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ID PMID Title PublicationDate abstract
15011812 The history of gold therapy for tuberculosis. 2004 Jan This is a historical study of the popularization of a medical therapy contrary to pertinent experimental findings. Presumably this circumstance reflects the desperation about tuberculosis: highly prevalent, highly fatal, and lacking any etiologically directed therapy. Gold compounds were introduced, based initially on the reputation of Robert Koch, who had found gold cyanide effective against M. tuberculosis in cultures, but not in experimentally infected animals. Treatment of pulmonary tuberculosis with these compounds was popularized, particularly by Danish physicians, in the mid-1920s, despite consistently negative experimental results, based on Paul Ehrlich's theories of antimicrobial drug effects. Difficulties in the design of interpretable clinical studies were soon recognized but also generally ignored, thus permitting data to be interpreted as favorable to antituberculous gold therapy. Eventually toxicity was considered to outweigh the alleged therapeutic benefit of all gold compounds. This resulted in their discard shortly before the introduction of streptomycin therapy.
12136889 Expression of QK/QR/RRRAA or DERAA motifs at the third hypervariable region of HLA-DRB1 an 2002 Jul OBJECTIVE: To examine the relationship between disease severity in patients with confirmed rheumatoid arthritis (RA) and the carriage of alleles expressing the high risk epitope (HRE) QK/QR/RRRAA or the low risk epitope (LRE) DERAA at positions 70-74 of the third hypervariable region of HLA-DRB1. METHODS: A case-control design to compare allele carriage rates in 204 Caucasian subjects with severe RA and mild RA and healthy controls. Patients had a mean disease duration of 12-18 years and severity of RA was defined using clinical and therapeutic criteria. Molecular typing at the HLA-DRB1 locus was performed using a polymerase chain reaction method. RESULTS: Eighty-seven percent of patients (52/60) with severe RA had one or more of the alleles bearing the QK/QR/RRRAA motif or HRE, compared with 54% (21/39) with mild RA (OR 5.57, p = 0.0007) and 39% (41/105) of controls (OR 10.15, p < 0.0001). Twenty-five percent of patients (15/60) with severe disease expressed 2 disease associated HRE DRB1 alleles, compared with 13% of patients (5/39) with mild disease (OR 2.3, p = NS) and 5% (5/105) of controls (OR 6.67, p = 0.0003). In contrast, only 5% of patients (3/60) with severe RA expressed one of the LRE alleles that carry the DERAA motif at positions 70-74, compared with 31% of patients (12/39) with mild RA (OR 0.12, p = 0.0013) and 22% of controls (23/105) (OR 0.19, p = 0.0082). No patient or control was homozygous for LRE alleles. Eighty-three percent (50/60) of patients with severe RA expressed the HRE without the LRE, compared with 44% (17/39) of those with mild disease (OR 6.47, p < 0.0001) and 35% (37/105) of controls (OR 9.19, p < 0.0001). In contrast, only one patient (2%) with severe disease expressed the LRE without the HRE, compared with 20% (8/39) of those with mild disease (OR 0.07, p = 0.0047) and 16% (17/105) of controls (OR 0.09, p = 0.009). There was no significant difference between the 3 groups in the frequency of patients who expressed both or neither epitope. Logistic regression showed that age at disease onset (p = 0.0009), duration of disease (p = 0.007), positive rheumatoid factor status (p = 0.003), and presence of the HRE or LRE (p = 0.00005) were significantly associated with the presence of severe disease. CONCLUSION: HLA-DRB1 alleles appear to confer an important bidirectional influence on the risk of disease severity in RA, with 20-fold difference in OR between those associated with the highest (HLA-DRB1*0401) and lowest (HLA-DRB1*1301/02) risk. The HRE and LRE exhibit diametrically opposed effects, which may be mutually antagonistic. These data support a multistep pathogenesis in which MHC class II genes are one component of a coordinate genetic and environmental interaction leading to immunological injury and joint destruction.
15570633 Enhanced Fcgamma receptor I, alphaMbeta2 integrin receptor expression by monocytes and neu 2004 Dec OBJECTIVE: To investigate platelet and leukocyte activation and interaction in patients with rheumatoid arthritis (RA) and the effect of methotrexate (MTX) or anti-tumor necrosis factor-a (TNF-a) treatment on these variables. METHODS: Four-color flow cytometry analysis was performed for quantitative measurement of platelet (P-selectin, PAC-1) and leukocyte (CD11b, CD64) activation markers and estimation of percentage of leukocyte-platelet complexes in whole blood in 20 patients with RA before and after 6 weeks of therapy and in 20 controls. In addition, measures of soluble P-selectin (sP-selectin), beta-thromboglobulin, fibrinogen, prothrombin fragment 1+2, D-dimer, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin 6 (IL-6), and TNF-a and tender and swollen joint counts were carried out. RESULTS: Before therapy, PAC-1 binding, expression of CD11b and CD64 on monocytes and neutrophils, circulating levels of monocyte (CD11b+ or CD64+)-platelet complexes, monocyte-PAC-1+ platelet complexes, CRP, ESR, IL-6, TNF-a, fibrinogen, D-dimer and sP-selectin were significantly higher in RA patients compared to controls. The anti-TNF-a therapy significantly reduced levels of monocyte-PAC-1+ platelet complexes, sP-selectin, CRP, ESR, IL-6, TNF-a, fibrinogen, and D-dimer and tender and swollen joint counts. CD64 expression on monocytes was significantly decreased by MTX therapy. PAC-1 binding was not inhibited by MTX or anti-TNF-a. CONCLUSION: Increased platelet and leukocyte activation and increased formation of leukocyte-platelet complexes in patients with RA suggest a status of simultaneous activation of the immune and hemostatic systems.
12387812 Rheumatic fever and post-streptococcal arthritis. 2002 Jul Rheumatic fever resulting from group A beta-haemolytic Streptococcus infection continues to be a prevalent disease and an important cause of morbidity and mortality in developing countries. Molecular mimicry and CD4 T lymphocytes, interleukins and adhesion molecules play a crucial role in the pathogenesis of this disease. Arthritis, followed by carditis and chorea, are the main manifestations of the disease. Evidence of asymptomatic carditis has been increasing; however, abnormality identified by echo-Doppler evaluation is not considered as a criterion for diagnosis of rheumatic carditis. Benzathine penicillin is still the best therapeutic option for the treatment of streptococcal infection and secondary prophylaxis, due to its efficacy and low cost.
12370009 Protein regulators of eicosanoid synthesis: role in inflammation. 2002 Aug A variety of factors contribute to the complex course of inflammation. Microbiological, immunological and toxic agents can initiate the inflammatory response by activating a variety of humoral and cellular mediators. In the early phase of inflammation, excessive amounts of cytokines and inflammatory mediators are released. These factors activate, in addition to other signaling pathways, the lipid synthesis pathways, which play a crucial role in the pathogenesis of organ dysfunction. Arachidonic acid (AA), the precursor of pro-inflammatory eicosanoids, is released from membrane phospholipids by the action of phospholipase A(2) (PLA(2)), and is metabolized to prostaglandins (PGs) and leukotrienes (LTs) by the action of cyclooxygenase (COX) and lipoxygenase (LO) enzymes, respectively. Disordered activation of PLA(2), LO and COX enzymes have been implicated in many inflammatory diseases. PLA(2) is activated by phospholipase-A(2)-activating protein (PLAP) and LO by 5-lipoxygenase-activating protein (FLAP). The inducible form of COX-2 enzyme, which is usually not present under basal conditions, is induced in inflammation. In this article the function of these enzymes in eicosanoid synthesis, their regulation, and their implication in inflammatory disorders will be reviewed. The properties, function and regulation of the protein activators PLAP and FLAP will also be discussed.
11899751 Functional and health status assessment in patients with rheumatoid arthritis. 2002 Assessing functional and health status in patients with rheumatoid arthritis (RA) can provide information on the individual's functioning in routine occupations and on the individual's well-being. Data can be obtained by a variety of functional tests and questionnaires. At the Department of Rheumatology at the Vienna University, a specific assessment for outpatients with RA is performed every 3 months. It consists of functional tests, questionnaires, Visual Analog Scales, joint counts, and parameters of disease activity. These data are used to supplement the rheumatologist's decision about medical management of the disease and about further therapeutic strategies.
14969075 Role of biologics in early arthritis. 2003 Sep Recent advances in the management and treatment of rheumatoid arthritis (RA) have provided evidence for the importance of early diagnosis and treatment of the disease. Biological therapy with monoclonal antibodies, including anti-tumor necrosis factor (TNF) agents have shown major efficacy in terms of disease activity and outcome of inflammatory arthritis in trials. Interest has focused on the treatment of early rheumatoid arthritis with anti-TNF agents to induce long-term impact on outcome. A major study of etanercept versus methotrexate (MTX) showed some benefit at one year for the etanercept group, but long-term data have shown greater benefit. Two double-blind placebo-controlled studies of infliximab in patients with early RA yielded promising data, showing the possibility of a true 'window of opportunity' with long-term benefit from a short term treatment period. Aggressive treatment by anti-TNF agents as well as combination therapies of disease modifying anti-rheumatic drugs (DMARDs) in patients with very early disease would be a logical approach to be investigated in the future.
15105671 Morphologic characteristics of atlantoaxial complex in rheumatoid arthritis and surgical c 2004 May 1 STUDY DESIGN: A morphometric study of lateral mass from C1 to C2 and involving 42 patients with rheumatoid arthritis (RA). OBJECTIVE: To provide anatomic data on the lateral mass of the upper cervical spine and quantitatively assess structure feature of a C1-C2 lateral mass in RA and its association with adjacent structures. SUMMARY OF BACKGROUND DATA: No anatomic study on C1-C2 lateral mass in Chinese RA patients exists, nor is there a study describing the risk of transarticular screws fixation in these patients. METHODS: Forty-two patients with RA were obtained for study of the bony structure of the C1-C2 lateral mass. Using reconstructed CT scan, the anatomic variability of bony structure to rheumatoid inflammatory change was assessed via C2 isthmus width and height measurement. The mediolateral diameter, superoinferior diameter, and sagittal length of the atlantoaxial lateral mass were also calculated. Additionally, the possible screw trajectory angles were assessed. RESULTS: Forty-two patients displayed bony erosion of the C1-C2 mass. The dimension change of the C2 isthmus was weakly correlated with age and rheumatoid history. Furthermore, predominant destruction on either side of lateral mass is noted in 21.4% (n = 9) of patients. The mean shortest isthmus height of C2 is 4.69 +/- 1.66 mm, while its mean shortest width is 5.14 +/- 1.23 mm. Furthermore, the average distance between the anterior margin of C1 lateral mass and the same side posterior cortex of the C2 inferior facet is 36.53 +/- 3.94 mm. Meanwhile, the distance of coronal aspect of C1 lateral mass is 11.20 +/- 1.92 mm. The medial/lateral and caudo-cephalic inclinations of the isthmus with respect to the C2 inferior facet are 86.66 +/- 7.69 degrees and 40.82 +/- 7.29 degrees. Bilateral 3.5-mm screw placement could be safely achieved in only 30.9% (n = 13) of patients with chronic RA with upper cervical lesions. CONCLUSIONS: The work provides detailed bony data on the rheumatoid C2 isthmus and C1 structure. Anatomic variation in either side or both sides of the C2 isthmus is severe during erosion in patients with RA. Unilateral C1-C2 transarticular screw, modification of screw diameter, or alternative techniques for C1-C2 arthrodesis should be considered in most Chinese rheumatoid cases.
15345503 Methotrexate ameliorates T cell dependent autoimmune arthritis and encephalomyelitis but n 2005 Apr OBJECTIVE: To investigate the mode of action of methotrexate (MTX) in different types of models for rheumatoid arthritis (RA) and multiple sclerosis (MS). METHODS: Models for RA and MS were selected known to have different pathogenesis--that is, fibroblast induced arthritis in SCID mice, collagen induced arthritis (CIA), anticollagen II antibody induced arthritis (CAIA), and experimental autoimmune encephalomyelitis (EAE) in (Balb/c x B10.Q)F1 and B10.Q mice, and Pristane induced arthritis in DA rats (PIA). The MTX treatment was started 1 day after the onset of disease and continued for 14 days to compare effects on the different models. RESULTS: All models known to be critically dependent on T cell activation (CIA, PIA, and EAE) were effectively down regulated by titrated doses of MTX. In contrast, no effects were seen on fibroblast induced arthritis or CAIA. No effects were seen on the levels of anticollagen II antibodies in the CIA experiment. CONCLUSION: The data show that MTX has strong ameliorative effect on both classical models of RA, like CIA and PIA, but also on a model for MS, EAE. It also suggests that MTX operates only in diseases which are preceded by, and dependent on, T cell activation. A comparison of CAIA and CIA suggested that MTX operates independently of arthritogenic antibodies. These results demonstrate that different animal models reflect the complexity of the corresponding human diseases and suggest that several models should be used for effective screening of new therapeutic agents.
14566746 Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthro 2003 Oct Influence of the infrapatellar fat pad resection in a synovectomy during total knee arthroplasty (TKA) was evaluated in patients with rheumatoid arthritis (RA). Our findings for 120 RA patients at 28 to 38 months after surgery showed that (i) a significant decrease in the number of patients with anterior aching discomfort despite a lower-lying patella was seen in patients with infrapatellar synovectomy compared with patients without infrapatellar synovectomy, and (ii) an increase in the number of patients with anterior aching discomfort, significant limited motion, slight quadriceps weakness, and significant shortening of patellar tendon length and patella height were noted among patients with infrapatellar synovectomy, including fat pad resection, than in patients without infrapatellar synovectomy.
12847900 [Assessment of mineral density of bone tissue in patients with rheumatoid arthritis using 2003 AIM: To examine bone mineral density in rheumatoid arthritis (RA) patients using echoosteometry (EOM), to analyze the speed of ultrasound bone conduction in patients with different variants of RA. MATERIAL AND METHODS: The study included 122 patients with verified RA diagnosis (ARA, 1987) who had not previously taken glucocorticosteroids, basic drugs or antiosteoporosis therapy. Group 1 consisted of 48 women of reproductive age, group 2--of 46 postmenopausal women and group 3 of 28 male patients. EOM measured the speed of ultrasonic conduction in collar-bones and radii (Echoosteometer EOM-02). RESULTS: The speed of ultrasound conduction in collar-bones and radii in RA patients is slower than control. This shows bone density loss. EOM demonstrated correlations between ultrasound bone conduction and RA patients age, RA duration and x-ray stage of the disease.
11894837 Insufficiency fractures in patients with chronic inflammatory joint diseases. 2002 Jan OBJECTIVE: To describe the typical sites of stress fractures in the lower extremities and pelvis in rheumatoid patients (rheumatoid arthritis, juvenile chronic arthritis, psoriatic arthritis, ankylosing spondylitis). METHODS: Thirty-three patients with 52 stress fractures [mean age 44 years (range 11-73)] were studied at the authors' institution when they were being treated for their rheumatic diseases. Fourteen patients had RA, 9 JCA, 5 PsoA, and 5 SPA. Stress fractures were detected from patient documents and from series radiographs in suspected cases. In some cases magnetic resonance imaging was also performed. RESULTS: One patient presented with 5 fractures, 2 patients with 4 and 3 fractures, and 7 patients with 2 fractures each. Other patients (n = 19) had only one fracture each. The metatarsal (MT) bones were the most common site of involvement. Twenty-five of the 52 fractures were located on MT I-V. The second and third most common sites were thefibula (n = 13) and tibia (n = 6). All fractures of the lower tibia or fibula were associated with valgus malalignment of the ankle. CONCLUSION: If a patient with rheumatic disease experiences sudden and unexplained pain localised in the forefoot, above the ankle, below the knee, or in the pelvis, a stress fracture should be suspected. Patients with severe osteoporosis, high-load corticosteroid or methotrexate therapy, or marked joint deformity are at high risk of developing stress fracture.
15083882 Correlation between expression of CD44 splice variant v8-v9 and invasiveness of fibroblast 2004 Mar OBJECTIVES: Rheumatoid arthritis is characterized by inflammation, hyperplasia of the synovial membrane, pannus formation and degradation of cartilage and bone. Fibroblast-like synoviocytes are thought to be involved in the invasion and subsequent degradation of cartilage. Two processes play a role in cellular invasion: cellular migration and degradation of the extracellular matrix. The adhesion molecule CD44 and chemokine receptors are instrumental in migration and invasion. Both components have been reported to play a role in tumour metastasis but also appear to be implicated in the destruction of synovial joints in rheumatoid arthritis. CD44, an ubiquitously expressed receptor for the glycosaminoglycan hyaluronan, contains 9 exons that are alternatively spliced and this gives rise to the expression of multiple splice variants, each exhibiting different functional capacities. METHODS: In this report we describe an analysis of the expression of chemokine receptors and CD44 splice variants in diseased synovial tissues using the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). We have correlated our findings with the clinical diagnosis of rheumatoid or osteoarthritis, with invasion into the extracellular matrix in vitro, and with the rate of proliferation of fibroblast-like synoviocytes. RESULTS AND CONCLUSIONS: We conclude that fibroblast-like synoviocytes from both osteo- and rheumatoid arthritis express a number of different chemokine receptors and CD44-splice variants, but none of these correlate with a particular diagnosis. However, elevated expression of CD44v8-9 was found to correlate negatively with the invasive capacity of fibroblast-like synoviocytes.
12510363 [Systemic corticosteroids in rheumatoid arthritis: to use or not to use?]. 2002 Dec Systemic corticosteroids(steroids) were initially introduced after the dramatic efficacy in individual patients with rheumatoid arthritis(RA). Since the outcome of steroid therapy in RA turned to be awesome, steroids had been put at the apex of the therapeutic pyramid for a long time. However, most rheumatologists have subscribed steroids for the treatment of early active RA because they can provide rapid and significant clinical response. Moreover, recent several studies have shown that low dose(5 to 10 mg/day) of prednisolone retard joint destruction in a few years. However, the demonstrated negatives(opportunistic infections, osteoporosis, metabolic disorders, atherosclerotic vascular events etc.) of steroids may outweigh these advantages in the longterm clinical course of RA.
11974899 [Follicular bronchiolitis preceding rheumatoid arthritis]. 2002 Mar A 52-year-old woman visited our hospital because of a cough and stridor in 1994. She had a history of non-tuberculous mycobacteriosis and chronic paranasal sinusitis. Her chest CT scan showed scattered centrilobular nodular shadows and peribronchial thickening, and so we suspected recurrent non-tuberculous mycobacteriosis or diffuse panbronchiolitis. Clarithromycin treatment was initiated, but she soon ceased taking the drug. She visited our hospital again because of a severe cough three and half years later. A new chest CT scan showed increased abnormal shadows, and so we suspected worsening non-tuberculous mycobacteriosis or diffuse panbronchiolitis. Consequently, we commenced treatment with rifampicin, ethambutol hydrochloride as well as clarithromycin. One year later, rheumatoid arthritis was diagnosed because of a swollen proximal interphalangeal joint in both fourth fingers. Her respiratory symptoms were not relieved with clarithromycin or antituberculous drugs, so a thoracoscopic biopsy was performed for a more accurate diagnosis. Histological examination revealed follicular bronchiolitis.
12889997 Association between polymorphisms in the human chemokine receptor genes CCR2 and CX3CR1 an 2003 Aug Cell trafficking into the rheumatoid synovium is thought to play an important role in the inflammation seen in rheumatoid arthritis. Chemokine receptors play a central role in this process, and several common variants are known, including the CCR2 variant, CCR2-64I, and two variants of the CX3CR1 gene, V249I and T280M. All three variants result in functional amino acid substitutions. We studied the association of these chemokine receptor variants with susceptibility to and severity of rheumatoid arthritis in two Dutch patient populations; 282 consecutive rheumatoid arthritis patients from a rheumatology outpatient clinic, and a cohort of 101 female rheumatoid arthritis patients, followed closely for a 12-year period, from whom hand and feet X-rays taken at three year intervals were scored and analyzed in this study. Although there was a trend towards increased severity of disease in patients carrying CX3CR1 variants, this was not independent of known risk factors. We found no evidence for a significant independent role for the CCR2 and CX3CR1 variants in the susceptibility to or severity of rheumatoid arthritis.
12747277 Prevalence of Sindbis-related (Pogosta) virus infections in patients with arthritis. 2003 Mar OBJECTIVE: To determine the role of Pogosta virus as a triggering infection in non-specific arthritis. METHODS: Serum samples of 142 patients with acute arthritis were screened for the evidence of Pogosta virus infection. Serological tests for Chlamydia trachomatis, salmonella, parvovirus B19, and Borrelia burgdorferi were also carried out. As verified later, 78 of the patients had rheumatoid arthritis and 63 seronegative poly- or oligoarthritis, while one had systemic lupus erythematosus. RESULTS: In the early stage of the joint symptoms 4 patients with rheumatoid arthritis, 1 with seronegative polyarthritis and 1 with systemic lupus erythematosus had recent Pogosta virus infection. Four of them had probably had Pogosta disease at the time of the onset of arthritis. In 11 patients with a diagnosis of seronegative arthritis, serological evidence of preceding infection due to salmonella or Chlamydia trachomatis was found, strongly suggesting classical reactive arthritis in these cases. CONCLUSIONS: Our study suggests that also a Sindbis virus infection may be associated both to an acute joint inflammation as a part of Pogosta disease or chronic arthritis. At present, this possibility still needs further research.
15033655 True infliximab resistance in rheumatoid arthritis: a role for lymphotoxin alpha? 2004 Oct BACKGROUND: The combination of methotrexate and the anti-tumour necrosis factor alpha (TNFalpha) antibody infliximab is a very effective treatment for rheumatoid arthritis (RA). However, a proportion of patients are not responsive to this treatment. Inefficacy may represent a TNFalpha independent disease or insufficient drug at the site of action. CASE REPORT: A patient with RA resistant to repeated high dose infliximab infusions and intra-articular infliximab into an inflamed knee is described. No beneficial clinical effect was observed. Pre-injection arthroscopic biopsy of the study knee demonstrated TNFalpha staining but also confirmed the presence of lymphotoxin alpha (LTalpha or TNFbeta) on immunohistochemistry. Subsequent treatment with etanercept (which blocks LTalpha as well as TNFalpha) resulted in clinical remission of disease. CONCLUSION: This case suggests that resistance to TNF blockade may occur when TNFalpha is not the dominant inflammatory cytokine and suggests that LTalpha may have a pathogenic role in RA.
14658006 Proposal for a sonographic classification of target joints in rheumatoid arthritis. 2005 Apr OBJECTIVE: The purpose of this study was to classify sonographically the joint damage of target joints in patients with rheumatoid arthritis (RA). METHODS: During a 3-year cross-sectional study, standardized arthrosonography of symptomatic target joints was performed in patients with RA. According to those findings, a classification with progressive deterioration of joint alteration in RA was created that grades visible morphological changes of the joint components. Using elbow joints as a subgroup, inter- and intraobserver reliability was calculated. RESULTS: Examined and included in this study were 1211 joints of 425 patients with RA. The mean disease activity score was 5.2 (range 0.75-7.79). Sonographically visible changes could be classified and divided into six stages. A standardized sonographic evaluation system was developed. In reference to the elbow joint, overall percentages for intra- and interobserver reliability of sonography were 90.8% and 88.8%, respectively. CONCLUSION: Sonography is a valuable tool for assessing and classifying joint alteration in RA. Particularly in early stages of joint affection, ultrasound is superior to X-ray in detecting soft tissue changes and minor erosions.
12086167 Cross-sectional and longitudinal study of osteoporosis in patients with rheumatoid arthrit 2002 May To elucidate the pathology of osteoporosis associated with rheumatoid arthritis (RA), bone mass measurements were performed in 146 female patients with RA and compared with those in 150 age-matched female patients with osteoarthritis (OA) and postmenopausal osteoporosis (OP). Bone mineral density (BMD) was measured at the lumbar spine (L-BMD), the mid-radius (MR-BMD) and the calcaneus (C-BMD) by dual-energy X-ray absorptiometry (DXA), and at the distal radius by peripheral quantitative computed tomography (pQCT). The RA group showed significantly lower BMD at all sites, except L-BMD, than the OA group. Compared with the OP group, the RA group showed a significantly higher L-BMD but no difference at other sites. BMD in RA decreased with disease severity at all sites and lean body mass was highly correlated with L-BMD and C-BMD. Cross-sectional analysis revealed early bone loss at the distal radius and a decrease of L-BMD, MR-BMD, and C-BMD with disease duration. Longitudinal analysis showed that the annual loss of L-BMD, MR-BMD and C-BMD tended to be lower with increasing disease duration. Glucocorticoid administration had no influence on L-BMD, MR-BMD or C-BMD. We concluded that, unlike postmenopausal osteoporosis, osteoporosis associated with RA is characterised by relatively preserved bone mass in the axial bone and marked loss in the peripheral bone. The risk factors for generalised osteoporosis are a long disease duration, severity of disease, and decreased lean body mass.