A Comparison of Demographics, Disease Activity, Disability, and Treatment Among Rheumatoid Arthritis Patients with and without Osteoporosis

Figures & data

Table 1 Multivariable Logistic Regression Analysis of RA-Only Patients and RA-OP Patients Based on Demographics, Clinical Characteristics, and Treatment.

Variable	Odds Ratio	Sig.	95% Confidence Interval of Odds Ratio
			Lower	Upper
Age (years)	0.952	0.036	0.909	0.997
Gender (Male)	3.191	0.076	0.886	11.488
Gender (Female)	Reference group
Nationality (Saudi)	1.949	0.181	0.733	5.181
Nationality (non-Saudi)	Reference group
Comorbidities* (yes)	1.029	0.923	0.538	1.754
Comorbidities (No)	Reference group
DAS28 score 1st visit	0.795	0.290	0.519	1.216
DAS28 score 2nd visit	1.940	0.058	0.978	3.849
DAS28 score 3rd visit	0.784	0.550	0.354	1.739
On biological DMARDs (Yes)	2.450	0.071	0.927	6.474
On biological DMARDs (No)	Reference group
On non-biological DMARDs (Yes)	2.039	0.266	0.582	7.151
On non-biological DMARDs (No)	Reference group
Use of Steroid (Yes) ng/mL	1.891	0.167	0.765	4.674
Vitamin D level (ng/mL)	1.003	0.721	0.987	1.020
BMI	0.987	0.741	0.915	1.065
RF positivity (YES)	0.927	0.884	0.337	2.548
RF positivity (No)	Reference group
ACPA positivity (YES)	0.510	0.194	0.185	1.409
ACPA positivity (No)	Reference group
CRP	1.007	0.770	0.961	1.055

Notes: The RA-only patients’ group is the reference group. The control group is RA and OP. *Comorbidities include: Diabetes mellitus, Hypertension, and Chronic kidney disease.

Abbreviations: DAS28-CRP, disease activity score in 28 joints; DMARDs, disease modifying anti-rheumatic drugs; BMI, body mass index; RF, rheumatoid factor; ACPA, anti-citrullinated peptide antibody; CRP, C-reactive protein.

Table 2 Demographic Characteristics of Study Patients

Characteristics		All Patients N= 408 (100%)	RA** N= 353 (86.5%)	RA and OP** N=55 (13.5%)	P value*
Age (years)			46.3 ± 10.3	64.8 ± 10.8	0.04
RA duration			79.5 ± 52.5	106.6 ± 62.6	0.01
OP duration			–	82.0 ± 47.9	–
Gender	Male	92 (22.5)	83 (23.5)	9 (16.4)	0.23
	Female	316 (77.5)	270 (76.5)	46 (83.6)
Nationality	Saudi	255 (62.7)	217 (61.6)	38 (69.1)	0.28
	Non-Saudi	152 (37.3)	135 (38.4)	17 (30.9)
Smoking status	Smoker	86 (21.1)	81 (22.9)	5 (9.1)	0.01
	Non-Smoker	322 (78.9)	272 (77.1)	50 (90.9)
Comorbidities***	Yes	262 (64.2)	227 (64.3)	35 (63.6)	0.92
	No	146 (35.8)	126(35.7)	20 (36.4)
BMI	Underweight	3 (0.7)	1 (0.3)	2 (3.6)	0.20
	Normal Weight	85 (20.9)	74 (21.1)	11 (20.0)
	Overweight	108 (26.6)	94 (26.8)	14 (25.5)
	Obese	210 (51.7)	182 (51.9)	28 (50.9)
Vitamin D level (ng/mL)			58.2 ± 27.1	55.8 ± 26.0	0.23
DAS28 score		1st visit	3.00 ± 0.98	3.1 ± 1.0	0.52
		2nd visit	1.90 ± 0.60	2.13 ± 0.56	0.40
		3rd visit	1.68 ± 0.51	1.74 ± 0.33	0.42
HAQ- DI score		1st visit	0.64 ± 0.42	0.79 ± 0.41	0.68
		2nd visit	0.28 ± 0.25	0.51 ± 0.33	0.001
		3rd visit	0.14 ± 0.18	0.39 ± 0.30	0.001

Notes: *P-value based on chi-square, Fisher exact test, or independent t-test as appropriate. ** N (%) and Mean ± SD are presented as appropriate. ***Comorbidities include: Diabetes mellitus, Hypertension, and Chronic kidney disease.

Abbreviations: RA, rheumatoid arthritis; OP, osteoporosis; BMI, body mass index; DAS28, disease activity score in 28 joints; HAQ –DI, Health Assessment Questionnaire-Disability Index.

Table 3 Disease Activity as Measured by DAS28 Score During the First 3 Clinic Visits in RA-only Patients and RA-OP Patients. Comparison of Patients with Remission & Low Disease Activity to Those with Moderate & High Disease Activity. Data Presented as Number and (%)

Characteristics		All Patients N= 408	RA N= 353	RA and OP N= 55	P value**
DAS 28 score 1st visit	Remission & Low disease activity	238 (58.3)	210 (59.5)	28 (50.9)	0.23
	Moderate to High disease activity	170 (41.7)	143 (40.5)	27 (49.1)
DAS 28 score 2nd visit	Remission & Low disease activity	392 (96.1)	339 (96.0)	53 (96.4)	0.90
	Moderate to High disease activity	16 (3.9)	14 (4.0)	2 (3.6)
DAS 28 score 3rd visit	Remission & Low disease activity	396 (97.3)	341 (96.9)	55 (100)	0.14
	Moderate to High disease activity	11 (2.7)	11 (3.1)	0

Note: ** Chi-square or Fisher exact test as appropriate.

Abbreviations: RA, rheumatoid arthritis; OP, osteoporosis; DAS28, disease activity score in 28 joints.

Table 4 Types of Treatment Used by Diseased Groups. N(%)

Type of Treatment		Only RA (N=353)	RA with OP (N=55)	P value*
Biologic RA treatment received	Yes	196 (55.2)	24(43.6)	0.11
	No	157(44.8)	31(56.4)
Type of biological treatment	Actemra§	26(13.3)	1(1.8)	0.07
	Baricitinib	3(1.5)	1(1.8)	0.25
	Cimzia	23(11.7)	1(1.8)	0.59
	Enbrel	41(20.9)	3(5.5)	0.48
	Humira	43(21.9)	6(10.9)	0.34
	Rituximab	4(2.0)	2(3.6)	0.68
	Tofacitinib	55(28.1)	10(18.2)	0.78
Non-biologic RA DMARDs received	Yes	302(85.6)	47(85.5)	0.35
	No	51(14.4)	8(14.5)
Type of non-biological DMARD	Arava	36(11.9)	6(12.8)	0.48
	Methotrexate	100(33.1)	22(46.8)	0.09
	Plaquenil	86(28.5)	11(23.4)	0.87
	Sulfasalazine	5(1.7)	1(2.1)	0.63
	Methotrexate and plaquenil	52(17.2)	2(4.3)	0.47
	Methotrexate and Arava	12(4.0)	0	-
	Arava and plaquenil	6(2.0)	3(6.4)
	Sulfasalazine	1(0.3)	0	-
	Cellcept	0	1(2.1)	-
	Plaquenil and sulfasalazine	1(0.3)	1(2.1)	0.98
	Sulfasalazine and Methotrexate	2(0.7)	0	-
Use of Steroids for RA	Yes	126 (41.7)	29 (61.7)	0.03
	No	176 (58.3)	18 (38.3)
OP treatment	Yes	-	52(94.5)	-
	No	-	3(5.5)
	Fosamax	-	19(36.5)
	Densukl; mab	-	32 (61.5)
	Protelos	-	1(1.9)

Note: *p-value based on chi-square test or Fisher exact test as appropriate.

Abbreviations: RA, rheumatoid arthritis; OP, osteoporosis; DMARDs, disease modifying anti- rheumatic drugs.