Bone mineral density in young females with juvenile idiopathic arthritis
Background. Study of bone mineral density (BMD) in young adults with juvenile idiopathic arthritis (JIA) is important because long-term administration of glucocorticoids and the presence of chronic systemic inflammation can lead to loss of bone tissue in young people with chronic inflammatory disease in anamnesis. Objective: the study of BMD in young female with juvenile onset of JIA. Materials and methods. Ninety-nine female patients aged 19 to 39 years were divided into two groups: І — 59 healthy young female, ІІ — 40 young female with JIA. The following parameters were evaluated: the age of the disease onset, the duration of delayed diagnosis, disease duration, the ILAR-variant in the disease onset, the BMD in different areas and their T and Z scores. Results. It was found that the onset of JIA was at the age of 11.16 ± 4.34 years, it took 23.52 ± 21.37 months from the beginning of the first clinical manifestations to the time of diagnosis, the disease duration was 11.9 ± 9.4 years, persistant oligoarthritis was detected in 25 % of patients, RF-negative polyarthritis in 22.5 %, extended oligoarthritis in 10 %, RF-positive polyarthritis in 10 %, systemic-onset JIA in 12.5 %, enthesitis-related JIA in 15 %, undifferentiated arthritis in 10 %, psoriatic arthritis in 5 % of patients. BMD (p < 0.000001), T (p = 0.00001) and Z scores in the lumbar spine were lower in female with JIA than in healthy people. Femoral neck BMD (p < 0.000001) and T score (p = 0.00002), total body BMD (p < 0.000001), T- (p = 0.00009) and Z-scores (p < 0.000001) were lower in patients with JIA than in healthy people. However, ultradistal forearm BMD in the female patients differed from healthy ones’ only in T and Z scores (p = 0.004). Z score < –2 SD in young adults was detected in 40 % of patients in the lumbar spine, in 24 % of patients in the femoral neck, in 35.5 % of patients in the total body and in 52.9 % of patients in ultradistal forearm, and T score < –2.5 SD in 3.3 % patinets in lumbar spine, in 3.4 % patients in the femoral neck, in 36.7 % patients in the total body, in 23.5 % patients in the ultradistal forearm. Osteopenia by T score at the lumbar spine was found in 43.3 %, the femoral neck in 41.4 %, the total body in 36.7 %, ultradistal forearm in 23.5 % of patients. Conclusions. А significant decrease of bone mineral density, T- and Z-scores was observed in young female with JIA in the lumbar spine, femoral neck and total body, compared to healthy female patients of the corresponding age. The presence of JIA in childhood negatively affects the formation of peak bone mass and leads to a decrease of the BMD in adulthood, that requires the active observation and appointment of prophylactic therapy in childhood and, if necessary, treatment to prevent osteoporotic complications.
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Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone. 2017 Jan 22. pii: S8756-3282(17)30024-8. doi: 10.1016/j.bone.2017.01.024.
Resolution of Research and Training conference of Association of Rheumatologists of Ukraine ‘Validation and Directions in Rheumatology Innovative therapy’. Ukrajinskij Revmatologіchnij Zhurnal. 2016;64(2):67-8. (In Ukrainian).
Bertilsson L, Andersson-Gäre B, Fasth A, et al. Disease course, outcome and predictors of outcome in a population-based juvenile chronic arthritis cohort followed for 17 years. J Rheumatol. 2013;40:715-24. PMID: 23418376. doi: 10.3899/jrheum.120602.
Górska A, Urban М, Bartnicka M, Zelazowska-Rutkowska B, Wysocka J. Bone mineral metabolism in children with juvenile idiopathic arthritis. Ortopedia, Traumatologia, Rehabilitacja. 2008;10(1):54-62. PMID: 18391906.
Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton 2001. J Rheumatol. 2004;31:390-2. PMID: 14760812.
Ferrari S, Bianchi ML, Eisman JA, Foldes AJ, Adami S, Wahl DA, Stepan JJ, de Vernejoul M-C, Kaufman J-M. Osteoporosis in young adults: pathophysiology, diagnosis, and management. Osteoporos Int. 2012;23:2735-48. doi: 10.1007/s00198-012-2030-x.
Simon D, Fernando C, Czernichow P, Prieur AM. Linear growth and final height in patients with systemic juvenile idiopathic arthritis treated with longterm glucocorticoids. J of Rheum. 2002;29(6):1296-300. PMID: 12064849.
Burnham JM, Shults J, Weinstein R, Lewis JD, Leonard MB. Childhood onset arthritis is associated with an increased risk of fracture: a population based study using the General Practice Research Database. Ann Rheum Dis. 2006;65(8):1074-9. PMID: 16627541. PMCID: PMC1798264. doi: 10.1136/ard.2005.048835.
Lien G, Flatø B, Haugen M, et al. Frequency of osteopenia in adolescents with early-onset juvenile idiopathic arthritis: a long-term outcome study of one hundred five patients. Arth & Rheum. 2003;48(8):2214-2223. doi: 10.1002/art.11097.
Haugen M, Lien G, Flatø B, et al. Young adults with juvenile arthritis in remission attain normal peak bone mass at the lumbar spine and forearm. Arth & Rheum. 2000;43(7):1504-10. PMID:10902752. doi: 10.1002/1529-0131(200007)43:7<1504::AID-ANR13>3.0.CO;2-0.
Bianchi ML. Glucorticoids and bone: some general remarks and some special observations in pediatric patients. Calcified Tissue International. 2002;70(5):384-90. PMID: 11960203. doi: 10.1007/s00223-001-0043-0.
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