Value of clinical factors in selecting postmenopausal women with rheumatoid arthritis for bone densitometry

Objective-Criteria to decide which patients with rheumatoid arthritis (RA) should be examined by dual energy x ray absorptiometry (DXA) are currently not available. The rheumatologists from Amsterdam have proposed preliminary criteria based on clinical risk factors (age, disease activity, and functi onal status). These criteria are preliminary and not widely accepted but mi ght be helpful in practice. The value of the proposal in a group of Spanish postmenopausal women with RA is analysed. Methods-DXA (lumbar spine and femoral neck) was performed in 128 patients r ecruited from a clinical setting, and the proposed criteria were applied. T and Z scores were established for a Spanish reference population. Results-The mean (SD) age of the patients was 61.3 (10.7) and mean duration of the postmenopausal period 14.5 (10.1) years. Mean duration of RA was 13 .7 (7.7) years. Mean C reactive protein was 22 (21) mg/l; mean erythrocyte sedimentation rate 26 (18) mm/1st h; and mean Health Assessment Questionnai re score 1.25 (0.79). Ninety (70%) patients fulfilled the proposed criteria . Their sensitivity for the diagnosis of osteoporosis (T score less than or equal to -2.5 SD) was 86% and their specificity, 43%. Positive predictive value was 54% and negative predictive value, 79%. Conclusions-The proposed criteria seem a good screening method for the sele ction of those patients with RA whose bone mineral density should be assess ed as the sensitivity and negative predictive value are acceptable.