High dose methylprednisolone pulse therapy on bone mass and bone metabolism in patients with RA

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J Rheumatol. 2004 Jun;31(6):1083-7.

Effects of high dose methylprednisolone pulse therapy on bone mass and

biochemical markers of bone metabolism in patients with active

rheumatoid arthritis: a 12-month randomized prospective controlled

study.

Frediani B, Falsetti P, Bisogno S, Baldi F, Acciai C, Filippou G,

Bacarelli MR, Filipponi P, Galeazzi M, Marcolongo R.

Department of Clinical Medicine and Immunological Sciences, Division of

Rheumatology, University of Siena, Siena, Italy.

OBJECTIVE: To study the effects of one year of high dose

6-methylprednisolone pulse therapy (MPPT) on bone mass, seric bone

alkaline phosphatase (sBAP), and urinary deoxypyridinoline (uDpyr) in

patients with active rheumatoid arthritis (RA), and to compare results

with those of patients with active RA treated with oral

methylprednisolone (OMP). METHODS: Thirty-one women with active RA were

given 1000 mg of MP IV for 3 alternate days, with a mean interval of

administration of 76 days (+/- 8.3 SD) for one year (MPPT group). Bone

mineral density (BMD) (total body, lumbar spine, and femur neck), plasma

levels of sBAP, and urinary concentrations of uDpyr were assessed at the

beginning of the treatment and every 3 months until the end of the

study. Moreover, erythrocyte sedimentation rate (ESR), joint

score, and early morning stiffness were assessed at study entry and

every month. The control group, 31 women with active RA treated with

oral MP, was followed in the same way (OMP group). RESULTS: In the MPPT

group there was no significant reduction of BMD at any site compared to

significant reductions in lumbar BMD at 6 and 12 months and total body

BMD and femur neck BMD at 12 months in the OMP group. Also in the OMP

group, a significant reduction in the mean sBAP was observed. The mean

uDpyr levels were not significantly reduced in either group.

CONCLUSION: Our results show that MPPT, compared to continuous therapy

with oral corticosteroids, preserves bone mass without modifying the

biochemical markers of bone metabolism.

PMID: 15170918

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