Impact of sustaining SDAI remission for preventing incident of bone fragility fracture in patient with rheumatoid arthritis

It is well known that rheumatoid arthritis (RA) has a determinant risk for bone fragility, and patient with RA has a seriously high risk for bone fragility fracture (BFF).1 On the other hand, the BFF risks in the patient with RA owe disease activity.2 3 We hypothesised that if disease activity is successfully controlled and achieved clinical remission, adverse effects on bone metabolism would be minimised, resulting in a lower incidence of BFF.4 We therefore statistically examined whether there was a difference in the incidence of BFF between patients with and without RA who achieved clinical remission. Patients who matched the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria under the T2T since August 2010, have been treating RA and were measured bone mineral density (BMD) with dual-energy X-ray absorptiometry, were recruited. The initial target of therapy is the attainment of remission with a Simplified Disease Activity Index (SDAI) within 6 months of initiation.5 The primary outcome was incident BFF. Follow-up started at BMD measurement (baseline) and continued until the development of the first fracture or censoring at death, loss to follow-up or end of the study. Kaplan-Meier survival curves were determined for incident BFF incidence up to the last observation. Risks for the incidence of BFF were classified as RA specific and general candidate. In general candidate, comorbidities that might affect the incidence of BFF, such as lifestyle-related diseases,6 and increased ability to fall or a disorder were included. Candidate risk factors …