风湿性疾病与骨质疏松症

Osteoporosis and rheumatoid diseases

类风湿性关节炎(RA)和强直性脊柱炎(AS)是两种炎性关节病,以伴发骨代谢异常骨质疏松症为特点。在RA表现为关节周围骨丢失及骨侵蚀、全身性骨质疏松症,患者的骨折风险明显增加。RA骨折的发生与下列因素相关:女性多发,骨折发生率随着年龄增长而增加,与RA疾病的严重性、糖皮质激素的使用相关。然而,进一步的数据表明,RA的骨量丢失亦可发生在未使用糖皮质激素患者;及时控制关节炎症可以减少关节结构损伤、减少骨量流失。因此,炎症在RA骨吸收中发挥重要作用。强直性脊柱炎性骨质疏松症可发生在疾病早期阶段,致椎体骨折风险增加。由于年轻成年男性易患AS,并且糖皮质激素并不用于治疗AS,因此,AS骨质疏松症与年龄、性别、糖皮质激素使用无关,AS骨丢失主要与炎症活动相关。AS特征是循序渐进、缓慢发展的晨僵和脊椎炎,进一步说明了炎症在局部骨形成中的潜在作用。

Rheumatoid arthritis（RA） and ankylosing spondylit（AS） are two inflammatory joint diseases characterized by the complications of abnormal bone metabolism osteoporosis.The bone loss,bone erosions,and systemic osteoporosis around the joint can appear in RA patients.The fracture risk of RA patients significantly increases.The RA fracture is related to the following factors： gender（more common in female）,age（increasing along with age）,the severity of RA,and the use of glucocorticoid.However,more data show that the RA bone loss can also appear in glucocorticoid-naive patients.Prospective data show that the optimal control of inflammation in RA can decrease the structural damage and bone loss.Inflammation plays an important role in RA bone absorption.AS accompanied osteoporosis can occur in the early stage and can increase vertebral fracture risk.Because AS is common in young males and cannot be treated with glucocorticoid,AS accompanied osteoporosis is not related to age,gender,and the use of glucocorticoid.The bone loss of AS is mainly related to the inflammation.AS is characterized with progressive stiffness and ankylosis of the spine.This further illustrates the potential role of inflammation in local bone formation.