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Published on: January 29, 2018
Bone mineral density in egyptian children with juvenile idiopathic arthritis: possible correlation to serum RANKL /
Riham Eid1, Maha Abdelsalam2,3, Aya Ahmed Fathy4
1Paediatric Nephrology Unit, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura University, Mansoura, 35561, Egypt. rihameid@mans.edu.eg.
Insights
Juvenile idiopathic arthritis (JIA) in children is linked to lower bone mineral density (BMD). Specific osteoprotegerin (OPG) gene variants and higher RANKL/OPG ratios are associated with reduced BMD in JIA patients.
Area of Science:
- Pediatric Rheumatology
- Bone Metabolism
- Genetic Epidemiology
Background:
- Juvenile idiopathic arthritis (JIA) increases children's risk of decreased bone mineral density (BMD).
- Causes include genetic, disease-related, and medication-related factors.
- Osteoprotegerin (OPG) and its related factors may influence BMD in JIA.
Purpose of the Study:
- To investigate the impact of OPG gene polymorphisms on BMD in children with JIA.
- To assess the association between serum OPG, RANKL levels, and the RANKL/OPG ratio with BMD in JIA.
- To identify potential determinants of reduced BMD in pediatric arthritis.
Main Methods:
- Evaluated OPG gene polymorphisms (rs2073617, rs3134069) and serum RANKL, OPG, and RANKL/OPG ratio in 60 JIA children and 100 controls.
- Measured BMD using dual-energy X-ray absorptiometry (DEXA), classifying patients by z-score.
- Assessed disease activity with Juvenile Arthritis Disease Activity Score (JADAS) and articular damage with the juvenile arthritis damage index (JADI).
Main Results:
- No significant differences in genotype or allele frequencies between JIA patients and controls.
- Serum RANKL and RANKL/OPG ratio were significantly higher in JIA patients.
- Patients with BMD z-score below -2 showed higher frequencies of rs2073617 TT genotype/T allele, elevated RANKL/OPG ratio, and greater disease damage.
Conclusions:
- Egyptian children with JIA exhibit decreased BMD.
- The rs2073617 TT genotype and T allele, along with the RANKL/OPG ratio, are potential determinants of reduced BMD in JIA.
- Monitoring BMD and controlling disease activity are crucial for preserving bone health in JIA.
Background:
Children with juvenile idiopathic arthritis (JIA) are at higher risk of decreased bone mineral density (BMD) compared with healthy children due to genetic, disease and medication-related causes. This study aims to investigate the possible effects of osteoprotegerin (OPG) gene polymorphisms and serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor κB-ligand (RANKL) and RANKL/OPG ratio on BMD in children with JIA.
Methods:
OPG gene rs2073617, rs3134069, serum RANKL, OPG and RANKL/OPG ratio were evaluated in 60 JIA children and 100 matched healthy controls. BMD was evaluated by lumbar dual energy X-ray absorptiometry (DEXA) according to which patients were classified in 2 groups (DEXA z-score above and below - 2). Composite disease activity was measured using the Juvenile Arthritis Disease Activity Score (JADAS) 27-joints. Articular damage was scored using the juvenile arthritis damage index (JADI).
Results:
Patients aged 12.05 ± 3.2 years, included 38 females and 31% had BMD z-score below-2. Systemic-onset JIA was the most frequent phenotype (38%). Genotypes and alleles frequencies of the 2 studied polymorphisms did not differ between patients and controls (p > 0.05 for all) while serum RANKL and RANKL/OPG ratio were significantly higher in patients compared to controls (p = < 0.001 and 0.03 respectively). Patients with BMD < -2 had significantly greater frequencies of rs2073617 TT genotype and T allele (p < 0.001), higher serum RANKL, RANKL/OPG ratio (p = 0.01, 0.002), female predominance (p = 0.02), higher articular and extra-articular damage index (p = 0.008,0.009) and more frequent steroid usage (p = 0.02) compared to patients with BMD z-score >-2. Multivariate analysis showed rs2073617 TT genotype, RANKL/OPG ratio, long disease duration (above 36 months) and use of steroid to be associated with decreased BMD (p = 0.03,0.04,0.01,0.01 respectively) in JIA children.
Conclusions:
Egyptian children with JIA have decreased BMD. rs2073617 TT genotype and T allele, RANKL/OPG ratio are possible determinants of reduced BMD in JIA. Our results underline the importance of frequent monitoring of BMD in JIA children and trying to control disease activity to preserve long term bone health.
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