Asociace mezi svalovou hmotou a zlomeninami u pacientů s anamnézou juvenilní idiopatické artritidy

Association between lean mass and fractures in patients with anamnesis of juvenile idiopathic arthritis

Objective:
Juvenile idiopathic arthritis (JIA) is associated with an increased fracture risk throughout the life. The aim of this study was to investigate factors contributing to an increased occurrence of fractures in young adults with JIA. Patients and methods: In 23 patients with JIA (who met the criteria for the treatment with biological agents, and in whom the treatment has yet to be initiated) and 52 healthy controls, bone mineral density, body composition, tests of lower extremity function and biochemical markers of bone remodeling were measured. Results: JIA was diagnosed at an average age of 9.9 ± 4.9 years, and the mean duration of the disease was 15.4 ± 8.4 years. At the time of examination, clinical and laboratory activity of JIA was documented in all of our patients (DAS 28 6.1 ± 1.3). Low bone mass (less than -2 SD in Z score) was found in 61% of patients with JIA (in 71% of patients treated with glucocorticoids, and in 22% of patients treated without glucocorticoids). During the course of the disease, 22% of patients with JIA suffered a low-impact fracture. In our patients, a significant association between the prevalent fracture and low lean mass was observed. The patients had significantly poorer results of the chair-rise test in comparison with healthy controls. Conclusion: Our results confirm a decrease in bone mass of patients with JIA, and highlight the significance of low lean mass as a next potential marker of the risk of fracture.

Key words:
juvenile idiopathic arthritis, fractures, bone mineral density (BMD), lean mass, glucocorticoids

Autori: K. Brábníková Marešová; K. Jarošová; J. Štěpán
Pôsobisko autorov: Revmatologický ústav a Revmatologická klinika, 1. lékařská fakulta, Univerzita Karlova v Praze
Vyšlo v časopise: Čes. Revmatol., 18, 2010, No. 1, p. 12-18.
Kategória: Původní práce

Súhrn

Cíl:
Onemocnění juvenilní idiopatickou artritidou (JIA) je spojeno s klinicky významným zvýšením rizika zlomenin během celého života. Cílem práce bylo studovat faktory, které přispívají k častějšímu výskytu zlomenin u mladých dospělých pacientů s juvenilní idiopatickou artritidou. Soubor a metodika: V souboru 23 pacientů s JIA, kteří splnili podmínky pro podání biologické léčby a jsou před zahájením této léčby, a 52 zdravých kontrol jsme hodnotili denzitu kostního minerálu, složení těla, testy funkce dolních končetin a biochemické markery kostní remodelace. Výsledky: Onemocnění JIA začalo v průměru ve věku 9,9 ± 4,9 let, trvalo v průměru 15,4 ± 8,4 let a v době vyšetření bylo klinicky i laboratorně aktivní u všech pacientů (DAS 28 6,1 ± 1,3). Nízkou kostní hmotu (nižší než -2 SD v Z-skóre) mělo 61% všech pacientů s JIA (71% pacientů léčených glukokortikoidy a 22% pacientů, kteří nebyli léčeni glukokortikoidy). Během onemocnění JIA prodělalo nízkotraumatickou zlomeninu 22% pacientů s JIA. Údaje o prodělané zlomenině byly u pacientů s JIA statisticky významně asociovány s nižší svalovou hmotou. Funkce dolních končetin, hodnocená pomocí chair-rise testu, byla u pacientů významně horší než u zdravých osob kontrolní skupiny. Závěry: Výsledky potvrzují snížení kostní hmoty u pacientů s JIA a upozorňují na význam svalové hmoty jako dalšího možného ukazatele rizika zlomenin.

Klíčová slova:
juvenilní idiopatická artritida, zlomeniny, denzita kostního minerálu (BMD), svalová hmota, glukokortikoidy

MUDr. Kristýna Brábníková Marešová
Revmatologický ústav
Na Slupi 4
128 50
Praha 2
e-mail: maresova.kristyna@seznam.cz

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