Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Rheumatoid arthritis (RA) is a chronic, painful, and disabling disease associated with reduced health-related quality of life (HRQOL) compared to the general population. Higher levels of comorbidity can make the physical disability of RA patients even worse. Osteoporosis leading to bone fracture is one of the main co-morbidities of RA, and approximately one-third of women with RA report a fracture within 5 years of follow-up. Few studies have examined the influence of vertebral fracture (VF) on the outcome of patients with RA. The aim of the present study was to compare functional disability between RA patients with and without VF.
Methods: All female RA patients aged 50 years or older who visited our hospital for periodic examination between April 2011 and August 2011 were asked to participate in this study. Of these 169 patients, 100 were consecutively enrolled after excluding 69 patients who either did not wish to participate or recently had a routine examination for osteoporosis. Participants completed questionnaires via interview regarding demographic and lifestyle characteristics. Functional disability as a primary outcome was evaluated with the Health Assessment Questionnaire Disability Index (HAQ-DI). Each participant underwent thoracolumbar radiography, and the results were evaluated by two radiologists. We used multivariable-adjusted logistic regression analysis to test for associations between functional disability and the presence of VF, the severity of VF, and the number of VFs.
Results: Among the 100 RA patients, 47 had at least one VF, but 34 of these patients were unaware that they had experienced a fracture. The presence of two or more VFs (OR 3.0, CI 1.1~8.1) and moderate or severe VF (OR 3.4, CI 1.3~9.0) were related to disability in univariate analyses, but these effects were no longer significant after adjusting for age, disease duration, current steroid use, disease activity, and no previous history of VF. Among those RA patients with higher disease activity (n=51), the presence of VF (OR 5.1, CI 1.2~21.7) and moderate or severe VF (OR 7.1, CI 1.3~39.4) were associated with disability.
Conclusion: Many patients with RA have occult VF. Among RA patients with higher disease activity, the presence and severity of VF may affect functional disability.
Table1. Factors influencing functional disability in patients with RA (n=100)
|
Unadjusted analysis |
Adjusted analysis |
|
|
Age 50-60 61-70 71 ≤ |
1 2.3 (0.9~5.8) 2.0 (0.7~6.1) |
|
|
Disease duration (years) 10 ≤ |
1.8 (0.7~4.3) |
|
|
BMI Normal or low (≤22.9) Over weight (23.0~24.9) Obesity (25.0<) |
1 1.3 (0.5~3.2) 0.9 (0.3~2.4) |
|
|
Current steroid use |
1.3 (0.6~2.8) |
|
|
DAS28 Remission and low (<3.2) Moderate and high (≥3.2) |
1 4.7 (2.0~10.9) |
1 5.4 (2.2~13.2) |
|
No previous history of VF |
0.7 (0.2~1.8) |
0.4 (0.1~1.3) |
|
Presence of VF |
2.2 (1.0~4.9) |
|
|
Number of VFs 0 1 ≥ 2 |
1 1.6 (0.6~4.4) 3.0 (1.1~8.1) |
|
|
Severity of VF None Mild Moderate or severe |
1 1.3 (0.5~3.8) 3.4 (1.3~9.0) |
|
Table 2 Influence of vertebral fracture on disability in RA patients with moderate or high disease activity
|
Regression model |
Details of VF |
OR (95% CI) |
|
Moderate or high disease activity (n=51) |
||
|
Model 1 |
Presence of VF |
5.1 (1.2~21.7) |
|
Model 2 |
Number of VFs 0 1 2≤ |
1 3.2 (0.5~23.2) 4.8 (0.9~24.7) |
|
Model 3 |
Severity of VF Normal Mild Moderate or sever |
1 3.3 (0.6~18.6) 7.1 (1.3~39.4) |
Disclosure:
S. K. Cho,
None;
J. H. Lee,
None;
M. K. Han,
None;
S. Lee,
None;
J. Y. Kim,
None;
J. A. Ryu,
None;
Y. Y. Choi,
None;
S. C. Bae,
None;
Y. K. Sung,
None.
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