CONCISE REPORT

Increase in bone mineral density of patients with spondyloarthropathy treated with anti-tumour necrosis factor

F Allali¹, M Breban¹, R Porcher², J F Maillefert³, M Dougados¹, C Roux¹

¹ Rheumatology Department, René Descartes University, Cochin Hospital, Paris, France
² Biostatistics Department, Saint-Louis Hospital, INSERM U444, Paris, France
³ Rheumatology Department, Dijon, France

Correspondence to:
Correspondence to:
Dr C Roux, Hôpital Cochin, Département de Rhumatologie, 27 rue du Faubourg St Jacques, 75014 Paris, France;
christian.roux{at}cch.ap-hop-paris.fr

Objective: To determine the changes in bone mineral density (BMD) in patients with spondyloarthropathy (SpA) treated with infliximab.

Patients and methods: 29 patients (six women; 23 men) aged 22–68 years, with persistently active SpA despite a high dose of non-steroidal anti-inflammatory drug and/or treatment with methotrexate or sulfasalazine, were studied. Median duration of disease was 13 years (range 3–30). Twenty five patients were treated with 5 mg/kg and four with 3 mg/kg of infliximab at weeks 0, 2, 6 and then received either no infusion (n=3), or additional infusion of infliximab every other month (n=6), and the remainder received one infusion only in the case of a relapse. Lumbar and femoral BMD was measured by dual energy x ray absorptiometry at baseline and six months later. Serum osteocalcin and urinary deoxypyridinoline were measured in 19 patients at weeks 0, 2, 24, and in 13 patients at all visits.

Results: In six months there was a significant increase in BMD at the spine (3.6%, p=0.001), total hip (2.2%, p=0.0012), and trochanter (2.3%, p=0.0012). A trend for increase (1.1%) was observed at the femoral neck. There was an increase in osteocalcin between baseline and week 6 (third infusion)—median 1.45 µg/l (p=0.013). No change in marker of bone resorption was observed at the same time. There was no change in biochemical markers between baseline and final visits. There was a trend for a correlation between the decrease at six months in erythrocyte sedimentation rate, and lumbar spine BMD change (r_s=-0.35, p=0.06).

Conclusion: These data suggest that a benefit of anti-tumour necrosis factor therapy on BMD in patients with SpA may be through an uncoupling effect on bone cells.

Keywords: anti-tumour necrosis factor ; osteoporosis; bone mineral density; spondyloarthropathy

Abbreviations: AS, ankylosing spondylitis; BMD, bone mineral density; CRP, C reactive protein; D-Pyr, deoxypyridinoline; DXA, dual energy x ray absorptiometry; ELISA, enzyme linked immunosorbent assay; ESR, erythrocyte sedimentation rate; SpA, spondyloarthopathy; TNF, tumour necrosis factor

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Wijbrandts, C A, Klaasen, R, Dijkgraaf, M G W, Gerlag, D M, van Eck-Smit, B L F, Tak, P P (2009). Bone mineral density in rheumatoid arthritis patients 1 year after adalimumab therapy: arrest of bone loss. Ann Rheum Dis 68: 373-376 [Abstract] [Full Text]  
• Visvanathan, S, van der Heijde, D, Deodhar, A, Wagner, C, Baker, D G, Han, J, Braun, J (2009). Effects of infliximab on markers of inflammation and bone turnover and associations with bone mineral density in patients with ankylosing spondylitis. Ann Rheum Dis 68: 175-182 [Abstract] [Full Text]  
• Ding, C., Parameswaran, V., Udayan, R., Burgess, J., Jones, G. (2008). Circulating Levels of Inflammatory Markers Predict Change in Bone Mineral Density and Resorption in Older Adults: A Longitudinal Study. J. Clin. Endocrinol. Metab. 93: 1952-1958 [Abstract] [Full Text]  
• Zochling, J., Brandt, J., Braun, J. (2005). The current concept of spondyloarthritis with special emphasis on undifferentiated spondyloarthritis. Rheumatology (Oxford) 44: 1483-1491 [Full Text]  
• Lange, U., Teichmann, J., Muller-Ladner, U., Strunk, J. (2005). Increase in bone mineral density of patients with rheumatoid arthritis treated with anti-TNF-{alpha} antibody: a prospective open-label pilot study. Rheumatology (Oxford) 44: 1546-1548 [Abstract] [Full Text]  
• Briot, K, Garnero, P, Le Henanff, A, Dougados, M, Roux, C (2005). Body weight, body composition, and bone turnover changes in patients with spondyloarthropathy receiving anti-tumour necrosis factor {alpha} treatment. Ann Rheum Dis 64: 1137-1140 [Abstract] [Full Text]  
• Keat, A., Barkham, N., Bhalla, A., Gaffney, K., Marzo-Ortega, H., Paul, S., Rogers, F., Somerville, M., Sturrock, R., Wordsworth, P., on behalf of the BSR Standards, Guidelines and Aud, (2005). BSR guidelines for prescribing TNF-{alpha} blockers in adults with ankylosing spondylitis. Report of a working party of the British Society for Rheumatology. Rheumatology (Oxford) 44: 939-947 [Full Text]  
• Simonini, G., Giani, T., Stagi, S., de Martino, M., Falcini, F. (2005). Bone status over 1 yr of etanercept treatment in juvenile idiopathic arthritis. Rheumatology (Oxford) 44: 777-780 [Abstract] [Full Text]  
• Sieper, J, Rudwaleit, M (2005). Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 64: 659-663 [Abstract] [Full Text]  
• Kruithof, E, Baeten, D, Van den Bosch, F, Mielants, H, Veys, E M, De Keyser, F (2005). Histological evidence that infliximab treatment leads to downregulation of inflammation and tissue remodelling of the synovial membrane in spondyloarthropathy. Ann Rheum Dis 64: 529-536 [Abstract] [Full Text]  
• Paul, S., Keat, A. (2005). Assessment of patients with spondyloarthropathies for treatment with tumour necrosis factor {alpha} blockade. Rheumatology (Oxford) 44: 17-23 [Full Text]  
• Kast, R E, Altschuler, E L (2004). Bone density loss in Crohn's disease: role of TNF and potential for prevention by bupropion. Gut 53: 1056-1056 [Full Text]