Study of bone marrow density (BMD) in patients with rheumatoid arthritis and its co-relation with severity of the disease.

INTRODUCTION Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by a symmetric, peripheral polyarthritis.1-3 People with rheumatoid arthritis are at increased risk of osteoporosis. Hence this article intends to highlight the importance of BMD measurement in patients with RA as a tool for assessment of disease activity and severity. OBJECTIVE To evaluate Bone Mineral Density in patients of Rheumatoid Arthritis and Co-relate it with severity of disease. MATERIAL AND METHODS Hand bone density was measured on the plain radiographs of the right hand using digital x-ray radiogrammetry (Pronosco Xposure System 2.0). This BMD was correlated with markers of disease activity using DAS 28 Scoring system.4. RESULTS In our study there were 200 patients with equal number of controls. 70 patients in study group and 131 patients in control group were <45 years old and had normal Z-score while in age group >45 years 26 and 20 cases in study and control groups respectively had their Z-score within normal range. There were total 21 and 2 cases of study and control groups respectively (age <45 years) who had osteoporosis while in age group >45 years 12 and 10 cases in study and control groups respectively had osteopenia. CONCLUSIONS Patients with RA are more susceptible for bone loss in comparison to normal age and gender related subjects. Patients with longer duration and higher disease activity are more susceptible for developing osteopenia and osteoporosis. Occurrence of joint deformities increases with longer disease duration. Limitation of physical activity impairs the bone mineral density. Patient taking anti-rheumatic therapy (steroids and Disease-modifying antirheumatic drugs) are at increased risk of bone loss. All these factors contribute to bone loss independent of each other.