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Last Updated: 2001-08-07 15:30:57 EDT (Reuters Health)
LONDON (Reuters Health) – Previously published criteria for identifying which postmenopausal women with rheumatoid arthritis may benefit from bone mineral density (BMD) screening for osteoporosis appear to be clinically useful, Spanish researchers report.
As proposed by two rheumatologists in Amsterdam, the criteria are: mean C-reactive protein level above 20 mg/L, or persistently increased erythrocyte sedimentation rate above 20 mm/first hour, or both; female >50 years of age or male >60 years of age; and Health Assessment Questionnaire score of 1.25 or more, or a Steinbrocker's score of 3 or more, or both. BMD screening is recommended for patients who meet two or more of these criteria.
Dr. J. M. Nolla and colleagues, from Ciutat Sanitaria i Universitaria de Bellvitge, Barcelona, used dual energy X-ray absorptiometry to assess BMD in 128 postmenopausal women with rheumatoid arthritis, according to their report in the August issue of Annals of the Rheumatic Diseases. The study subjects were recruited from a clinical setting, not from the general population.
The researchers found that 70% of the patients met two or three of the screening criteria. The DXA results revealed that 44% of the patients had osteoporosis at either the femoral neck or the lumbar spine, while 16% had normal BMD at both sites.
The sensitivity for these criteria was 86% and the specificity was 43%. The criteria had a positive predictive value of 54% and a negative predictive value of 79%, Dr. Nolla's team reports.
"Our results suggest that the proposal of the rheumatologists from Amsterdam may be a screening method to decide which postmenopausal women with rheumatoid arthritis should be investigated for osteoporosis; the sensitivity and negative predictive value obtained seem acceptable in clinical practice," Dr. Nolla and colleagues conclude.
Ann Rheum Dis 2001;60:700-801.
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