Lina Vencevičienė1, Irena Butrimienė2, Rimantas Vencevičius3, Eglė Sadauskienė4, Vytautas Kasiulevičius5, Virginijus Šapoka6. 1. Centre of Family Medicine, Vilnius University, Vilnius, Lithuania. Electronic address: linaven@gmail.com. 2. Centre of Rheumatology, Vilnius University, Vilnius, Lithuania; Centre for Innovative Medicine, State Research Institute, Vilnius, Lithuania. 3. Centre of Traumatology, Orthopedics and Plastic and Reconstructive Surgery, Vilnius University, Vilnius, Lithuania. 4. Centre of Cardiology and Angiology, Vilnius University, Vilnius, Lithuania. 5. Centre of Family Medicine, Vilnius University, Vilnius, Lithuania. 6. Centre of Internal Medicine, Vilnius University, Vilnius, Lithuania.
Abstract
OBJECTIVE: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs). METHODS: A cohort of 41 SpA patients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, BMD using were monitored at the baseline and 4-year follow-up. The 4% BMD loss at either of the proximal femurs was defined as significant. RESULTS: Over the 4-year study period, 27% of SpA patients experienced femoral BMD loss. Baseline BMD>0.85g/cm(2) (p=0.011) was the baseline factor associated with BMD loss at 4-year follow-up. Several clinical and functional tests were helpful in identifying the BMD loss at follow-up: CRP>15.6mg/L (sens. 91%, spec. 70%), ESR>29mm/h (sens. 82%, spec. 73%), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)>4.75 (sens. 91%, spec. 62%). At follow-up anti-TNFα treatment history, stable or improved lateral flexion and intermalleolar distance (NPV, accordingly, 95%, 88% and 87%), made BMD loss unlikely. Deterioration of the physician assessment of global disease activity (PAGDA) score from baseline to follow-up was a remarkable predictor of BMD loss (PPV=0.83), while stable or improved score excluded the BMD loss (NPV=0.83). According to multiple logistic regression analysis, baseline BMD value and follow-up CRP levels, when considered together, identify BMD status correctly in 85% of SpA patients (Nagelkerke R(2)=0.676). CONCLUSION: Baseline BMD, anti-TNFα treatment, PAGDA score, spinal mobility tests and disease activity markers are useful factors in predicting the BMD loss in SpA patients and can provide surrogate information on BMD status.
OBJECTIVE: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs). METHODS: A cohort of 41 SpApatients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, BMD using were monitored at the baseline and 4-year follow-up. The 4% BMD loss at either of the proximal femurs was defined as significant. RESULTS: Over the 4-year study period, 27% of SpApatients experienced femoral BMD loss. Baseline BMD>0.85g/cm(2) (p=0.011) was the baseline factor associated with BMD loss at 4-year follow-up. Several clinical and functional tests were helpful in identifying the BMD loss at follow-up: CRP>15.6mg/L (sens. 91%, spec. 70%), ESR>29mm/h (sens. 82%, spec. 73%), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)>4.75 (sens. 91%, spec. 62%). At follow-up anti-TNFα treatment history, stable or improved lateral flexion and intermalleolar distance (NPV, accordingly, 95%, 88% and 87%), made BMD loss unlikely. Deterioration of the physician assessment of global disease activity (PAGDA) score from baseline to follow-up was a remarkable predictor of BMD loss (PPV=0.83), while stable or improved score excluded the BMD loss (NPV=0.83). According to multiple logistic regression analysis, baseline BMD value and follow-up CRP levels, when considered together, identify BMD status correctly in 85% of SpApatients (Nagelkerke R(2)=0.676). CONCLUSION: Baseline BMD, anti-TNFα treatment, PAGDA score, spinal mobility tests and disease activity markers are useful factors in predicting the BMD loss in SpApatients and can provide surrogate information on BMD status.