Danveer Bhadu

Lean mass and disease activity are the best predictors of bone mineral loss in the premenopausal women with rheumatoid arthritis

Background and Objectives: Factors determining bone mineral (BM) loss in rheumatoid arthritis (RA) are not well known. This study aimed to determine the occurrence and predictors of BM loss in the young premenopausal women with RA. Methods: Ninety-six females with RA and 90 matched controls underwent clinical, biochemical, BM density (BMD), and body composition assessments. RA disease activity was assessed using disease activity score-28 (DAS-28) and hand X-ray. Results: In the young premenopausal females with RA having median symptom and treatment duration of 30 (18–60) and 4 (2–12) months, respectively, with moderate disease activity (DAS-28, 4.88 ± 1.17), occurrence of osteoporosis and osteopenia was 7.29% and 25% at spine, 6.25% and 32.29% at hip, and 17.7% and 56.25% at wrist, respectively (significantly higher than controls). RA patients had lower BMD at total femur, lumbar spine (LS), radius total, and radius ultra-distal. Total lean mass (LM) and BM content were significantly lower in RA (P = 0.022 and <0.001, respectively). In RA, BMD at majority of sites (LS, neck of femur, greater trochanter, radius total, and radius 33%) had the strongest positive correlation with LM followed by body fat percent. RA patients with most severe disease had lowest BMD at different sites and lowest LM. Stepwise linear regression revealed LM followed by DAS-28 to be best predictors of BMD. RA patients receiving glucocorticoids did not have significantly different BMDs from patients not taking glucocorticoids. Interpretation and Conclusion: BM loss is a significant problem in the young premenopausal women with recent-onset RA. LM and disease severity were the best predictors of BMD.

Synovial chondromatosis involving multiple joints in rheumatoid arthritis: A case report review of the literature

Dear Editor, Synovial chondromatosis is a benign disorder of the synovial lining, characterized by the presence of loose cartilaginous bodies. Ossification of these cartilaginous bodies is known as osteochondromatosis. Although often benign, malignant transformation can occur. It typically presents unilaterally in large joints. The knee is the most commonly involved joint but it can also involve the shoulder, elbow, hip, ankle and temporomandibular joints. Synovial chondromatosis in patients with rheumatoid arthritis (RA) are reported. To the best of our knowledge, multiple-joint synovial chondromatosis with RA has not been reported in the literature thus far. Here we present a 48-year-old man, a case of seropositive RA with secondary synovial chondromatosis involving multiple joints.