

[DOI: 10.1007/s11926-012-0253-7 ]

Heinlen L and Humphrey MB. Skeletal complications of rheumatoid arthritis. Osteoporos Int, 2017. 28(10): p. 2801-2812. [DOI: 10.1007/s00198-017-4170-5 ]

Shim JH, Stavre Z, and Gravallese EM. Bone loss in Rheumatoid Arthritis: Basic Mechanisms and Clinical Implications. Calcif Tissue Int 2018. 102(5): p. 533-546. [DOI: 10.1007/s00223-017-0373-1 ]

Walsh NC, and Gravallese EMJIR. Bone remodeling in rheumatic disease: a question of balance. Immunol Rev, 2010. 233(1): p. 301-312. [DOI: 10.1111/j.0105-2896.2009.00857.x ]

Geusens P. The role of RANK ligand/osteoprotegerin in rheumatoid arthritis. Ther Adv Musculoskelet Dis, 2012. 4(4): p. 225-233. [doi: 10.1177/1759720X12438080]

Jung SM, et al. Cytokine-mediated bone destruction in rheumatoid arthritis. J Immunol Res, 2014. 2014: p. 263625-263625. [DOI: 10.1155/2014/263625 ]

Firestein GS, and IB McInnes. Immunopathogenesis of Rheumatoid Arthritis. Immunity, 2017. 46(2): p. 183-196.[ DOI: 10.1016/j.immuni.2017.02.006 ]

Vis M, Güler-Yüksel M, and Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int, 2013. 24(10): p. 2541-2553. [DOI:10.1007/s00198-013-2334-5]

Zhu TY, et al. Bone Density and Microarchitecture: Relationship Between Hand, Peripheral, and Axial Skeletal Sites Assessed by HR-pQCT and DXA in Rheumatoid Arthritis. Calcif Tissue Int 2012. 91(5): p. 343-355. [DOI: 10.1007/s00223-012-9644-z ]

Güler-Yüksel M, et al. Accelerated hand bone mineral density loss is associated with progressive joint damage in hands and feet in recent-onset rheumatoid arthritis. Arthritis Res Ther, 2010. 12(3): p. R96. [doi: 10.1186/ar3025]

Tanner SB and Moore CF, Jr. A review of the use of dual-energy X-ray absorptiometry (DXA) in rheumatology. Open Access Rheumatol, 2012. 4: p. 99-107. [doi: 10.2147/OARRR.S29000]

Hoes JN, Bultink IEM, and Lems WF, Management of osteoporosis in rheumatoid arthritis patients. Opin Pharmacother, 2015. 16(4): p. 559-571. [DOI: 10.1517/14656566.2015.997709 ]

Annamalai R and Kumar A. Study of biochemical profile and 25-hydroxy Vitamin D association with disease activity in rheumatoid arthritis patients. J Orthop Allied Sci, 2018. 6(1): p. 17-21. [DOI: 10.4103/joas.joas_37_17]

Yoshii I, Chijiwa T, and Sawada N. Rheumatoid arthritis in tight disease control is no longer risk of bone mineral density loss. Osteoporos Sarcopenia, 2020. 6(2): p. 75-81. [DOI: 10.1016/j.afos.2020.04.002 ]

Nielung L, et al. Validity and Agreement between the 28-Joint Disease Activity Score Based on C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients with Rheumatoid Arthritis. Arthritis, 2015. 2015: p. 401690. [doi: 10.1155/2015/401690]

Lian IA and Ã…sberg A. Should total calcium be adjusted for albumin? A retrospective observational study of laboratory data from central Norway. BMJ Open, 2018. 8(4): p. e017703.[DOI:10.1136/bmjopen-2017-017703 ]

Hwang J, et al. Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis. Osteoporos Int, 2017. 28(1): p. 231-237. [doi: 10.1056/NEJMoa1107142]

Raterman HG, Bultink IE, and Lems WF. Osteoporosis in patients with rheumatoid arthritis: an update in epidemiology, pathogenesis, and fracture prevention. Expert Opin Pharmacother, 2020. 21(14): p. 1725-1737. [DOI: 10.1080/14656566.2020.1787381 ]

Mobini M, Kashi Z, and Ghobadifar A. Prevalence and associated factors of osteoporosis in female patients with rheumatoid arthritis. Caspian J Intern Med, 2012. 3(3): p. 447-450. [PMID: 24009912]

Sezer A, Altan L, and Ö. Özdemir. Multiple Comparison of Age Groups in Bone Mineral Density under Heteroscedasticity. BioMed Research International, 2015. 2015: p. 426847. [https://doi.org/10.1155/2015/426847]

Henry MJ, et al. Bone mineral density reference ranges for Australian men: Geelong Osteoporosis Study. Osteoporos Int, 2010. 21(6): p. 909-917. [DOI: 10.1007/s00198-009-1042-7 ]

Zhang ZQ, et al. Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int, 2014. 25(2): p. 497-507. [DOI: 10.1007/s00198-013-2418-2 ]

Adami G and Saag KG. Osteoporosis Pathophysiology, Epidemiology, and Screening in Rheumatoid Arthritis. Curr Rheumatol Rep, 2019. 21(7): p. 34. [DOI: 10.1007/s11926-019-0836-7 ]

Aletaha D, Alasti F, and Smolen JS. Rheumatoid factor, not antibodies against citrullinated proteins, is associated with baseline disease activity in rheumatoid arthritis clinical trials. Arthritis Res Ther, 2015. 17(1): p. 229. [DOI: 10.1186/s13075-015-0736-9 ]

Mat Suwito KH, Suryana BPP, Kalim H, Wahono CS. Correlation between anti-cyclic citrullinated peptide antibodies and the severity of clinical manifestation, laboratory manifestation, and radiological joint destruction in rheumatoid arthritis patients. Indonesian Journal of Rheumatology, 2010. 2: p. 14 -17.

Bugatti S, et al. The Clinical Value of Autoantibodies in Rheumatoid Arthritis. Front Med 2018. 5: p. 339-339. [ doi: 10.3389/fmed.2018.00339]

Aletaha, D. and S. Blüml, Therapeutic implications of autoantibodies in rheumatoid arthritis. RMD Open, 2016. 2(1): p. e000009. [http://dx.doi.org/10.1136/rmdopen-2014-000009]

Rocha SDB, Baldo DC, and Andrade LEC. Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis %J Advances in Rheumatology. Adv Rheumatol, 2019. 59. [DOI: 10.1186/s42358-018-0042-8 ]

Bellan M, Pirisi M, and Sainaghi PP. Osteoporosis in rheumatoid arthritis: role of the vitamin D/parathyroid hormone system. Rev. Bras. Reumatol, 2015. 55(3): p. 256-263. [http://dx.doi.org/10.1016/j.rbr.2014.10.007]

Peacock M. Calcium Metabolism in Health and Disease. Clin J Am Soc Nephrol, 2010. 5(Supplement 1): p. S23. [DOI: 10.2215/CJN.05910809 ]

Liu M, Yao X, and Zhu Z. Associations between serum calcium, 25(OH)D level and bone mineral density in older adults. J Orthop Surg Res, 2019. 14(1): p. 458. [doi: 10.1186/s13018-019-1517-y]

Dalemo S, et al. Bone mineral density in primary care patients related to serum calcium concentrations: a longitudinal cohort study from Sweden. Scand J Prim Health Care, 2018. 36(2): p. 198-206. [doi: 10.1080/02813432.2018.1459430]

Cerani A, et al. Genetic predisposition to increased serum calcium, bone mineral density, and fracture risk in individuals with normal calcium levels: mendelian randomisation study. BMJ, 2019. 366: p. l4410. [doi: https://doi.org/10.1136/bmj.l4410]

Amin S, et al. Are Young Women and Men with Rheumatoid Arthritis at Risk for Fragility Fractures? A Population-based Study. J Rheumatol, 2013. 40(10): p. 1669. [doi: 10.3899/jrheum.121493]

Zhu K. et al., Associations between body mass index, lean and fat body mass and bone mineral density in middle-aged Australians: The Busselton Healthy Ageing Study. Bone, 2015. 74: p. 146-152. [DOI: 10.1016/j.bone.2015.01.015 ]

Mu M, et al. Dietary Patterns Are Associated with Body Mass Index and Bone Mineral Density in Chinese Freshmen. J Am Coll Nutr, 2014. 33(2): p. 120-128.

[DOI: 10.1080/07315724.2013.874897 ]

Tournadre A, et al. Changes in body composition and metabolic profile during interleukin 6 inhibition in rheumatoid arthritis. J Cachexia Sarcopenia Muscle, 2017. 8(4): p. 639-646. [ DOI: 10.1002/jcsm.12189 ]

Mochizuki T, et al. Sarcopenia-associated factors in Japanese patients with rheumatoid arthritis: A cross-sectional study. Geriatr Gerontol Int, 2019. 19(9): p. 907-912. [DOI: 10.1111/ggi.13747 ]

El Maghraoui A, et al. Does Rheumatoid Cachexia Predispose Patients with Rheumatoid Arthritis to Osteoporosis and Vertebral Fractures? J Rheumatol, 2015. 42(9): p. 1556. [DOI: 10.3899/jrheum.141629 ]

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Published

2021-05-03

How to Cite

Megawanto, N. H., Suryana, B. P. P., & Rosandi, R. (2021). Relationship between Disease Activity and Calcium Levels with Bone Mineral Density in Rheumatoid Arthritis Patients. Clinical and Research Journal in Internal Medicine, 2(1), 116–123. https://doi.org/10.21776/ub.crjim.2021.002.01.2

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Original Article