J Rheum Dis.  2019 Jan;26(1):31-40. 10.4078/jrd.2019.26.1.31.

Rheumatoid Factor Positivity is Associated with Lower Bone Mass in Korean Male Health Examinees without Clinically Apparent Arthritis

• Hwang J
• Ahn JK
• Lee J
• Koh EM
• Cha HS

• KMID: 2442032
• DOI: http://doi.org/10.4078/jrd.2019.26.1.31

Abstract

OBJECTIVE
This cross-sectional study aimed to investigate the association between rheumatoid factor (RF) positivity and bone mineral density (BMD) in male Korean subjects without any history of joint disease.
METHODS
Of 84,344 males who had undergone a comprehensive health checkup program in 2012, 1,390 male health examinees were recruited, whose BMD and RF results were available. A RF titer ≥20 IU/mL was considered positive. BMD was measured at lumbar spine (L1~L4) or hip (femoral neck and total hip) by dual-energy X-ray absorptiometry.
RESULTS
The association between RF positivity and BMD was assessed by multiple linear regression analysis. The mean age was 52.7±10.9 years (range 19~88 years), and RF was detected in 64 subjects (4.6%). Demographics and laboratory data were not different between RF-positive and -negative subjects except hepatitis B surface antigen (HBsAg), which was more frequently seen in RF-positive subjects (15.6% vs. 4.3%, p=0.001). RF-positive subjects had significantly lower BMD compared to RF-negative subjects in lumbar spine but not in total hip regardless of the existence of HBsAg (1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.002 in total subjects; 1.17±0.16 g/cm2 vs. 1.10±0.18 g/cm2, p=0.004 in HBsAg-negative subjects). After adjusting for multiple confounders, RF positivity was negatively associated with lumbar spine BMD (B=−0.088 and standard error=0.035, p=0.011).
CONCLUSION
Our results show that the presence of RF could have an unfavorable impact on bone density in apparently normal males. Additional studies to elucidate the osteoimmunological mechanism of rheumatoid factor are warranted.

Keyword

Rheumatoid factor; Bone density; Male; Men's health

MeSH Terms

Absorptiometry, Photon
Arthritis*
Bone Density
Cross-Sectional Studies
Demography
Hepatitis B Surface Antigens
Hip
Humans
Joint Diseases
Linear Models
Male*
Men's Health
Neck
Rheumatoid Factor*
Spine
Hepatitis B Surface Antigens
Rheumatoid Factor

Figure

• 

  Figure 1. Selection of subjects. BMD: bone mineral density, RF: rheumatoid factor.

• 

  Figure 2. Mean BMD and the proportion of low bone mass in lumbar spine along RF titers. (A) and (C) drawn for total subjects, and (B) and (D) for HBsAg-negative subjects. (A, B) RF titers were grouped into four categories, and each rhombus dot represents the mean estimated value (±95% CI) of lumbar BMD in the corresponding RF titer group. The imaginary connecting line between the dots demonstrates the decreasing tendency of BMD as the RF titers increase on one-way ANOVA testing (p=0.015 in A) and p=0.027 in B, respectively). (C, D) Each column represents the percentage of subjects with osteopenia (dark gray) and osteoporosis (light gray). Across the four groups, low bone mass frequency increases as RF titers increase (p for trend ＜0.001, both). BMD: bone mineral density, RF: rheumatoid factor, HBsAg: hepatitis B surface antigen, CI: confidence intervals.

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