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Association of High Anti–Cyclic Citrullinated Peptide Seropositivity and Lean Mass Index With Low Bone Mineral Density in Rheumatoid Arthritis
Author(s) -
Wysham Katherine D.,
Shoback Dolores M.,
Imboden John B.,
Katz Patricia P.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23440
Subject(s) - medicine , bone mineral , rheumatoid arthritis , osteoporosis , lean body mass , femoral neck , body mass index , rheumatoid factor , body weight
Objective Osteoporotic fractures are associated with high morbidity and mortality. Persons with rheumatoid arthritis ( RA ) have twice the risk of osteoporosis‐related fracture than age‐matched controls, the causes for which remain unknown. We investigated contributions of RA characteristics, medication use, and body composition to low bone mineral density ( BMD ) in patients with RA . Methods Data were from the Arthritis, Body Composition, and Disability Study (n = 138; 82 women, 56 men). Demographic, clinical, laboratory, and functional variables were collected at study visits. Body composition (fat, lean muscle, and BMD ) was measured by dual x‐ray absorptiometry. Linear regression analyses evaluated the association between predictors and femoral neck BMD . Results Average disease duration was 19 years, 70% of patients were rheumatoid factor positive, and 55% were high‐positive anti–cyclic citrullinated peptide (anti‐ CCP ). Age and high anti‐ CCP positivity were negatively associated with BMD after controlling for other variables (β = −0.003 and −0.055, respectively, P < 0.05). Appendicular lean mass index ( ALMI ) was positively associated with BMD (β = 0.053, P < 0.0001). In high anti‐ CCP positivity participants, increasing anti‐ CCP levels were associated with a negative linear trend in BMD (β = −0.011, P = 0.026). Conclusion High anti‐ CCP positivity and ALMI were strongly associated with BMD in patients with RA . The linear relationship of anti‐ CCP levels with lower BMD supports the hypothesis that processes specific to RA negatively impact BMD . In contrast, ALMI was positively associated with BMD , emphasizing the importance of this potentially modifiable risk factor. Our findings highlight the complicated interplay of RA disease‐specific and functional factors and their impact on bone mass.