The study aimed to explore the association of sarcopenia and vitamin D deficiency with glucocorticoid-induced osteoporosis (GIOP) in Chinese patients with rheumatoid arthritis (RA). Skeletal muscle mass, serum 25(OH)D levels, and bone mineral density (BMD) were assessed. The prevalence of OP, sarcopenia, and vitamin D deficiency in RA patients was significantly higher than in controls (all P < 0.001). The percentage of GC use was 56.9

目的 探讨类风湿关节炎(RA)合并2型糖尿病(T2DM)的危险因素.方法 根据是否合并T2DM,将782例RA患者分为合并T2DM组(70例)和未合并T2DM组(712例),比较两组患者的临床资料.采用趋势χ2检验比较不同年龄段、不同病程RA患者T2DM的发病率,RA患者合并T2DM的危险因素分析采用二分类logistic回归分析.结果 RA患者合并T2DM的患病率为8.95％,且随年龄和病程增长患病率逐渐增高(P<0.05).合并T2DM组患者较不合并T2DM组年龄、合并原发性高血压和使用糖皮质激素(GC)患者比例、GC日剂量、Sharp评分更高,病程和使用GC疗程更长(P<0.05).二分类logistic回归分析结果显示,年龄(OR=1.028,P=0.017,95％CI 1.005～1.051)、使用GC(OR=1.911,P=0.023,95％CI 1.095～3.336)及合并原发性高血压(OR=1.985,P=0.014,95％CI 1.151～3.423)是RA合并T2DM的危险因素.结论 8.95％的RA患者合并T2DM,且随年龄和病程增长患病率逐渐增高,高龄、使用GC及合并原发性高血压为RA患者合并T2DM的危险因素.

目的 探讨肌少症对女性类风湿关节炎(RA)患者脊柱骨质疏松性骨折(OPF)发生的影响.方法 纳入399例女性RA患者(RA组)和98例年龄等相匹配的健康女性(对照组).根据是否合并脊柱OPF,将RA患者分为OPF组82例和非OPF组317例;根据是否合并肌少症,将RA患者分为肌少症组246例和无肌少症组153例;根据是否合并骨质疏松(OP),将RA患者分为OP组156例和非OP组243例.比较各组患者的临床资料,采用多元logistic回归分析评估女性RA患者发生脊柱OPF的影响因素.结果 RA组患者各部位骨密度(BMD)、骨骼肌质量指数(SMI)均低于对照组,OP、脊柱OPF及肌少症的发生率均高于对照组(P＜0.001).肌少症组年龄、病程、健康状况问卷(HAQ)评分、Sharp评分、绝经患者比例及OP的发生率均高于无肌少症组,BMI及各部位BMD均低于无肌少症组(P＜0.05).OP组绝经患者比例高于无OP组(P＜0.001).OPF组患者各部位骨骼肌质量、SMI及晨僵时间均低于无OPF组,年龄、病程、HAQ评分、使用糖皮质激素(GC)及绝经患者比例均高于无OPF组(P＜0.05).多元logistic回归分析结果显示,年龄、使用GC为女性RA患者发生脊柱OPF的危险因素,SMI为其保护因素(P＜0.05).结论 女性RA患者脊柱OPF和肌少症的发生率明显增高,较高的SMI为女性RA患者发生脊柱OPF的保护因素.

OBJECTIVES:This study aimed to investigate the synergistic effect of sarcopenia and poor balance on osteoporotic vertebral fracture (VOPF) in Chinese patients with rheumatoid arthritis (RA).METHODS:A total of 238 RA patients and 158 normal subjects were enrolled in the case-control study. Poor balance capability (Berg balance scale (BBS) score < 40) and sarcopenia (skeletal muscle mass index (SMI) <7.0 (male)/5.7 (female)) between RA patients and normal subjects were compared. Associations of poor balance capability or sarcopenia with disease activity, structural damage, and joint function in different groups were also investigated.RESULTS:The incidence of sarcopenia in RA was 58.4%, significantly higher than that in controls (P<0.0001). Moreover, the percentages of low balance capacity (BBS<40) in RA were 43.7%, which was higher than that in controls (P<0.0001). The prevalence of VOPF in the case group was 19.3%, which was higher than that in the controls (P<0.0001). In the RA group, compared to RA patients without VOPF, RA patients with VOPF had higher percentages of poor balance and sarcopenia (P<0.05). Compared with RA patients without sarcopenia or good balance, RA patients with sarcopenia or poor balance had a higher incidence of VOPF, higher disease activity, severer structural damage, and worse joint function (P<0.05). The incidence of VOPF in patients combined with good balance and non-sarcopenia (4.8%) was significantly lower than that in patients combined with poor balance and sarcopenia (38.2%) (P<0.0001). Logistic regression indicated that higher SMI and higher BBS scores were protective factors for VOPF in RA patients, while age was a risk factor for VOPF in RA patients (P<0.0001).CONCLUSION:Sarcopenia and poor balance are popular in Chinese patients with RA, and they are associated with disease activity and structural damage. There is a synergistic effect of sarcopenia and poor balance on VOPF in RA. Key Points • Sarcopenia and balance capability were popular (about a half) in patients with RA. • Sarcopenia and poor balance had a synergistic effect on VOPF in RA.

目的 调查安徽医科大学第一附属医院风湿免疫科门诊患者胃肠道危险因素的流行病学特征.方法 通过问卷调查936例我院风湿免疫科门诊患者胃肠道危险因素的发生情况,分别比较不同病种间各胃肠道危险因素发生率的差异.结果 936例患者中,类风湿关节炎(RA)268例(28.6％,RA组),系统性红斑狼疮(SLE)205例(21.9％,SLE组),其他弥漫性结缔组织病(CTD)159例(17.0％),脊柱关节炎(SpA)122例(13.0％),骨关节炎(OA)101例(10.8％,OA组),痛风39例(4.2％),其他疾病42例(4.5％).936例患者中各胃肠道危险因素的发生情况:年龄≥60岁205例(21.9％),有消化性溃疡史99例(10.6％),曾使用抗凝药物9例(1.0％),曾使用非甾体抗炎药(NSAIDs)387例(41.3％),曾使用糖皮质激素(GC)527例(56.3％),曾使用低剂量阿司匹林(ASA)109例(11.6％),曾感染幽门螺杆菌4例(0.4％),吸烟51例(5.4％),酗酒10例(1.1％).其中,低风险54例(5.8％);中风险795例(84.9％),其中存在1项胃肠道危险因素466例(49.8％),存在2项胃肠道危险因素329例(35.1％);高风险(存在至少3项胃肠道危险因素)87例(9.3％).936例患者中曾使用抗凝药物、NSAIDs、GC或低剂量ASA任何1项644例(68.8％),曾使用其中两项及以上191例(20.4％),其中使用NSAIDs和GC联合治疗87例(9.3％),而未曾使用上述4种药物仅101例(10.8％).RA组年龄≥60岁、曾使用NSAIDs、NSAIDs联合GC患者比例高于SLE组(P<0.001),曾使用抗凝药物、GC、低剂量ASA患者比例低于SLE组(P<0.01).RA组使用GC、NSAIDs联合GC患者比例均高于OA组(P<0.001).SpA组使用NSAIDs、吸烟及酗酒患者比例均高于RA组、OA组(P<0.05).结论 94.2％的风湿免疫科门诊患者存在中度以上胃肠道风险,单项胃肠道危险因素发生率最高者为GC使用(超过50％),其次为NSAIDs使用(约40％),不同风湿免疫性疾病患者的胃肠道危险构成比存在明显差异.

肌肉细胞因子是由骨骼肌分泌的体液细胞因子和生长因子，通过自分泌、旁分泌或内分泌方式于骨骼、肌肉、脂肪、肝脏、胰腺等多个靶器官中发挥重要的生理、病理功能，参与机体的物质和能量代谢，从而维持机体的生物学稳态。目前已发现的肌肉细胞因子有数百种，本文主要研究肌肉抑制素、活化素、鸢尾素、肌联素、脑源性神经营养因子、肌肉素等细胞因子在骨骼、肌肉、骨质疏松中的作用及潜在的临床价值。

Objective:To explore the correlation between sarcopenic obesity and disease activity, osteoporosis in patients with rheumatoid arthritis (RA).Methods:Four hundred and eighteen RA patients from January 2016 to December 2018 were enrolled into the study. One hundred and fifty-six age and sex-matched normal subjects were enrolled as control group. Clinical and laboratory indicators in RA patients were also recorded in detail. Bone mineral density (BMD) at lumbar vertebra and total hip were detected by dual energy X-ray absorptiometry (DEXA) in RA patients and control group, skeletal muscle mass and body fat percentage (PBF) were measured by bioelectrical electrical impedance. All individuals were divided into 4 groups (normal, obesity, sarcopenia, sarcopenic obesity) according to the presence of PBF and sarcopenia. Numerical data and categorical data comparisons were analyzed using χ2 test, non-parametric test, correlation analysis and logistic regression analysis test. Results:① Median of PBF in RA patients was higher than that in the control group ( Z=1.993 , P=0.046). There were obvious differences in the composition ratio of different sarcopenic obesity groups between the two groups ( χ2=100.575, P<0.01). ② There was no significant difference in sarcopenic obesity composition among groups with different disease activity (including in low disease activity, moderate disease activity and high disease activity) in RA patients (normal, obesity, sarcopenia, sarcopenic obesity, χ2=9.577, P=0.144). ③ Among different sarcopenic obesity groups, the erythrocyte sedimentation rate (ESR), disease activity score in 28 joints (DAS28) and Healthassessment questionnaire (HAQ) levels of RA patients were significantly different ( P<0.05), which were higher in sarcopenia and sarcopenic obesity groups. There was no significant difference about disease activity indicators in RA pa-tients among different sarcopenic obesity groups ( P>0.05). ④ Among different sarcopenic obesity groups, BMD of RA patients was significantly different ( P<0.01), with a trend of gradual decreasing. Incidences of osteoporosis (OP) were significantly different among different sarcopenic obesity groups in RA ( P=0.02), which was higher in sarcopenia and sarcopenia obesity groups. ⑤ Among different sarcopenia obesity groups (normal, obesity, sarcopenia, sarcopenic obesity), X-ray staging ratio {[normal group (stage Ⅰ (28.6%): stage Ⅱ (23.8%): stage Ⅲ (32.1%): stage Ⅳ (15.5%)]; obesity group (stage Ⅰ (27.2%): stage Ⅱ (13.6%): stage Ⅲ (35.0%): stage Ⅳ (24.3%)]: sarcopenia group [(stage Ⅰ (16.7%): stage Ⅱ (15.3%): stage Ⅲ (36.1%): stage Ⅳ (31.9%)]: sarcopenic obesity group (stage Ⅰ (9.7%): stage Ⅱ (21.5%): stage Ⅲ (34.0%): stage Ⅳ (34.7%); χ2=26.002, P<0.01]} and sharp scores were sign-ificantly different in RA patients [10.00(2.00, 47.00); 14.00(2.00, 71.00); 48.00 (12.00, 111.00); 55.00 (7.00, 130.00), Z=29.240, P<0.01], with a trend of gradual increasing. ⑥ Correlation analysis showed that PBF was positively correlated with joint function ( r=0.124, P=0.007), X-ray staging ( r=0.192, P<0.01) of both hands and Sharp scores ( r=0.179, P<0.01) of RA patients. There were negative linear correlations between PBF and BMD (femoral neck and total hip) in patients with RA ( P<0.01). ⑦ Logistic regression analysis revealed that female, advanced age and sarcopenia obesity were risk factors for OP in RA patients ( P<0.01). Conclusion:Incidence of sarcopnic obesity is increased in RA patients, which is closely associated with disease activity and OP in RA patients.

Objective:To investigate the synergistic effect of sarcopenia and osteoporosis on the occurrence of spinal osteoporotic fracture (OPF) in patients with rheumatoid arthritis (RA).Methods:A total of 389 hospitalized RA patients and 156 age and sex-matched normal subjects (control group) were recruited. Dual energy X-ray absorptiometry (DEXA) method was used to measure bone mineral density (BMD) of lumbar spine and hip, and bioelectrical impedance method was applied to determine skeletal muscle mass of limbs. X-ray examination of spin was conducted and spinal OPF was diagnosed according to semi-quality method. Student's t test was used for comparison of measurement date between the two groups, χ2 test was used for comparison of intergroup rates, and Logistic Regression(Backward LR) method was used for multivariate Regression analysis of binomial classification data. Results:BMD of all test sites in RA patients was significantly lower than that in the control group ( P<0.01). The incidence of total OP in RA group was significantly higher than that in the control group [(32.9% vs 12.8%), χ2=22.706, P<0.01]. A total of 84 patients with RA developed spinal OPF, with an incidence of 21.6% which was higher than that in the control group [(3.8%), χ2=25.439, P<0.01]. The incidence of sarcopenia in RA was 54.8%, significantly higher than that in the control group [(9.6%), χ2=93.241, P<0.01]. The incidence of sarcopenia combined with osteoporosis in RA group (28.5%) was significantly higher than that in the control group [(5.8%), χ2=118.110, P<0.01]. Comparison of the incidence of spinal OPF in RA patients among groups with different bone mass (normal bone mass, osteopenia, osteoporosis) showed that the incidence of spinal OPF among these groups was statistically different ( χ2=43.373, P<0.01), and the incidence of spinal OPF increased along with the decrease of bone mass ( χ2=43.003, P<0.01). The incidence of spinal OPF in RA patients with sarcopenia (27.2%, 58/213) was significantly higher than that in RA patients without sarcopenia [(14.8%, 26/176), χ2=8.833, P=0.003]. All participants were divided into three groups: group 1=no OP and sarcopenia, group 2=with sarcopenia or OP, group 3=both sarcopenia and OP. Difference of incidence of spine OPF in RA patients among three groups was statistically significant ( χ2=33.832, P<0.01), and the incidence of spinal OPF raised gradually in group 1 and 3, ( χ2=37.164, P<0.01). Incidences of sarcopenia, OP and spinal OPF in RA treated with glucocorticoid (GC) were higher than those in RA without GC ( P<0.05, P<0.01). Results of logistic regression showed advanced age[ OR(95% CI)=1.069(1.038, 1.101), P<0.01], usage of GC [ OR(95% CI)=3.169(1.679, 5.984), P<0.01] and sarcopenia combined with OP [ OR(95% CI)=2.113(1.430, 3.124), P<0.01] were risk factors for spinal OPF in RA patients. Conclusion:Incidences of sarcopenia, OP and spinal OPF in RA patients are higher than that in normal controls. Sarcopenia and OP have a synergistic effect on spinal OPF in RA patients.

目的 探讨肌少症、骨量减少/骨质疏松在类风湿关节炎(rheumatoid arthritis,RA)患者合并脊柱骨质疏松性骨折发生中的临床意义.方法 选择2017年1月至2018年12月我院383例RA患者和158名健康者,记录RA临床、实验室指标.摄脊柱(T5-L5)X线正侧位片并采用半定量法判断有无脊柱骨折发生,以生物电阻抗法测四肢骨骼肌质量,双能X线骨密度吸收仪测定髋部和腰椎骨密度(bone mineral density,BMD).383例RA患者根据其骨骼肌质量指数(skeletal muscle mass index,SMI)和BMD分为4组:无肌少症且无骨量减少/骨质疏松组64例,有肌少症无骨量减少/骨质疏松组44例,无肌少症有骨量减少/骨质疏松组86例,有肌少症且有骨量减少/骨质疏松组189例,分析肌少症、骨量减少/骨质疏松在RA患者合并脊柱骨质疏松性骨折发生的意义.结果 RA组脊柱骨折发生率显著高于对照组(21.1％vs 3.8％,χ2=24.954,P<0.001),RA组较对照组骨量减少/骨质疏松和肌少症发生率均明显增高(71.8％vs 41.8％,χ2=43.287;60.8％vs 9.0％,χ2=120.093,P均<0.001),且4组RA间脊柱骨折发生率有明显差别(4.7％、11.4％、17.4％和30.7％,χ2=23.947,P<0.001).非参数检验显示4组RA间关节压痛、压痛指数、血沉、DAS28、糖皮质激素日剂量和疗程、HAQ及sharp评分均有明显差异(P均<0.05).多元Logistic回归结果 显示:年龄(OR=1.073,P<0.001,95％CI:1.041～1.107)和糖皮质激素的使用(OR=3.221,P=0.001,95％CI:1.663～6.242)是RA患者发生脊柱骨折的危险因素,而腰椎BMD(OR=0.093,P=0.009,95％CI:0.015～0.555)和SMI(OR=0.716,P=0.032,95％CI:0.527～0.973)是RA患者发生脊柱骨折的保护因素.结论 RA患者肌少症、骨量减少/骨质疏松和脊柱骨质疏松性骨折发生率均明显增高,肌少症、骨量减少/骨质疏松与RA患者的脊柱骨质疏松性骨折的发生密切相关.

This study aimed to investigate the relationship of serum hemoglobin (HB) level with disease activity and structural damage in Chinese patients with rheumatoid arthritis (RA). A total of 890 RA patients and 890 normal subjects were enrolled in the case-control study. A HB threshold of< 110 g/L (women) and < 120 g/L (men) was used to determine anemia. All the patients were divided into three groups: non-anemia group (HB ≥ 120 g/L (male) or 110 g/L (female)), mild anemia group ((90 g/L < HB < lower limit of normal), and medium to severe anemia group (HB ≤ 90 g/L). Serum HB level and anemia prevalence between RA patients and normal subjects were compared. Associations of HB level with disease activity, structural damage, and function of joint in different groups were also investigated. The average of HB level in RA was (109.08 ± 17.96)g/l, which was lower than that in controls (136.75 ± 14.57)g/l (P < 0.001). Anemia was observed in 47% of the RA patients, while prevalence of anemia in control group was only 4.4%. In RA group, percentages of non-anemia, mild anemia, and medium to severe anemia were 47%, 38%, and 15%. Compared with non-anemia RA patients, RA patients with anemia had higher disease activity, severer structural damage and worse function of joint (P < 0.001). With the increase of anemia, the disease activity, structural damage, and dysfunction of joints increased significantly (P < 0.05–0.001). Linear regression analysis showed that HB level was negatively correlated with disease activity parameters, degree of joint destruction, and function (P < 0.05–0.001). Logistic regression indicated that serum HB level was protective factors for disease activity and structural damage in RA (P < 0.001). HB level was significantly related to disease activity and structural damage in RA patients.

Objective:To explore the clinical value of sarcopenia and vitamin D deficiency on gluco-corticoid induced osteoporosis (GIOP) in patients with rheumatoid arthritis (RA).Methods:Three hundred and eleven patients with RA from January 2017 to December 2018 were enrolled in the study. One hundred and fifty-eight sex, age-matched normal subjects were recruited as control group. Clinical and laboratory features, daily dosage and treatment duration of glucocorticoid (GC) were recorded in detail. Skeletal muscle mass was measured by biological electrical impedance. Serum levels of 25-hydroxy vitamin D [25(OH)D] were examined using electro-chemiluminescence. Bone mineral density (BMD) at total hip and lumbar vertebra were detected by dual energy X-ray absorptiometry (DEXA). Numerical data and categorical data comparisons were analyzed using χ2 test, non-parametric test, Logistic regression analysis test. Results:① The prevalence of osteoporosis (OP) in RA patients was 33.4%(104/311), which was higher than that in the control group 12.7%(20/158)( χ2=23.267, P<0.01). Percentage of GC taking in 311 RA patients was 56.6%(176/311), and the prevalence of GIOP was 40.9%(72/176). The prevalence of sarcopenia in RA patients was 61.7%(192/311), which was higher than that in the control group [9.0%(14/156), χ2=117.310, P<0.01]. The prevalence of vitamin D deficiency in RA patients was 81.7%(254/311), which was higher than that in control group [38.0%(60/158), χ2=90.415, P<0.01]. ② The prevalence of OP in RA without sarcopenia was 17.6% (21/119), which was lower than that in patients with sarcopenia [43.2%(83/192), χ2=21.601, P<0.01]. In condition without GC, the prevalence of OP in RA without sarcopenia was 9.8%(6/61), which was significantly lower than that in patients with sarcopenia [35.1%(26/74), χ2=11.834, P<0.01]. Under circumstances with GC, the prevalence of OP in RA without sarcopenia (25.9%, 15/58), which was significantly lower than that in patients with sarcopenia (48.3%, 57/118, χ2=8.103, P<0.01). ③ No matter whether existing vitamin D deficiency or not, the prevalence of OP in RA without GC was 23.7%(32/135), which was significantly lower than that in patients with GC [40.9%(72/176), χ2=10.161, P<0.01]. In patients without vitamin D deficiency, the prevalence of OP in RA without GC was 21.4%(6/28), which was similar to that in patients with GC [31.0%(9/29), χ2=0.678, P>0.05]. In the case of vitamin D deficiency, the prevalence of OP in RA without GC was 24.3%(24/107), which was significantly lower than that in patients with GC [42.9% (63/147), χ2=9.370 2, P<0.01]. ④ In RA patients with GC, age( t=5.313, P<0.01), Sharp score ( Z=2.999, P<0.01), disease duration ( Z=2.141, P<0.05) and treatment duration of GC ( Z=2.460, P<0.05) were higher in group with GIOP than that in group without GIOP, while erythrocyte sedimentation rate (ESR)( Z=2.262, P<0.05), C-reactive protein levels (CRP) ( Z=2.551, P<0.05) and body mass index (BMI) ( t=2.425, P<0.05) were lower and the composition ratio of X-ray staging was worse ( χ2=12.484, P<0.01).⑤ Logistic regression analysis (LR Backward) showed that female gender [ OR(95% CI)=14.240(3.878, 52.288), P<0.01], age [ OR(95% CI)=1.079(1.042, 1.118), P<0.01] and sarcopenia [ OR(95% CI)=2.470(1.192, 5.120), P<0.05] were the risk factors for GIOP in RA patients. Conclusion:The proportion of treatment with GC in RA patients is very high (about 60%), and the prevalence of GIOP is 40.9%, which is closely related to sarcopenia and vitamin D deficiency.

RA是一种以滑膜炎为病理特征的慢性炎症性疾病.血清中自身抗体的检测提高了对RA的诊断,抗氨基甲酰化蛋白(Carp)抗体作为一种新型自身抗体,在RF和抗瓜氨酸蛋白抗体(ACPA)阴性的情况下可能有助于RA的诊断.