Study On Systemic Lupus Erythematosus And Osteoporosis

Systemic lupus erythematous is an autoimmune disease where many systems are involved and multiple organs are damaged, and whose etiology and pathogenesis is not entirely clear. SLE is harmful to human health, especially women of child bearing age, is the one of common diseases. As the treatment level is enhanced, survival time is gradually extended, SLE can lead to bone loss and osteoporosis in high risk groups. The SLE patients themselves and the disease control group on glucocorticoids, all are prone to bone loss and osteoporosis, therefore prevention and treatment of osteoporosis is. very important.OBJECTIVE:To study the correlation between the disease itself, hormones (glucocorticoid) and the bone mineral content by observing SLE bone mineral content changes on those who take the hormones and those who do not take it.METHODS:1.The clinical data of 83 cases of SLE patients were collected from hospitalized patients in Rheumatology Department of China-Japan Union Hospital from June 2009 to Feb 2011.All patients were according with the 1997 American Rheumatology association revised SLE diagnostic criteria. The control group was selected from healthy check up personnel of 26 cases from the Nuclear Medicine Department. To analyse the data SPSS software was used.2.The research patients were grouped into 3 groups,control group(healthy people),first group(not on hormones),treatment group(on hormones).The age in the groups ranged from 15-49 years old,and Dual-energy X-ray absorptiometry was used to determine the density of Lumbar vertebrae 1-4,Total Lumbar vertebrae,bilateral femoral neck,bilateral femoral big rotor,bilateral femoral BMD.In the first group and the treatment group the following tests were done:Routine blood, routine urine and biochemical tests (ALT, TP, ALB, A/G,TBIL, DBIL, GGT, ALP, AST, LDH, CR, BUN, UA, CHO, TG, PA, HDL-C, LDL-C, CK, Ca,P),immunologic test(ANA,anti-dsDNA,anti-Sm), Complement 3,Complement 4,Erythrocyte sedimentation rate (ESR), Immunoglobulin(IgG,IgA,IgM), PTH (radioimm-unoassay),24 hr urinary calcium,24 hr urinary phosphorus,24hr urinary protein,24 hr urinary creatinine.RESULTS:1. The bilateral Femoral neck, bilateral Femoral big rotor, bilateral Femoral BMD in the first group and the treatment group were significantly lower than the control group.The correlation on the left big rotor bone mineral density of the first group and the treatment group was statistically significant, but the bilateral femoral neck, right femoral big rotor, bilateral femur BMD, was not statistically significant, and the correlation on lumbar vertebrae bone mineral density of first group and treatment group was statistically insignificant. SLE itself causes bone metabolism changes, namely inhibition of osteoblast activity. SLE causes an autoimmune inflammation activity environment which leads to osteoporosis,therefore SLE itself is a potential risk factor for osteoporosis.2.In the first group patients,the right big rotor BMD negatively correlated with SLEDAI score (r=-0.421, p= 0.045);L2 BMD negatively correlated with ESR(r=-0.72,p=0.019);L4 BMD negatively correlated with ESR(r=-0.632,p= 0.050);L total BMD negatively correlated with ESR(r=-0.669,p=0.035).But the lumbar vertebrae, hip BMD obviously correlated with IgG,IgMand C3.3.In the first group patients the urinary protein is bounded by 0.5 g/24 hr,>0.5g is the high urinary protein group,< 0.5g is the low urinary protein group.Lumbar vertebrae BMD and double hip BMD of the first group compared with the high urinary protein group and low urinary protein group was not statistically sifgnificant.The first group of LI BMD negatively correlated with the 24 hr urinary protein quantitative(r=-0.714, p=0.047);the left big rotor BMD positively correlated with the 24 hr urinary creatinine (r= 0.486, p =0.041);but the lumbar vertebrae and the double hip BMD did not correlate with urinary erythrocytes,24 hr urinary calcium,24 hr urinary phosphorous and PTH.4. L2,L total BMD of the first group positively correlated with blood lymphocyte count(respectively r=0.775, p=0.014, r=0.675, p=0.046); bilateral Femoral big rotor and bilateral Femoral positively correlated with haemoglobin (respectively r=0.443, p=0.034;r =0.495, p=0.016; r=0.424, p=0.044;r=0.426, p=0.043). Lumbar vertebrae and double hip BMD is unrelated with blood leukocytes, neutrophils, platelet and red blood cells.5.In SLE patients evaluating for joint performance, erosive arthritis involving two or more peripheral joints, presence of tenderness, swelling or effusion, Lumbar vertebrae BMD and double hip BMD of first group compared with the arthritis group and non arthritis group was not statistically significant.6.The study of the lumbar vertebrae and double hip BMD correlation analysis of the first group with ATP, TP, ALB, A/G, TBIL, DBIL, GGT, ALP, AST, LDH, CR, BUN, UA, CHO, TG, PA, HDL-C, LDL-C, CK, Ca, P.The result showed:L1, L3 negatively correlated with DBIL(r=0.709,p=0.022, r=0.705, p=0.023). L4,left Femoral big rotor, left total femur, right Femoral big rotor, left total femur, negatively correlated with LDH(r=-0.723,P=0.018;r=0.517,p=0.011l;r=0.479, p=0.021;r=-0.415,p=0.049;r=-0.416, p= 0.048).The left big rotor positively correlated with A/G (r=0.524, p=0.010), L 4 positively correlated with ALP(r=0.659, p=0.038), the right big rotor negatively correlated with AST(r=-0.435,p=0.038).The rest of the biochemical indicators was unrelated with the lumbar and the double hip BMD.CONCLUSION:1.In SLE patients the disease itself can decrease bone mineral density.2.The SLE patients on glucocorticoid hormone, the glucocorticoid hormone itself causes osteoporosis,mainly affecting the left big rotor osteoporosis, For the first time in China is reported.therefore patients on glucocorticoid should have regular bone monitoring. Therefore, for patients with glucocorticoid BMD of this part should be monitored.3.The right big rotor,L2,L4, L total, are most relevant with disease activity, and the high values of ESR and SLEDAI point to more incidence of osteoporosis.4. The SLE patients with urinary protein are more likely to have osteoporosis.5.24 hr urinary protein,24 hr urinary creatinine, blood LDH, ALP are predictors of lumbar vertebrae and double hip osteoporosis.