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Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis

Amkreutz, Josephine A.M.P. ; de Moel, Emma C. ; Theander, Lisa LU ; Willim, Minna LU ; Heimans, Lotte ; Nilsson, Jan Åke LU ; Karlsson, Magnus K. LU ; Huizinga, Tom W.J. ; Åkesson, Kristina E. LU and Jacobsson, Lennart T.H. LU , et al. (2021) In Arthritis and Rheumatology 73(6). p.921-930
Abstract

Objective: Autoantibodies, such as anti–citrullinated protein antibodies (ACPAs), have been described as inducing bone loss in rheumatoid arthritis (RA), which can also be reflected by bone mineral density (BMD). We therefore examined the association between osteoporosis and autoantibodies in two independent RA cohorts. Methods: Dual x-ray absorptiometry (DXA) of the lumbar spine and left hip was performed in 408 Dutch patients with early RA during 5 years of follow-up and in 198 Swedish patients with early RA during 10 years of follow-up. The longitudinal effect of ACPAs and other autoantibodies on several BMD measures was assessed using generalized estimating equations. Results: In the Dutch cohort, significantly lower BMD at baseline... (More)

Objective: Autoantibodies, such as anti–citrullinated protein antibodies (ACPAs), have been described as inducing bone loss in rheumatoid arthritis (RA), which can also be reflected by bone mineral density (BMD). We therefore examined the association between osteoporosis and autoantibodies in two independent RA cohorts. Methods: Dual x-ray absorptiometry (DXA) of the lumbar spine and left hip was performed in 408 Dutch patients with early RA during 5 years of follow-up and in 198 Swedish patients with early RA during 10 years of follow-up. The longitudinal effect of ACPAs and other autoantibodies on several BMD measures was assessed using generalized estimating equations. Results: In the Dutch cohort, significantly lower BMD at baseline was observed in ACPA-positive patients compared to ACPA-negative patients, with an estimated marginal mean BMD in the left hip of 0.92 g/cm2 (95% confidence interval [95% CI] 0.91–0.93) versus 0.95 g/cm2 (95% CI 0.93–0.97) (P = 0.01). In line with this, significantly lower Z scores at baseline were noted in the ACPA-positive group compared to the ACPA-negative group (estimated marginal mean Z score in the left hip of 0.18 [95% CI 0.08–0.29] versus 0.48 [95% CI 0.33–0.63]) (P < 0.01). However, despite clear differences at baseline, ACPA positivity was not associated with greater decrease in absolute BMD or Z scores over time. Furthermore, there was no association between BMD and higher levels of ACPAs or other autoantibodies (rheumatoid factor and anti–carbamylated protein antibodies). In the Swedish cohort, ACPA-positive patients tended to have a higher prevalence of osteopenia at baseline (P = 0.04), but again, ACPA positivity was not associated with an increased prevalence of osteopenia or osteoporosis over time. Conclusion: The presence of ACPAs is associated with significantly lower BMD at baseline, but not with greater BMD loss over time in treated RA patients. These results suggest that ACPAs alone do not appear to contribute to bone loss after disease onset when disease activity is well-managed.

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Contribution to journal
publication status
published
subject
in
Arthritis and Rheumatology
volume
73
issue
6
pages
10 pages
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85105477729
  • pmid:33314699
ISSN
2326-5191
DOI
10.1002/art.41623
language
English
LU publication?
yes
id
ee213488-df8c-4eae-ab42-afd3317701f0
date added to LUP
2021-05-28 13:03:54
date last changed
2024-06-15 11:42:26
@article{ee213488-df8c-4eae-ab42-afd3317701f0,
  abstract     = {{<p>Objective: Autoantibodies, such as anti–citrullinated protein antibodies (ACPAs), have been described as inducing bone loss in rheumatoid arthritis (RA), which can also be reflected by bone mineral density (BMD). We therefore examined the association between osteoporosis and autoantibodies in two independent RA cohorts. Methods: Dual x-ray absorptiometry (DXA) of the lumbar spine and left hip was performed in 408 Dutch patients with early RA during 5 years of follow-up and in 198 Swedish patients with early RA during 10 years of follow-up. The longitudinal effect of ACPAs and other autoantibodies on several BMD measures was assessed using generalized estimating equations. Results: In the Dutch cohort, significantly lower BMD at baseline was observed in ACPA-positive patients compared to ACPA-negative patients, with an estimated marginal mean BMD in the left hip of 0.92 g/cm<sup>2</sup> (95% confidence interval [95% CI] 0.91–0.93) versus 0.95 g/cm<sup>2</sup> (95% CI 0.93–0.97) (P = 0.01). In line with this, significantly lower Z scores at baseline were noted in the ACPA-positive group compared to the ACPA-negative group (estimated marginal mean Z score in the left hip of 0.18 [95% CI 0.08–0.29] versus 0.48 [95% CI 0.33–0.63]) (P &lt; 0.01). However, despite clear differences at baseline, ACPA positivity was not associated with greater decrease in absolute BMD or Z scores over time. Furthermore, there was no association between BMD and higher levels of ACPAs or other autoantibodies (rheumatoid factor and anti–carbamylated protein antibodies). In the Swedish cohort, ACPA-positive patients tended to have a higher prevalence of osteopenia at baseline (P = 0.04), but again, ACPA positivity was not associated with an increased prevalence of osteopenia or osteoporosis over time. Conclusion: The presence of ACPAs is associated with significantly lower BMD at baseline, but not with greater BMD loss over time in treated RA patients. These results suggest that ACPAs alone do not appear to contribute to bone loss after disease onset when disease activity is well-managed.</p>}},
  author       = {{Amkreutz, Josephine A.M.P. and de Moel, Emma C. and Theander, Lisa and Willim, Minna and Heimans, Lotte and Nilsson, Jan Åke and Karlsson, Magnus K. and Huizinga, Tom W.J. and Åkesson, Kristina E. and Jacobsson, Lennart T.H. and Allaart, Cornelia F. and Turesson, Carl and van der Woude, Diane}},
  issn         = {{2326-5191}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{6}},
  pages        = {{921--930}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Arthritis and Rheumatology}},
  title        = {{Association Between Bone Mineral Density and Autoantibodies in Patients With Rheumatoid Arthritis}},
  url          = {{http://dx.doi.org/10.1002/art.41623}},
  doi          = {{10.1002/art.41623}},
  volume       = {{73}},
  year         = {{2021}},
}