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, Danielle M Gerlag ², Berthe L. van Eck-Smit ² and Paul P. Tak ^2*

¹ Academic Medical Center/University of Amsterdam, Netherlands
² academic medical center/university of Amsterdam, Netherlands

^* To whom correspondence should be addressed. E-mail: p.p.tak{at}amc.uva.nl.

Accepted 31 March 2008

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.