Abstract:Objective: To investigate the changes of bone metabolism in patients without glucocorticoid rheumatoid arthritis (RA) and their influencing factors, and to investigate the therapeutic effect of tumor necrosis factorα (TNFα) inhibitor (Qiangke). Methods: Sixtyfive patients hospitalized in our hospital diagnosis and treatment of unused glucocorticoid RA patients were collected, serum type Ⅰ collagen Cterminal peptide (CTX), type Ⅰ collagen amino terminal propeptide (PINP) and osteocalcin levels were determined, and erythrocyte sedimentation rate (ESR), Creactive protein, rheumatoid factor (RF) and other factors for correlation analysis. The control group was 57 healthy medical examiners in our hospital. A total of 30 RA patients were given subcutaneous injection of 25 g twice a week, and bone metabolism indicators were measured again after 3 months to understand the changes before and after treatment. Results: ① The serum CTX level (511.37±204.48) ng/L in RA patients was significantly higher than that in the control group [(391.62±143.68) ng/L, P<0.05], and the serum PINP level (42.19±15.39) μg/L was significantly lower than the control group [(49.61±15.42) μg/L, P<0.05]. ② Serum CTX levels in RA patients were positively correlated with age, DAS28 score, ESR, Creactive protein (r were 0.483, 0.367, 0.410, 0.361 respectively, all P<0.01), and serum PINP and osteocalcin levels were positively correlated with disease duration (r were 0.272, 0.303 respectively, all P<0.01). ③ Serum PINP and osteocalcin levels were significantly higher in RA patients after treatment with Qiangke [(80.79±63.88) μg/L vs (60.23±45.93) μg/L, P<0.05; (22.13±14.46) μg/L vs (16.74±8.46) μg/L, P<0.05]. Conclusion: RA patients showed increased osteoclast and decreased osteogenesis. The level of bone metabolism was related to the course of disease and disease activity. Bone metabolism was improved after TNFα inhibitor treatment.
史敦绘, 史伟, 娄方明, 锁星星, 李晶, 汤郁. 肿瘤坏死因子-α抑制剂对未使用糖皮质激素类风湿关节炎患者骨代谢水平的影响[J]. 江苏大学学报:医学版, 2019, 29(02): 138-141.
SHI Dun-hui, SHI Wei, LOU Fang-ming, SUO Xing-xing, LI Jing, TANG Yu.
Effects of TNF-α inhibitors on bone metabolism in rheumatoid arthritis
patients without glucocorticoid treatment. Journal of Jiangsu University(Medicine Edition), 2019, 29(02): 138-141.
[1]McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis[J]. N Eng J Med,2011,365(23):2205-2219.[2]Murariu RV, Macovei LA, Brujbu IC. Osteoporosis in rheumatoid arthritis[J]. Rev Med Chir Soc Med Nat Iasi,2013,117(2):394-403.[3]Hlaing TT, Compston JE. Biochemical markers of bone turnoveruses and limitations[J]. Ann Clin Biochem,2014,51(Pt 2):189-202.[4]Hauser B, Riches PL, Wilson JF, et al. Prevalence and clinical prediction of osteoporosis in a contemporary cohort of patients with rheumatoid arthritis[J]. Rheumatology (Oxford), 2014,53(10):1759-1766.[5]Oelzner P, Schwabe A, Lehmann G, et al. Significance of risk factors for osteoporosis is dependent on gender and menopause in rheumatoid arthritis[J]. Rheumatol Int,2008,28(11):1143-1150.[6]Wislowska M, Jakubicz D, Stepien K, et al. Serum concentrations of formation (PINP) and resorption (Ctx) bone turnover markers in rheumatoid arthritis[J]. Rheumatol Int,2009,29(12):1403-1409.[7]Fardellone P, Sejourne A, Paccou J, et al. Bone remodelling markers in rheumatoid arthritis[J]. Mediators Inflamm,2014,2014:484280.[8]Schett G, Saag KG, Bijlsma JW. From bone biology to clinical outcome: state of the art and future perspectives[J]. Ann Rheum Dis,2010,69(8):1415-1419.[9]Nishizawa Y, Ohta H, Miura M, et al. Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition)[J]. J Bone Miner Metab,2013,31(1):1-15.[10]Zaitseva OV, Shandrenko SG, Veliky MM. Biochemical markers of bone collagen type Ⅰ metabolism[J]. Ukr Biochem J,2015,87(1):21-32.[11]Matuszewska A, Szechinski J. Evaluation of selected bone metabolism markers in rheumatoid arthritis patients[J]. Adv Clin Exp Med,2013,22(2):193-202.[12]楼慧玲, 彭程, 陈巧聪. 三种骨代谢标志物的测定在老年骨质疏松症患者髋部脆性骨折中的临床价值[J].南方医科大学学报,2012,32(9):1346-1349.[13]Wasserman AM. Diagnosis and management of rheumatoid arthritis[J]. Am Fam Physician,2011,84(11):1245-1252.[14]Cuchacovich M, Bueno D, Carvajal R, et al. Clinical parameters and biomarkers for antiTNF treatment prognosis in rheumatoid arthritis patients[J]. Clin Rheumatol,2014,33(12):1707-1714.[15]Pisetsky DS, Ward MM. Advances in the treatment of inflammatory arthritis[J]. Best Prac Res Clin Rheumatol,2012,26(2):251-261.