RESEARCH - Changes in BMD in patients with recent onset, active RA

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Published Online First: 20 July 2007. doi:10.1136/ard.2007.073817

ls of the Rheumatic Diseases 2008;67:823-828

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EXTENDED REPORTS

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

rheumatoid arthritis

M Güler-Yüksel 1, J Bijsterbosch 1, Y P M Goekoop-Ruiterman 1, J K de

Vries-Bouwstra 2, H M J Hulsmans 3, W M de Beus 4, K H Han 5, F C

Breedveld 1, B A C Dijkmans 2,6,7, C F Allaart 1, W F Lems 2,6,7

1 Department of Rheumatology, Leiden University Medical Center,

Leiden, The Netherlands

2 Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands

3 Department of Rheumatology, Haga Hospital, The Hague, The Netherlands

4 Department of Rheumatology, Medical Center Haaglanden, The Hague,

The Netherlands

5 Department of Rheumatology, Medical Center Rijnmond-Zuid, Rotterdam,

The Netherlands

6 Department of Rheumatology, Slotervaart Hospital, Amsterdam, The Netherlands

7 Department of Rheumatology, Jan van Breemen Institute, Amsterdam,

The Netherlands

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- 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-. 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.

http://ard.bmj.com/cgi/content/abstract/67/6/823?etoc

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