RESEARCH - Impact of low-dose prednisolone on bone synthesis and resorption in early RA - experiences from a two-year randomized study

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Arthritis Research & Therapy 2008, 10:R128doi:10.1186/ar2542

Published: 5 November 2008

Research article

Impact of low-dose prednisolone on bone synthesis and resorption in

early rheumatoid arthritis - experiences from a two-year randomized

study

Inga-Lill Engvall , Bjorn Svensson , Birgitta Tengstrand , Kerstin

Brismar and Ingiald Hafstrom for the BARFOT study group

Abstract (provisional)

Introduction

Patients with rheumatoid arthritis (RA) have increased frequency of

osteoporosis, mainly because of increased bone resorption. Reduction

of disease activity is suggested to reduce bone remodelling. It might

be possible that also prednisolone treatment could have this effect

since prednisolone has been shown to arrest the development of joint

destruction in early RA. Therefore, we examined the effects of

low-dose prednisolone on serum concentrations of bone remodelling

markers and insulin-like growth factor-1 (IGF-1) in RA patients in

relation to bone mineral density.

Methods

150 patients, 67% women, with early RA, disease duration mean (CI) 6(3

to 8) months, who had participated in the BARFOT low-dose prednisolone

study were included. They had been randomised to treatment with 7.5 mg

prednisolone daily, the P-group (n=70, mean (CI) age 51(48 to 54)

years), or no prednisolone, the NoP-group (n=80, age 58(56 to 61)

years), when they started with the first DMARD. Serum samples were

analysed at baseline, 3 and 12 months for the procollagen type I

N-terminal propeptide (P1NP), a marker of bone formation, and the

C-telopeptide crosslaps of type I collagen (CTX-1) and C-terminal

telopeptide of type I collagen (1CTP), markers of bone degradation.

IGF-1 was analysed at baseline and after 12 months. Bone mineral

density (BMD) at lumbar spine and femoral neck was assessed by DXA at

baseline and after 24 months.

Results

P1NP decreased rapidly in the P-group (p<0.001). CTX-1 and 1CTP

decreased in both treatment groups, significantly more in the P-group

(differences between groups p<0.019 and <0.001, respectively). IGF-1

increased in the P-group (p<0.001) but remained stable in the

NoP-group. BMD decreased in spine in both groups, significantly more

in postmenopausal women from the P-group. In femur BMD decreased only

in the NoP-group.

Conclusions

Low dose prednisolone in early RA counteracts the negative impact of

rheumatoid inflammation on bone tissue in hip, a juxta-articular

localisation. Thus BMD was preserved in femur in the P-group and 1CTP

decreased rapidly. However, the systemic inflammatory consequences on

bone could not be prevented in lumbar spine, especially not in

postmenopausal women, probably because the combined effect of

suppression of bone synthesis by prednisolone and the postmenopausal

status.

http://arthritis-research.com/content/10/6/R128/abstract

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