AB0677 Bone mineral density and glucocorticoid treatment in patients with giant cell arteritis and/or polymyalgia rheumatica

• Published in: Annals of the rheumatic diseases Vol. 77; no. Suppl 2; p. 1482
• Main Authors: Zeiner, K.N., Freier, D., Wiebe, E., Robert, B., Schneider, U., Alexander, T., Buttgereit, F.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2018
• Subjects: Absorptiometry; Arteritis; Autoimmune diseases; Bone density; Bone mineral density; Disease; Disease control; Dual energy X-ray absorptiometry; Epidemiology; Fractures; Funding; Glucocorticoids; Immunomodulation; Immunosuppressive agents; Interleukin 6; Methotrexate; Osteopenia; Osteoporosis; Patients; Polymyalgia rheumatica; Rheumatic diseases; Statistical analysis; Vein & artery diseases
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-eular.2579

BackgroundGlucocorticoids (GC) are widely used in treating giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) because of their strong anti-inflammatory and immunomodulatory effects. However, considerable adverse effects like osteoporosis can occur, especially when GC are used as a long-term treatment and disease relapses are frequent. While additional treatment options with conventional immunosuppressive drugs such MTX showed modest effects, the most recent and promising evidence points towards use of biologic agents like the IL-6-receptor antagonist Tocilizumab (TCZ) as an efficient novel treatment option in GCA.ObjectivesRh-GIOP is an ongoing prospective study monitoring GC induced osteoporosis in patients with inflammatory rheumatic diseases, established in 2015 at the Charité University Hospital (ClinicalTrials.gov Identifier NCT02719314). To date, our database comprises clinical data and bone mineral density (BMD) data measured by dual x-ray absorptiometry (DXA) collected from 592 patients with inflammatory rheumatic diseases. The objective of this cross-sectional analysis was to describe GCA and PMR patients in terms of their clinical characteristics, immunosuppressive therapies and BMD.MethodsWe evaluated data from the initial visit of 61 patients (37 female, 24 male), 43 (70.5%) with PMR, and 18 (29.5%) with GCA (with or without PMR symptoms). Statistical analyses were performed for the overall cohort (GCA +PMR) and separately for the subgroups GCA and PMR. For subgroup analyses non-parametric tests were used.ResultsThe whole group showed a mean age of 70.4 years (±9.0), BMI of 27.7 kg/m2 (±4.8), disease duration of 2.9 years (±4.0), daily GC dose of 12.5 mg (±19.6) and cumulative GC dose (CGCD) of 6.1 g (±6.5). While 40 (93%) PMR patients and all 18 GCA patients received GC on a daily base, GCA patients took significantly higher median doses (8.75 mg, interquartile range (IR) 5/27.5 mg) than PMR patients did (5 mg, IR 3.5/10 mg, p=0.03). However, no significant difference was seen in the CGCD. Overall, 34 (55.7%) patients demonstrated osteopenia and 5 (8.2%) patients osteoporosis. 27 (44.3%) patients suffered from at least one fracture, while 10 (16.4%) of these cases were confirmed fragility fractures. Methotrexate (MTX) was the most common conventional immunosuppressive drug being used in 12 (27.9%) PMR and in 6 (33.3%) GCA patients. 2 (11.2%) GCA patients and 1 (1.6%) PMR patient were treated with TCZ.ConclusionsNo increased prevalence of osteoporosis or fractures was found in our patient cohort compared to a normal German population over 50 years.1 This might be due to therapeutic approaches, which include optimal disease control, the use of lowest possible GC doses and GC-sparing co-medications, and a rigorous osteoporosis prevention and treatment strategy. Alternatively, the number of patients may be still too small to identify significant differences when comparing with a non-diseased population.Reference[1] Hadji P, Klein S, Gothe H, Häussler B, Kless T, Schmidt T, Steinle T, Verheyen F, Linder R: The Epidemiology of Osteoporosis—Bone Evaluation Study (BEST): An Analysis of Routine Health Insurance Data. Deutsches Ärzteblatt International2013, 110(4):52–57.Disclosure of InterestK. Zeiner Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, D. Freier Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, E. Wiebe Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, B. Robert Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, U. Schneider Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, T. Alexander Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche, F. Buttgereit Grant/research support from: Rh-GIOP is supported by a joint funding of Amgen, BMS, Celgene, Generic Assays, GSK, Horizon, medac, Mundipharma, Pfizer and Roche