DOI: http://dx.doi.org/10.18203/2349-3933.ijam20172568

To study the bone mineral density and vitamin D in patients suffering from rheumatoid arthritis irrespective of duration in comparison to age and sex-matched controls who were not having any musculoskeletal disorder

Raj Kumar Bhimwal, Mohan Makwana, Harish Sanawadiya, Ratan Lal Bhati

Abstract


Background: Rheumatoid arthritis is a chronic inflammatory disease of synovial tissue of joints of unknown etiology marked by a symmetric, peripheral, polyarthritis. Osteoporosis is a progressive systemic skeletal disease characterised by reduced bone mass/density and micro-architectural deterioration of bone tissue. Osteoporosis is more common in patients with rheumatoid arthritis than an age and sex-matched population. Chronic use of glucocorticoids and disability-related immobility also contributes to osteoporosis.

Methods: The present study was conducted at Department of Medicine, Dr. S. N. Medical College, Jodhpur, India. Case control study was conducted to determine bone mineral densities (BMD) and vitamin D levels among patients with rheumatoid arthritis attending the medicine OPD and IPD, Dr. S. N. Medical College, Jodhpur, Rajasthan, India. 25 patients with rheumatoid arthritis and 25 age and sex-matched controls were studied. All known cases of Rheumatoid Arthritis attending Medicine outdoor and patients who are admitted indoor. Patients with co-morbidities like diabetes mellitus, coronary artery disease, hypertension, chronic kidney disease and pre-existing osteoporosis.

Results: Mean age of the study population was 49.68±8.4 yrs; most of the subjects were females. Vitamin D levels were found to be comparatively lower in females. Vitamin D deficiency was more prevalent of in urban population. As the age increased the levels of vitamin D and BMD decreased. Inadequacy in vitamin D levels was more prevalent in Rheumatoid arthritis patients, 74.99% females had low BMD values. Correlation of low BMD with RA was statistically significant. The duration of Rheumatoid arthritis was related to vitamin D levels significantly (p<0.013). The longer the duration of disease more number of RA patients had vitamin D deficiency. All patients with RA for more than 4 years had osteoporosis. The duration of Rheumatoid arthritis was related to low BMD significantly (p<0.025). The correlation of HAQ (health assessment questionnaire) with BMD is statistically significant; the correlation of DAS score with RA duration is statistically significant. The correlation of DAS score with BMD is statistically significant. The lesser the BMD more number of RA patients had moderate or severe scores.

Conclusions: Vitamin D levels were found to be comparatively lower in females especially in urban areas. Vitamin D deficiency and low BMD is more prevalent in Patients of rheumatoid arthritis in comparison to controls. High index of suspicion is required during follow-up of rheumatoid arthritis patients.


Keywords


BMD, Osteoporosis, Osteopenia, Rheumatoid arthritis, Vitamin-D

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References


Lipsky PE. Rheumatoid Arthritis. In: Longo, Fauci, Kooper, Hauser, Jamson, Loscalzo, eds. Harrison’s principles of internal medicine. 18th ed. New York NY. The Mac Graw-Hill Companies. Inc.; 2012:2738.

Lipsky PE. Rheumatoid Arthritis. In: Longo, Fauci, Kooper, Hauser, Jamson, Loscalzo, eds. Harrison’s principles of internal medicine. 18th ed. New York NY. The Mac Graw-Hill Companies. Inc.; 2012:2741.

Lipsky PE. Rheumatoid Arthritis. In: Longo, Fauci, Kooper, Hauser, Jamson, Loscalzo, eds. Harrison’s principles of internal medicine. 18th ed. New York NY. The Mac Graw-Hill Companies. Inc.; 2012:2740.

Lipsky PE, Betty Diamond. Rheumatoid Arthritis. In: Longo, Fauci, Kooper, Hauser, Jamson, Loscalzo, eds. Harrison’s principles of internal medicine. 18th ed. New York NY. The Mac Graw-Hill Companies. Inc.; 2012:2829.

Sarav FD, Sayegh F. Bone Mineral Density and Body Composition of Adult Premenopausal Women with Three Levels of Physical Activity J Osteoporos. 2013;(2013).

Lips P, van Schoor NM. The effect of vitamin D on bone and osteoporosis. Best Pract Res Clin Endocrinol Metab. 2011;25:585-91.

Goswami R, Vatsa M, Sreenivas V, Singh U, Gupta N, Lakshmy R, et al. Skeletal muscle strength in young Asian Indian females after vitamin D and calcium supplementation: a double-blind randomized controlled clinical trial. J Clin Endocrinol Metabo. 2012;97(12):4709-16.

Bertone-Johnson ER, Chen WY, Holick MF, Hollis BW, Colditz GA, Willett WC, et al. Plasma 25-hydroxyvitamin D and 1, 25-dihydroxyvitamin D and risk of breast cancer. Cancer Epidemiol Biomarkers Prev. 2005;14(8):1991-7.

Merlino L, Curtis J, Mikuls T, Cerhan J, Criswell L, Saag K. Iowa Women’s Health Study Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum. 2004;50:72-7.

Marwaha RK, Tandon N, Garg MK, Kanwar R, Narang A, Sastry A, et al. Vitamin D status in healthy Indians aged 50 years and above. J Assoc Physicians India. 2011;59:706-9.

Agrawal NK, Sharma B. Prevalence of osteoporosis in otherwise healthy Indian males aged 50 years and above. Arch Osteoporos. 2013;8:116.

Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev. 2001;22:477-501.

Gluer CC. The use of bone densitometry in clinical practice. Bailleres Best Pract Res Clin Endocrinol Metab. 2000;14(2):195-211.

Multani SK, Sarathi V, Shivane V, Bandgar TR, Menon PS, Shah NS. Study of bone mineral density in resident doctors working at a teaching hospital. J Postgrad Med. 2010;56:65-70.

Aizer J, Reed G, Onofrei A, Harisson MJ. Predictors of bone density testing in patients with rheumatoid arthritis. Rheumatol Int. 2009;29:897-905.

Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, et al. Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arth Res Therapy. 2010;12(4):R154.

Sinigaglia L, Nervetti A, Mela Q, Bianchi G, Del Puente A, Di Munno O, et al. A multicenter cross-sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol. 2000; 27(11):2582-9.

Laan RFJM, van Riel PLCM, van de Putte LBA. Leflunomide and methotrexate. Curr Op Rheumatol. 2001;13(3):159-63.

Güler-Yüksel M, Bijsterbosch J, Goekoop-Ruiterman YP, Breedveld FC, Allaart CF, de Vries-Bouwstra JK, et al. Bone mineral density in patients with recently diagnosed, active rheumatoid arthritis. Ann Rheum Dis. 2007;66(11):1508-12.

Richards JS, Peng J, Amdur RL, Mikuls TR, Hooker RS, Michaud K, et al. Dual energy X-ray absorptiometry and evaluation of osteoporosis self-assessment tool in men with rheumatoid arthritis. J Clin Densitom. 2009;12(4):434-40.

Craig S, Yu F, Curtis J, Alarcón G, Conn D, Jonas B, et al. (2010) Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol. 2010;37:275-81.

Braun-Moscovici Y, Toledano K, Markovits D, Rozin A, Nahir A, Balbir-Gurman A. Vitamin D level: is it related to disease activity in inflammatory joint disease? Rheumatol Int. 2011;31:493-9.

El Meidany Y, El Gaafary M, Ahmed I. Cross-cultural adaptation and validation of an Arabic Health Assessment Questionnaire for use in rheumatoid arthritis patients. Joint Bone Spine. 2003;70:195202.

Kerr G, Sabahi I, Richards J, Caplan L, Cannon G, Reimold A, et al. Prevalence of vitamin D insufficiency/ deficiency in rheumatoid arthritis and associations with disease severity and activity. J Rheumatol. 2011;38:53-9.

Aletaha D, Smolen JS. The Simplified Disease Activity Index (SDAI) and the clinical disease activity index (CDAI): A review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S100-8.

Baker J, Baker D, Toedter G, Shults J, Von Feldt J, Leonard M. Associations between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis. Clin Exp Rheumatol. 2012;30:658-64.