RESEARCH - Changes in hand and generalized BMD in patients with recent-onset RA

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Ann Rheum Dis. Published Online First: 28 March 2008.

doi:10.1136/ard.2007.086348

Changes in hand and generalized bone mineral density in patients with

recent-onset rheumatoid arthritis

M Güler-Yüksel 1*, C F Allaart 2, Y PM Goekoop-Ruiterman 1, J K de

Vries-Bouwstra 1, J HLM van Groenendael 3, C Mallée 4, M HW de Bois 5,

F C Breedveld 6, B AC Dijkmans 7 and W F Lems 8

1 Leiden University Medical Center, Netherlands

2 LUMC, Netherlands

3 Franciscus Hospital, Netherlands

4 Kennemer Gasthuis, Netherlands

5 MC Haaglanden, Netherlands

6 University Hospital Leiden, Netherlands

7 VU Medical Center, Netherlands

8 VU Medicale Center, Netherlands

Abstract

Objectives: To evaluate changes in bone mineral density (BMD) in the

hands, hip and spine after 1 and 2 years of follow-up, in relation to

antirheumatic and antiresorptive therapies and disease and demographic

variables in patients with recent-onset rheumatoid arthritis (RA).

Methods: Changes in BMD measured in the metacarpals 2-4 by digital

X-ray radiogrammetry and in the hip and spine by dual energy X-ray

absorptiometry were assessed at baseline and after 1 and 2 years of

follow-up in 218 recent-onset RA patients from the BeSt study, who

received one of four treatment strategies: sequential monotherapy

(group 1), step-up combination therapy (group 2), initial combination

therapy with tapered high-dose prednisone (group 3), or initial

combination therapy with infliximab (group 4).

Results: After 1 and 2 years, there was significant BMD loss in all

locations, with significantly greater BMD loss in the hands than

generalized BMD loss in the hip and spine. Initial combination therapy

with prednisone or infliximab were associated with less hand BMD loss

compared with initial monotherapy after 1 and 2 years (-0.9 and -1.6%,

-0.6 and -1.4%, -1.7 and -3.3%, and -2.6 and -3.6% for group 4-1 after

1 and 2 years, overall p=0.001 and p=0.014, respectively). Progression

in erosions was independently associated with increased BMD loss both

in the hands and hip after 1 year. The use of bisphosphonates

protected only against generalized BMD loss in the hip and spine.

Conclusion: The association between joint damage progression and both

hand and generalized BMD loss in RA suggests common pathways between

these processes, with hand BMD loss occurring earlier in the disease

course than generalized BMD loss.

http://ard.bmj.com/cgi/content/abstract/ard.2007.086348v1

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