Relationship between C-reactive protein concentration, bone mineral density and cardiovascular disturbances in patients with rheumatoid arthritis

Objective. To study relationship between serum level of hs-CRP, bone mineral density (BMD) and cardiovascular disturbances in patients with rheumatoid arthritis (RA). Material and methods. 132 pts with RA with mean age 50 years (45-53 years) and mean disease duration 132 months (48-216 months) were examined. BMD was evaluated by dichroic X-ray densitometry in femur neck with Gologic apparatus. CRP concentration was assessed by high sensitivity nephelometric immunoassay with latex amplification with BN 100 analyzer (Dade Behring, Germany). Results. Mean BMD value in pts with RA was lower than in control group —1,4 SD and -0,45 SD respectively (p=0,00001). Normal BMD, osteoporosis and osteopenia were revealed in 38%, 47% and 15% of pts respectively. Clinical and subclinical signs of atherosclerosis in RA were more frequent than in control: coronary heart disease (CHD) and stroke (ST) in 25% and in 6% respectively (p=0,004), plaques (P) and intima-media complex (IMC) thickening in 65% and 35% respectively (p=0,003). In groups with osteopenia and osteoporosis ST and CHD revealed after RA development were more frequent, (p<0,05), RA duration was longer (p=0,02), hs CRP concentration was higher (p=0.001). Frequency of subclinical signs of atherosclerosis (P and IMC thickening) in groups with normal and decreased BMD was similar. Pts with combination of osteopenia and osteoporosis (n=81) had higher frequency of CHD and high hs-CRP than pts with normal BMD (p<0,05). Mean hs-CRP level in RA was significantly higher than in control. Mean hs-CRP values in normal BMD, osteopenia and osteoporosis were 7,02 (2,4-14,5) mg/1, 9,3 (4,4-22) mg/1, 15,3 (8,6-36,2) mg/l respectively (p=0,001). 65 pts with mean hs- CRP level 3,9 (1,8-7,02) mg/l had higher BMD value than 67 pts with mean hs-CRP level 22 (12,6-34) mg/l (-1,75 SD and -1,0 SD respectively, p=0,016). Frequency of clinical, subclinical signs of atherosclerosis and traditional risk factors did not differ in different groups. The pts were divided into 4 groups depending on hs-CRP level: 33 ptswith hs- CRP<3,9 mg/l, 33 pts with hs-CRP 3,9-9,01 mg/l, 34 pts with hs-CRP 9,01-22,1 mg/l, 33 pts with hs-CRP>22,l mg/l. Age, duration of disease, frequency of clinical and subclinical signs of atherosclerosis did not differ in these groups. Increase of hs-CRP concentration was associated with decrease of BMD and IMC (p<0,05) Conclusion. Decrease of BMD in RA pts is accompanied by increase of clinical signs of atherosclerosis and hs-CRP level. Increase of CRP may reflect inflammatory activity of the disease and may be a marker of atherosclerosis.

rheumatoid arthritis, C-reactive protein, bone mineral density

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