RESEARCH - Bone mineral density in RA patients one year after Humira therapy: arrest of bone loss?

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Ann Rheum Dis. Published Online First: 13 April 2008.

doi:10.1136/ard.2008.091611

Copyright © 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

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Extended Report

Bone mineral density in rheumatoid arthritis patients 1 year after

adalimumab therapy: arrest of bone loss?

Carla A. Wijbrandts 1, Ruth Klaasen 2, Marcel G. W. Dijkgraaf 2,

le M Gerlag 2, Berthe L. van Eck-Smit 2 and P. Tak 2*

1 Academic Medical Center/University of Amsterdam, Netherlands

2 academic medical center/university of Amsterdam, Netherlands

Abstract

Objective: To explore the effects of anti-TNF antibody therapy on bone

mineral density (BMD) of the lumbar spine and femur neck in patients

with rheumatoid arthritis (RA).

Methods 50 patients with active RA (DAS28 3.2) who started adalimumab

(40 mg subcutaneously / 2 weeks) were included in an open label

prospective study. All patients used stable methotrexate and were

allowed to use prednisone ( " T 10 mg/day). The BMD of the lumbar spine

and femur neck was measured before, and one year after start of

treatment.

Results: Both disease activity at baseline (DAS28) and disease

duration were inversely correlated with femoral neck BMD and lumbar

spine BMD (P < 0.05). Mean BMD of both lumbar spine and femur neck

remained unchanged after one year of adalimumab therapy (+0.3% and

+0.3%, respectively). Of interest, a beneficial effect of prednisone

on change in femur neck BMD was observed with a relative increase with

prednisone use (+2.5%) compared to no concomitant prednisone use

(-0.7%), (P = 0.015).

Conclusion In contrast to the progressive bone loss observed after

conventional disease modifying anti rheumatic drug therapy, TNF

blockade may result in an arrest of general bone loss. Consistent with

previous observations, the data also suggest that the net effect of

low dose corticosteroids on BMD in RA may be beneficial, possibly

resulting from their anti-inflammatory effects.

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http://ard.bmj.com/cgi/content/abstract/ard.2008.091611v1?papetoc

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