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

M Güler-Yüksel ^1*, J Bijsterbosch ¹, Y PM Goekoop-Ruiterman ¹, J K de Vries-Bouwstra ¹, H MJ Hulsmans ², W M de Beus ³, K H Han ⁴, F C Breedveld ⁵, B AC Dijkmans ⁶, C F Allaart ⁷ and W F Lems ⁶

¹ Leiden University Medical Center, Netherlands
² Haga hospital, Netherlands
³ Medical Center Haaglanden, Netherlands
⁴ Medical Center Rijnmond-Zuid, Netherlands
⁵ University Hospital Leiden, Netherlands
⁶ VU Medical Center, Netherlands
⁷ LUMC, Netherlands

^* To whom correspondence should be addressed. E-mail: m.yuksel{at}lumc.nl.

Accepted 5 July 2007

Abstract

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 recently diagnosed RA patients 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 treatment groups, including corticosteroids and the anti-TNF 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.

Conclusion: 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 dose of corticosteroids and anti-TNF. Joint damage and joint damage progression are predictors of high BMD loss, which emphasizes that BMD loss and erosive RA have common pathways in their pathogenesis.

Keywords: bone mineral density, corticosteroids, early rheumatoid arthritis, infliximab

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