Rheumatoid Arthritis

BMD of the distal and midradius was measured by DXA (Norland XR-26) in 34 women with rheumatoid arthritis and compared to 40 controls (92). The women with rheumatoid arthritis ranged in age from 40 to 79 years with a mean age of 61 years. The average duration of disease was 12 years. BMD in both the distal and midradius was reduced in the women with rheumatoid arthritis who were in their 50s and 60s compared to controls. Women with rheumatoid arthritis in their 40s and 70s did not have BMDs that were significantly lower than controls. The authors suggested that postmenopausal bone loss may amplify the bone loss seen in rheumatoid arthritis.

Forty-six postmenopausal women with rheumatoid arthritis with a disease duration of 2 to 35 years underwent bone density testing at a variety of skeletal sites (93). The ultradistal radius was evaluated with pQCT (Stratec XCT-960, Birkenfeld, Germany), the os calcis with ultrasound (McCue CUBA, McCue Ultrasonics Ltd., Winchester Hampshire, UK), and the spine and proximal femur with DXA (Norland XR-26 Mark II). Results were compared to 29 healthy postmenopausal women who served as controls. The postmenopausal women with rheumatoid arthritis had significantly lower bone density at all sites when compared to controls except at the lumbar spine and in the cortical measurement at the ultradistal radius. The total ultradistal BMD was 15.6% lower and the trabecular ultradistal BMD was 36.1% lower than controls. Femoral neck BMD was 15.4% lower than controls. Os calcis broadband ultasound attenuation was

31.7% lower and the velocity of sound was 6.6% lower. BMD at the lumbar spine in the women with rheumatoid arthritis was 6.7% lower than controls but this difference was not statistically significant.

BMD measurements of the hand, PA spine, and proximal femur were performed on 202 subjects (61 men, 141 women) with rheumatoid arthritis using DXA (Lunar DPX-L) (94). The average age of the subjects was 58 years and the median disease duration was 1.8 years. BMD measurements of the hand were significantly correlated with BMD at lumbar spine and femoral neck (r = 0.67 and r = 0.63, respectively). In a separate study of 56 subjects with rheumatoid arthritis, hand BMC was shown to be significantly reduced in subjects with rheumatoid arthritis compared to controls (95). In another 42 subjects with recent onset of rheumatoid arthritis who were followed prospectively with hand BMC, losses of 5.36% in men and 2.14% in women were noted in 1 year (96).

Lane et al. (97) evaluated 120 postmenopausal women with rheumatoid arthritis, measuring BMD at the PA lumbar spine and proximal femur with DXA (Hologic QDR-1000) and at the distal radius and os calcis with SPA (OsteoAnalyzer). The women with rheumatoid arthritis were divided into three groups based on corticosteroid use: never users, current users, and past users. Results were compared to 7966 age-matched controls. All of the women were 65 years of age or older. Women with rheumatoid arthritis were found to have significantly lower BMD at all measurement sites when compared to controls. Women with rheumatoid arthritis who were never users had significantly lower BMD at the distal radius, os calcis, and total femur compared to controls. Women with rheumatoid arthritis who were current users had the lowest BMD at the distal radius, os calcis, and total femur. The authors concluded that postmenopausal women with rheumatoid arthritis have lower appendicular and axial bone densities that cannot be attributed to corticosteroid use.

In 1996, Deodhar and Woolf (98) reviewed bone densitometry studies in patients with rheumatoid arthritis. They concluded that patients with rheumatoid arthritis have lower bone density in both the appendicular and axial skeletons when compared with controls and that the most rapid bone loss occurred within the first year after the onset of disease. They also noted that the evidence suggested that doses of oral corticosteroids greater than 5 mg per day were associated with significant bone loss in patients with rheumatoid arthritis.

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