Bone Health in Adult Men and Women with a History of Juvenile Idiopathic Arthritis

Objective. Our aim was to determine areal bone mineral density (BMDa) and disease-related factors linked with BMDa in adults with a history of juvenile idiopathic arthritis Methods. Men and women with a history of JIA attending a young adult rheumatology clinic in Newcastle. UK, underwent dual energy x-ray absorptiometry (DEXA) of the lumbar spine and total hip. Information was obtained about disease duration and subtype, previous treatment including corticosteroid and methotrexate therapy, and large-joint replacement. Subjects completed the modified Health Assessment Questionnaire (HAQ). Blood was taken for assessment of C-reactive protein, erythrocyte sedimentation rate, and rheumatoid factor (RF). Results. Seventy-one women and 16 men, mean age 28.7 and 31.4 years, and mean disease duration 20.6 and 24.0 years, respectively, were studied. Mean BMDa was 0.982 (Z-score = -0.328; 95% CI -0.657,0.001) and 1.028 g/cm(2) (Z-score = 0.251; 95% CI -1.266, 0.764) in women and men, respectively, at the spine and 0.817 (Z-score = -0.542; 95% CI -0.975,-0.109) and 0.857 g/cm(2) (Z-score = -0.176; 95% CI -2.323, 1.971) at the hip. After adjusting for age and sex, increasing HAQ score was associated with both lower spine BMDa and hip BMDa. Compared with patients with oligoarticular disease, those with enthesitis-related arthritis had higher BMDa at the spine, while those with extended oligoarticular and polyarticular RF-negative disease had lower hip BMDa. Oral corticosteroids and the presence of a large-joint replacement were associated with lower BMDa at both the spine and hip. Conclusion. There was a trend toward low BMDa in women with a history of JIA. These patients May be at risk of the complications of osteoporosis including fragility fractures and should be considered for targeted preventive measures. (First Release June 15 2011; J Rheumatol 2011;38:1689-93; doi:10.3899/jrheum.101232)