The Relationship Between Anti-Cyclic Citrullinated Peptide (anti-CCP) Levels and Bone Mineral Density (BMD) or Fragility Fracture in Patients with Rheumatoid Arthritis (RA)

Tien-Tsai Cheng^1,2, Yin-Chou Chen^1,2, Shan-Fu Yu^1,2, Han-Ming Lai^1,2, Ben Yu-Jih Su^1,2, Fu-Mei Su^2,3, Wen-Chan Chiu^1,2, Chung-Yuan Hsu^1,4, Jia-Feng Chen¹ and Chi-Hua Ko¹, ¹Division of Allergy, Immunology and Rheumatology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ²Chang Gung University College of Medicine, Kaohsiung, Taiwan, ³Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ⁴Division of Rheumatology, Allergy, and Immunology, Chang Gung University College of Medicine, Kaohsiung, Taiwan

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: fractures, Osteoporosis and rheumatoid arthritis (RA)

Session Information

Date: Sunday, November 13, 2016

Session Title: Osteoporosis and Metabolic Bone Disease – Clinical Aspects and Pathogenesis - Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: To explore the relationship of anti-CCP levels with BMD or fragility fracture in patients with RA

Methods: This is a prospective cross sectional study. Consecutive RA patients who visited Rheumatology clinic at Chang Gung Memorial Hospital in Kaohsiung between 01-Sep- 2014 and 31-May-2016 were enrolled in this study. Those patients who fulfilled the classification criteria of RA (ACR 2010) and inclusion criteria were registered as participants. During the period, we checked anti-CCP, ESR, CRP, DAS28 for each participant at enrollment and collected demographics, evidence of prevalent fragility fracture (history or radiography), personal life style and behaviors, risk factors of fragility fracture in FRAX tool, and medication history. We also measured BMD when anti-CCP checked. The descriptive summary is presented in the form of mean ± standard deviation. Continuous variables were evaluated by one-way ANOVA or Kruskal-Wallis test. Chi-square test or Fisher’s exact test were used for the qualitative variables. A level of statistical significance of p <0.05 was used for all statistical tests performed.

Results: A total of 521 participants were enrolled during the period. Demographics are presented in Table 1. The participants were categorized into 4 groups according to quartiles of anti-CCP levels(QI -IV). There were 130, 127, 132, and 132 participants in group I to IV, respectively. There was no obvious difference between ages, gender, body mass index, disease duration (Table 1), prevalence of fragility fracture (Table 2) between groups. However, the levels of RF (p<0.0001), ESR (p<0.0001), CRP (P= 0.009), and DAS28 (p<0.0001) was significant different between the groups. The BMD (g/cm²) of lumbar spine (total), from QI to IV, of each group was 0.902±0.177, 0.836± 0.155, 0.859±0.167, and 0.866±0.190 (p=0.0244), respectively. While, the BMD (g/cm²) of femoral neck was 0.661±0.129, 0.599±0.107, 0.623±0.126, 0.620±0.121, respectively (p=0.0011) (Table 2).

Conclusion: The levels of anti-CCP in RA patients are related to levels of RF and disease activity, in terms of ESR, CRP, and DAS28. The BMD, either lumbar spine or femoral neck, is significantly different between anti-CCP levels, while, there is no obvious difference in prevalence of fragility fracture between the groups. Via this investigation, it suggests that increased risk of fragility fracture in RA patients may not be related to the disease activity or anti-CCP levels. Table 1 Demographics of participants

Groups	I	II	III	IV	p
Anti-CCP (u/mL) quartiles	~2	2 ~ 60	60 ~ 290	> 290
n	130	127	132	132
Anti-CCP (u/mL)	0.8±0.5	24.3±18.7	150.0±66.0	441.4±67.0	<0.0001
Sex (F, %)	114 (87.7)	111 (87.4)	112 (84.9)	110 (83.3)	0.704
Age (years )	56.5 ±11.0	59.1±11.2	58.5±10.8	59.68 ±10.9	0.1048
Disease duration (years )	9.3 ±5.3	9.3±4.9	8.9± (5.6	9.1±5.7	0.9251
BMI, kg/m²	23.8±3.8	23.0 ±3.6	23.8±4.2	23.8±3.8	0.2786
Vit D (ng/mL)	22.7±7.4	22.4±7.1	23.5±9.1	22.8±7.8	0.7456
RF (IU/mL)	21.7±44.7	177.9±315.4	304.1 ±569.3	413.3±684.8	<0.0001
ESR (mm/h)	17.6 ±16.8)	24.8±21.0	24.1±20.2	31.6 ±26.4	<0.0001
DAS28 (ESR)	3.0 ±1.1	3.2±1.1	3.2 ±1.2	3.7 ±1.4	<0.0001
CRP (mg/L)	5.9±13.4	7.7 ±12.3	10.2± 20.5	14.2 ±31.2	0.009

Table 2 Bone mineral density and prevalence of fragility fracture of participants

Groups	I	II	III	IV	p
BMD (g/cm²) spine (total)	0.902±0.177	0.836±0.155	0.859±0.167	0.866±0.190	0.0244
BMD (g/cm²) femoral neck	0.661±0.129	0.599±0.107	0.623±0.126	0.620±0.121	0.0011
Hip fracture (n, %)	19(14.6)	28 (22.1)	23 (17.4)	26 (1 9.7)	0.4586
All fracture* (n, %)	27(21.1)	45(36.6)	38(30.9)	39(31.5)	0.0561

*Including history or evidence of any one fragility fracture at site of hip, spine, forearm, or pelvis

Disclosure: T. T. Cheng, None; Y. C. Chen, None; S. F. Yu, None; H. M. Lai, None; B. Y. J. Su, None; F. M. Su, None; W. C. Chiu, None; C. Y. Hsu, None; J. F. Chen, None; C. H. Ko, None.

To cite this abstract in AMA style:

Cheng TT, Chen YC, Yu SF, Lai HM, Su BYJ, Su FM, Chiu WC, Hsu CY, Chen JF, Ko CH. The Relationship Between Anti-Cyclic Citrullinated Peptide (anti-CCP) Levels and Bone Mineral Density (BMD) or Fragility Fracture in Patients with Rheumatoid Arthritis (RA) [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-relationship-between-anti-cyclic-citrullinated-peptide-anti-ccp-levels-and-bone-mineral-density-bmd-or-fragility-fracture-in-patients-with-rheumatoid-arthritis-ra/. Accessed February 26, 2020.

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