Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis

• Published in: Annals of the rheumatic diseases Vol. 67; no. 6; pp. 823 - 828
• Main Authors: Güler-Yüksel, M, Bijsterbosch, J, Goekoop-Ruiterman, Y P M, de Vries-Bouwstra, J K, Hulsmans, H M J, de Beus, W M, Han, K H, Breedveld, F C, Dijkmans, B A C, Allaart, C F, Lems, W F
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2008; BMJ; BMJ Publishing Group LTD
• Subjects: Absorptiometry, Photon; Adult; Aged; Antibodies, Monoclonal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - physiopathology; Biological and medical sciences; Bone Density; Bone Density Conservation Agents - therapeutic use; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Female; Follow-Up Studies; Glucocorticoids - therapeutic use; Humans; Hypotheses; Inflammatory joint diseases; Infliximab; Investigative techniques, diagnostic techniques (general aspects); Lumbar Vertebrae; Male; Medical sciences; Middle Aged; Odds Ratio; Osteoarticular system. Muscles; Osteoporosis; Osteoporosis - diagnosis; Osteoporosis - prevention & control; Pelvic Bones; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Regression Analysis; Rheumatoid arthritis; Rheumatology; Risk; Studies; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Vitamin D; Human; Immunopathology; Chronic; Rheumatoid arthritis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Bone mineral density
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2007.073817

Objectives:We examined the effects of four different treatment strategies on bone mineral density (BMD) in patients with recently diagnosed, active rheumatoid arthritis (RA) and the influence of disease-related and demographic factors on BMD loss after 1 year of follow-up in the BeSt trial.Methods:BMD measurements of the lumbar spine and total hip were performed in 342 patients with recent onset RA at baseline and after 1 year. Multivariable regression analyses were performed to determine independent associations between disease and demographic parameters and BMD loss after 1 year.Results:Median BMD loss after 1 year was 0.8% and 1.0% of baseline in the spine and the hip, respectively. No significant differences between the treatment groups, including corticosteroids and the anti-tumour necrosis factor-α infliximab, were observed with regard to BMD loss after 1 year of treatment. Joint damage at baseline and joint damage progression according to the Sharp–van der Heijde score were independently associated with more BMD loss after 1 year. The use of bisphosphonates independently protected against BMD loss.Conclusions:After 1 year of follow-up in the BeSt study, we did not find differences in BMD loss between the four treatment strategies, including high doses of corticosteroids and anti-tumour necrosis factor-α. Joint damage and joint damage progression are associated with high BMD loss, which emphasises that BMD loss and erosive RA have common pathways in their pathogenesis.