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Frigato, Marilena (2010) ARTROSI EROSIVA DELLE MANI E MASSA OSSEA:
VALUTAZIONE CLINICA, STRUMENTALE E LABORATORISTICA.
[Tesi di dottorato]

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Abstract (inglese)

Background: Osteoarthritis of the hand (HOA) can occur in two different types: erosive (EHOA) and common nodal OA (non-EHOA). HOA often affects the hands of middle-aged women; the main EHOA characteristics are erosions and frequently aggressive clinical course.
Aims: To investigate relationships between biomarkers (Coll2-1, Coll2-1NO2 and myeloperoxydase (MPO)), disease indices of severity and activity in EHOA and in non-EHOA patients and to describe the prevalence of low bone mineral density (BMD) in EHOA, in non-EHOA and healthy subjects who consecutively underwent phalangeal radiographic absorptiometry (pRA) in our outpatient clinic.
Methods: Coll2-1, Coll2-1NO2 and MPO were measured in 76 patients, 55 with EHOA (all F, median age 62,69±6,35 years) and 20 with non-EHOA (all F, mean age 62,66±8.26 years), fulfilling ACR criteria for hand OA. Patients showing at least two erosions in interphalangeal (IP) joints were included in the EHOA group, while erosions in metacarpophalangeal joints were excluded. Patients were also evaluated for disease duration, number of affected active (swollen and painful or tender) joints (NAAC), radiographic score (RS), family history, smoke, hypertension, hypercholesterolemia, heart disease, thyroid disease, osteoporosis, Body Mass Index.
A total of 262 patients (mean age 61.65 ± 6.7, range 45-76) were analysed by pRA: 20 with EHOA (mean age: 60,76±5,39 years); 52 with non-EHOA (mean age: 65,8 ± 6,2 years); 190 healthy subjects (N, mean age 67,8±7,73 years). BMD (gr/cm2) of the middle phalanges of the 2nd, 3rd and 4th digits of the non-dominant hand was assessed with a self-contained single energy (60 kV) X-ray system (Alara Metriscan, Hayward, Ca, USA). A density is estimated in the three phalanges and, after averaging, expressed in mineral mass/area. T-scores were calculated using local reference data. All patients gave their informed consent to the examination.
Results: Serum levels of Coll2-1 and Coll2-1NO2 were higher in patients with EHOA (105.18 ± 51.34 e 0.32 ± 0.51 nM respectively) than in those with non-EHOA (112.42 ± 56.42 e 0.22 ± 0.14 nM, p=N.S.), although a significance was only reached by MPO (238.61 ± 163.22 vs 180.36±116.85 ng/ml, p=0.043). No correlations were observed between the substances considered and the other indices of disease activity or severity.
Osteopenia was found in 35%, 21% and 43% respectively in EHOA, non-EHOA, and N while osteoporosis affected 20%, 28%, and 20% (EHOA vs non EHOA: p=0.03). Accordingly, BMD was higher in EHOA group versus non-EHOA and versus N (p=0,025; and p=0,0004, respectively). T and Z scores were significantly higher in EHOA vs N population (T: p=0.012 respectively; Z: p=0,0009).
Conclusions: MPO is the only biomarker which appeared to be significantly higher in EHOA patients as an evidence of inflammation. Phalangeal BMD is higher in EHOA patients with respect not only to normal population but also to non-EHOA subjects. The osteoreparative processes seem to be more pronounced in EHOA than in non-EHOA thus explaining the increased mineral density. On the other hand, local inflammation and erosion do not appear to determine sufficient bone loss to discriminate between EHOA and non-EHOA in terms of T and Z score.

Abstract (italiano)

Introduzione: L’artrosi erosiva (OAE) è ritenuta una variante aggressiva dell’artrosi (OA) delle mani caratterizzata da marcata reazione infiammatoria locale e aspetti radiologici di erosioni ossee delle articolazioni interfalangee.
Scopi: Valutare il rapporto tra AOE e densità minerale ossea nel sito di flogosi confrontando le caratteristiche cliniche, strumentali e laboratoristiche dell'OAE rispetto la forma non erosiva (non-OAE) ed una popolazione di soggetti sani.
Metodi: Dal punto di vista laboratoristico sono state dosate le concentrazioni di alcuni marcatori del collagene Coll1-2, Coll1-2 NO2 e mieloperossidasi (MPO) in 76 pazienti, 55 con OAE (età media 62,69±6,35 anni) e 20 con non-OAE (età media 62,66±8.26 anni) che soddisfacevano i criteri ACR per la diagnosi di OA della mano. La forma erosiva è stata definita sulla base della presenza di almeno due erosione centrale a carico delle articolazioni IFP o IFD. Per ogni paziente è stata valutata la durata di malattia, il numero di articolazioni attive clinicamente (NAAC), lo score radiologico (SR), la familiarità, l’abitudine al fumo di sigaretta, la presenza di ipertensione, dislipidemia, cardiopatia, tireopatia, osteoporosi, indice di massa corporea.
Sono state sottoposte ad assorbimetria radiografica digitale 262 pazienti (età media 61.65 ± 6.7, range 45-76): 20 con OAE (età media: 60,76±5,39 anni); 52 con non-OAE (età media: 65,8 ± 6,2 anni); 190 soggetti sani (N, età media 67,8±7,73 anni). La densità minerale ossea (BMD) delle
falangi medie del secondo, terzo e quarto dito della mano non dominante è stata valutata con un sistema a raggi X con energia a singola emissione (60kV) per lo studio della mano utilizzando uno strumento (Metriscan, Alara Metrica, Hayward, CA, USA). La densità delle con viene valutata nelle tre falangi e la media viene espressa quale massa minerale/area (gr/cm2). I T-score sono stati calcolati dati di riferimento della popolazione locale. Tutti le pazienti hanno rilasciato un consenso informato.
Risulati: i livelli sierici Coll2-1 e Coll2-1NO2 sono risultati più elevati senza una significatività statisticamente rilevabile nel gruppo OAE (105.18±51.34 e 0.32±0.51 nM rispettivamente) vs la non-OAE (112.42±56.42 e 0.22±0.14 nM, p=n.s). Tuttavia, significativamente elevati risultavano i valori di MPO in OAE (238.61 ± 163.22 vs 180,15 ± 116,9 ng/ml in non-OAE, p=0.043). Nessuna correlazione tra i biomarcatori e gli indici di attività e gravità di malattia.
L’osteopenia è stata riscontrata nel 35% dei pazienti con OAE, nel 21% non-OAE e nel 43% dei soggetti sani; mentre l’OP (T score:-2.5) era presente rispettivamente nel 20%, 28% e 20% (OAE vs non-OAE: p=0.03).
La BMD delle falangi era più elevata nei pazienti con OAE rispetto ai non-OAE e rispetto N (p=0,025; e p=0,0004, rispettivamente). T e Z score erano significativamente più elevate in OAE rispetto I soggetti sani (rispettivamente T: p=0.012; Z: p=0,0009).
Conclusioni: MPO è risultato l’unico biomarcatore che appare essere significativo nei pazienti con OAE, confermando la presenza di flogosi articolare. La BMD delle falangi è più elevata non solo rispetto alla popolazione di soggetti sani ma anche nei confronti delle pazienti con non-OAE. L’incremento di densità minerale ossea nell’OAE potrebbe essere dovuto a processi osteoriparativi più pronunciati. D’altro canto, l’infiammazione locale e le erosioni sono sembrano determinare una perdita di massa ossea tale da differenziare le due forme artrosiche in termini di T e Z score.

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Tipo di EPrint:Tesi di dottorato
Relatore:Punzi, Leonardo
Correlatore:Ramonda, Roberta
Dottorato (corsi e scuole):Ciclo 22 > Scuole per il 22simo ciclo > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE REUMATOLOGICHE
Data di deposito della tesi:NON SPECIFICATO
Anno di Pubblicazione:12 Marzo 2010
Informazioni aggiuntive:La tesi esplora il rapporto tra artrosi erosiva delle mani e alterazione della densità minerale ossea a livello delle falangi affette dalla malattia.
Parole chiave (italiano / inglese):Artrosi erosiva delle mani, artrosi, densità minerale ossea, marker del turnover osseo
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/16 Reumatologia
Struttura di riferimento:Dipartimenti > Dipartimento di Medicina Clinica e Sperimentale
Codice ID:3060
Depositato il:03 Nov 2010 09:17
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