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

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

Correspondence to:
M Güler-Yüksel, MD, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands; m.yuksel{at}lumc.nl

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.