Risk and predictors of fractures in early rheumatoid arthritis - A long term follow up study of an inception cohort.

Autor: Theander L; Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden. Electronic address: lisatheander@hotmail.com., Sharma A; Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden., Karlsson MK; Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Orthopedics, Skåne University Hospital, Malmö, Sweden., Åkesson KE; Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Orthopedics, Skåne University Hospital, Malmö, Sweden., Jacobsson LTH; Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden., Turesson C; Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Department of Rheumatology, Skåne University Hospital, Malmö and Lund, Malmö, Sweden.
Jazyk: angličtina
Zdroj: Seminars in arthritis and rheumatism [Semin Arthritis Rheum] 2024 Oct; Vol. 68, pp. 152497. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1016/j.semarthrit.2024.152497
Abstrakt: Objectives: To examine the risk of fractures in a cohort of patients with newly diagnosed rheumatoid arthritis (RA), compared to the background population, and predictors of fractures detectable early in RA.
Methods: An inception cohort of patients with RA (N = 233; 164 women/69 men, recruited 1995-2005) was evaluated according to a structured program, including repeated clinical assessments and measures of bone mineral density (BMD), from diagnosis to 10 years later. Matched population controls were identified using the national census register. Fractures through 2019 were identified based on ICD codes. Cox regression models were used to assess the risk of fractures in RA patients compared with controls, and for assessment of potential predictors for fractures in the RA population.
Results: RA patients had an increased risk of fractures (fully adjusted hazard ratio (HR) 1.52, 95 % CI 1.13; 2.06). In the RA cohort, high age, low body mass index, and low BMD were significant baseline predictors of future fractures in multivariate analyses, but baseline RA disease characteristics were not. Worse disability (i.e. higher Health Assessment Questionnaire (HAQ) scores) over time was significantly associated with increased risk of fractures (age-sex-adjusted HR 1.33 per SD, 95 % CI 1.09; 1.63) and there was an inverse association between BMD Z-scores over time and fractures.
Conclusion: Patients with RA had higher risk of fractures than controls. Fracture risk was related to BMD at baseline and over time in patients with RA. In addition, worse disability (measured by HAQ) over time was associated with higher risk of fractures.
Competing Interests: Declaration of competing interest Kristina E Åkesson has received consulting fees from Astellas Pharma, and has received honoraria for lectures from Amgen and UCB. Lennart TH Jacobsson has received consulting fees from Abbvie, Eli Lilly, Janssen, Novartis and Pfizer, and honoraria for lectures from Abbvie, Janssen and Novartis. Carl Turesson has received consulting fees from Abbvie, and honoraria for lectures from Abbvie, Nordic Drugs and Pfizer. The other authors declare that they have no competing interests.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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