Associations of vascular and bone status in arthritis patients
Anita Pusztai1, Attila Hamar1, Monika Czókolyová1
1Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei Str 98, Debrecen, 4032, Hungary.
Insights
Rheumatoid arthritis and ankylosing spondylitis patients treated with anti-TNF therapy show links between bone metabolism and vascular disease. Inflammation and disease activity in arthritis may influence both bone and vascular health.
Area of Science:
- Rheumatology
- Vascular Biology
- Bone Metabolism
Background:
- Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with increased risk of cardiovascular (CV) disease and osteoporosis (OP).
- Understanding the interplay between bone metabolism and vascular pathophysiology in these conditions is crucial for patient management.
Purpose of the Study:
- To assess bone and vascular biomarkers and parameters in RA and AS patients.
- To determine the effect of 1-year anti-TNF therapy on these markers.
- To identify correlations between vascular pathophysiology and bone metabolism.
Main Methods:
- A 12-month follow-up study included 36 RA patients and 17 AS patients treated with anti-TNF agents (etanercept, certolizumab pegol, or infliximab).
- Bone and vascular markers were measured using ELISA.
- Bone density was assessed by DXA and quantitative CT (QCT).
- Vascular parameters included flow-mediated dilation (FMD), intima-media thickness (IMT), and pulse-wave velocity (PWV) measured by ultrasound.
Main Results:
- Multiple correlation analyses revealed significant associations between bone and vascular markers.
- Osteoprotegerin, sclerostin, and cathepsin K correlated with FMD, IMT, and PWV, respectively.
- Bone mineral density (BMD) measured by QCT inversely correlated with IMT, while platelet-derived growth factor BB and IMT correlated with BMD.
- Anti-TNF treatment, along with baseline osteocalcin, P1NP, or vitamin D3 levels, influenced one-year changes in IMT.
- Disease activity indices and CRP levels affected correlations between bone and vascular markers.
Conclusions:
- Significant correlations exist between bone and vascular biomarkers in RA and AS patients undergoing anti-TNF therapy.
- Specific bone markers are associated with vascular pathophysiology, and vice versa.
- Systemic inflammation and disease activity in arthritis appear to be key drivers of both vascular and bone disease.
Abstract:
Cardiovascular (CV) disease and osteoporosis (OP) have been associated with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Bone and vascular biomarkers and parameters along with the effect of 1-year anti-TNF therapy on these markers were assessed in order to determine correlations between vascular pathophysiology and bone metabolism in RA and AS. Thirty-six patients treated with etanercept or certolizumab pegol and 17 AS patients treated with ETN were included in a 12-month follow-up study. Bone and vascular markers were previously assessed by ELISA. Bone density was measured by DXA and quantitative CT (QCT). Flow-mediated vasodilation (FMD), common carotid intima-media thickness (IMT) and pulse-wave velocity (PWV) were assessed by ultrasound. Multiple correlation analyses indicated associations between bone and vascular markers. Osteoprotegerin, sclerostin and cathepsin K were significantly associated with FMD, IMT and PWV, respectively (p < 0.05). Moreover, total and trabecular BMD determined by QCT inversely correlated with IMT (p < 0.05). On the other hand, among vascular parameters, platelet-derived growth factor BB and IMT correlated with DXA femoral and QCT total BMD, respectively (p < 0.05). In the RM-ANOVA analysis, anti-TNF treatment together with baseline osteocalcin, procollagen 1 N-terminal propeptide (P1NP) or vitamin D3 levels determined one-year changes in IMT (p < 0.05). In the MANOVA analysis, baseline disease activity indices (DAS28, BASDAI), the one-year changes in these indices, as well as CRP exerted effects on multiple correlations between bone and vascular markers (p < 0.05). As the pattern of interactions between bone and vascular biomarkers differed between baseline and after 12 months, anti-TNF therapy influenced these associations. We found a great number of correlations in our RA and AS patients undergoing anti-TNF therapy. Some of the bone markers have been associated with vascular pathophysiology, while some vascular markers correlated with bone status. In arthritis, systemic inflammation and disease activity may drive both vascular and bone disease.
Related Concept Videos
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:25Role of Vitamins in Maintaining Bone Health
Vitamin A
Vitamin A is involved in the process of bone remodeling. Retinoic acid, the active metabolite of Vitamin A, has nuclear receptors in osteoblasts and osteoclasts, which are involved in bone remodeling.
Vitamin B12
Vitamin B12 acts as a cofactor during the formation of osteoblast-related proteins, such as osteocalcin. Vitamin B12 plays a role...
01:29Blood and Nerve Supply to the Bones
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
01:22Connective Tissue Cell Types
Fat cells (adipocytes), smooth muscle cells (myoblasts), and bone cells (osteoblasts) are some connective tissue cell types. Some immune system cells...
01:23Bone as Supporting Connective Tissue
Bone Matrix
Bone, or osseous tissue, is a connective tissue that has a large amount of two different types of matrix material. The organic matrix is similar to the matrix material found in other connective tissues, including some amount of collagen and elastic fibers. This gives strength and flexibility to the tissue. The inorganic matrix consists of mineral salts— mostly calcium salts—...
01:22The Functions of the Skeletal System