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Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank

Objectives: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespr...

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Autores principales: Clynes, Michael A., Jameson, Karen, Prieto-Alhambra, Daniel, Harvey, Nicholas C., Cooper, Cyrus, Dennison, Elaine M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888088/
https://www.ncbi.nlm.nih.gov/pubmed/31849841
http://dx.doi.org/10.3389/fendo.2019.00817
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author Clynes, Michael A.
Jameson, Karen
Prieto-Alhambra, Daniel
Harvey, Nicholas C.
Cooper, Cyrus
Dennison, Elaine M.
author_facet Clynes, Michael A.
Jameson, Karen
Prieto-Alhambra, Daniel
Harvey, Nicholas C.
Cooper, Cyrus
Dennison, Elaine M.
author_sort Clynes, Michael A.
collection PubMed
description Objectives: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data. Methods: Diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status, and physical activity. Results: Of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50–63) in women and 58 (IQR 50–64) in men. RA was associated with lower eBMD (men: β −0.244, 95% CI −0.378, −0.110 p < 0.001; women: β −0.217, 95% CI −0.297, −0.138 p < 0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p < 0.001; women: OR 1.36, 95% CI 1.19, 1.56 p < 0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p < 0.001). Corticosteroid therapy in men (β −0.934, 95% CI −1.565, −0.304 p = 0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β −0.437, 95% CI −0.761, −0.112 p = 0.008; women: β −0.243, 95% CI −0.421, −0.065 p = 0.007), but not biologic therapy, were associated with a lower eBMD with RA. Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD.
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spelling pubmed-68880882019-12-17 Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank Clynes, Michael A. Jameson, Karen Prieto-Alhambra, Daniel Harvey, Nicholas C. Cooper, Cyrus Dennison, Elaine M. Front Endocrinol (Lausanne) Endocrinology Objectives: Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data. Methods: Diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status, and physical activity. Results: Of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50–63) in women and 58 (IQR 50–64) in men. RA was associated with lower eBMD (men: β −0.244, 95% CI −0.378, −0.110 p < 0.001; women: β −0.217, 95% CI −0.297, −0.138 p < 0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p < 0.001; women: OR 1.36, 95% CI 1.19, 1.56 p < 0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p < 0.001). Corticosteroid therapy in men (β −0.934, 95% CI −1.565, −0.304 p = 0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β −0.437, 95% CI −0.761, −0.112 p = 0.008; women: β −0.243, 95% CI −0.421, −0.065 p = 0.007), but not biologic therapy, were associated with a lower eBMD with RA. Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD. Frontiers Media S.A. 2019-11-26 /pmc/articles/PMC6888088/ /pubmed/31849841 http://dx.doi.org/10.3389/fendo.2019.00817 Text en Copyright © 2019 Clynes, Jameson, Prieto-Alhambra, Harvey, Cooper and Dennison. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Clynes, Michael A.
Jameson, Karen
Prieto-Alhambra, Daniel
Harvey, Nicholas C.
Cooper, Cyrus
Dennison, Elaine M.
Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title_full Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title_fullStr Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title_full_unstemmed Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title_short Impact of Rheumatoid Arthritis and Its Management on Falls, Fracture and Bone Mineral Density in UK Biobank
title_sort impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in uk biobank
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888088/
https://www.ncbi.nlm.nih.gov/pubmed/31849841
http://dx.doi.org/10.3389/fendo.2019.00817
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