在这项横断面研究中,我们调查了体积骨矿物质密度(vBMD),骨微结构,类风湿关节炎(RA)男性患者桡骨远端的生物力学能力。研究队列包括50名平均年龄为61.1岁的男性RA患者和50名年龄匹配的健康男性。髋关节的ArealBMD(aBMD),腰椎,和远端桡骨通过双能X线吸收法测量。桡骨远端的高分辨率外周定量计算机断层扫描(HR-pQCT)提供了皮质和小梁vBMD的测量,微观结构,和生物力学指标。调整体重后,RA患者的髋部而不是腰椎或桡骨的aBMD显着低于对照组。总计,皮质,桡骨远端骨小梁vBMD,平均而言,RA患者的-3.9%至-23.2%显著降低,这些差异不受体重调整的影响,睾酮水平,或者超视距半径处的aBMD。小梁微观结构指数为,平均而言,-8.1%(小梁数量)至28.7%(小梁网络不均匀性)明显劣质,而皮质孔隙体积和皮质孔隙度指数是,平均而言,80.3%和63.9%,分别,RA患者明显更高。RA患者的全骨僵硬度也明显降低,模数,和失效载荷,皮质和骨小梁应力分布更低和更不均匀。密度和微观结构指数与疾病活动显著相关,严重程度,和促炎细胞因子(白细胞介素[IL]12p70,肿瘤坏死因子,IL-6和IL-1β)。十名RA患者的局灶性骨膜骨并置在桡骨远端的尺掌侧最为突出。这些患者的病程较短,皮质孔隙率明显较高。总之,HR-pQCT显示骨密度显著改变,微观结构,男性RA患者桡骨远端的强度,并为慢性炎症伴随的骨脆性的微观结构基础提供了新的见解。
In this cross-sectional study, we investigated volumetric bone mineral density (vBMD), bone microstructure, and biomechanical competence of the distal radius in male patients with rheumatoid arthritis (RA). The study cohort comprised 50 male RA patients of average age of 61.1 years and 50 age-matched healthy males. Areal BMD (aBMD) of the hip, lumbar spine, and distal radius was measured by dual-energy X-ray absorptiometry. High-resolution peripheral quantitative computed tomography (HR-pQCT) of the distal radius provided measures of cortical and trabecular vBMD, microstructure, and biomechanical indices. aBMD of the hip but not the lumbar spine or ultradistal radius was significantly lower in RA patients than controls after adjustment for body weight. Total, cortical, and trabecular vBMD at the distal radius were, on average, -3.9% to -23.2% significantly lower in RA patients, and these differences were not affected by adjustment for body weight, testosterone level, or aBMD at the ultradistal radius. Trabecular microstructure indices were, on average, -8.1% (trabecular number) to 28.7% (trabecular network inhomogeneity) significantly inferior, whereas cortical pore volume and cortical porosity index were, on average, 80.3% and 63.9%, respectively, significantly higher in RA patients. RA patients also had significantly lower whole-bone stiffness, modulus, and failure load, with lower and more unevenly distributed cortical and trabecular stress. Density and microstructure indices significantly correlated with disease activity, severity, and levels of pro-inflammatory cytokines (interleukin [IL] 12p70, tumor necrosis factor, IL-6 and IL-1β). Ten RA patients had focal periosteal bone apposition most prominent at the ulnovolar aspect of the distal radius. These patients had shorter disease duration and significantly higher cortical porosity. In conclusion, HR-pQCT reveals significant alterations of bone density, microstructure, and strength of the distal radius in male RA patients and provides new insight into the microstructural basis of bone fragility accompanying chronic inflammation.