Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry.
OBJECTIVE
Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functional status). These criteria are preliminary and not widely accepted but might be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed.


METHODS
DXA (lumbar spine and femoral neck) was performed in 128 patients recruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population.


RESULTS
The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13.7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnaire score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria. Their sensitivity for the diagnosis of osteoporosis (T score < or =-2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%.


CONCLUSIONS
The proposed criteria seem a good screening method for the selection of those patients with RA whose bone mineral density should be assessed as the sensitivity and negative predictive value are acceptable.
Nolla
J M
JM
Rheumatology Department, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet, Barcelona, Spain. 28634apj@comb.es
Fiter
J
J
Gómez-Vaquero
C
C
Alegre
J J
JJ
Valverde
J
J
Roig-Escofet
D
D
D015502:Absorptiometry, Photon; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D016001:Confidence Intervals; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging*; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity
D002097:C-Reactive Protein