Background Rheumatoid arthritis (RA)is an inflammatory arthritis associated with bone loss and subsequent osteoporosis (OP). Although anti-inflammatory effect of low- dose prednisolone (LP) exert some beneficial effect against bone loss but cumulative doses of LP predisposes RA patients to osteoporosis (OP). Treatment of RA with methotrexate reduces decrease activity and reduces the rate of bone loss.
Objectives The present study aimed to compare the risk of OP in RA patients treated with LP alone versus patients received combination of MTX and LP.
Methods One-hundred and three RA and 111 age-matched controls entered to study. Freqency of OP in the femoral neck (FN) and lumbar spine (LS) in 42 patients taking LP alone, 39 taking MTX+LP, 20 taking NSAIDs alone were compared with controls.In statistical analysis the risk of FNOP and LS OP was determined by calculation of adjusted odds ratio (OR) with 95% confidence interval (95%CI) after controlling for age and DD.ANOVA chi square and logistic regression analysis were applied using SPSS version 18 software.
Results The mean age and mean disease duration (DD) of patients were 52±11.7 and 8.4±6.4 years and the mean age of control was 52±7.5 years. The Mean duration of treatment for three study groups were 46; 48; and 13 months respectively.
Prevalence of FNOP in the study groups and controls was 28.9%; 54.8%; 50%,and 13.5% (P=0.001) and the prevalence of LSOP 15.4%; 28.6%; 20; and 12.6% respectively (P=0.12).In patients treated with LP the risk of FNOP compared with controls increased by OR=7.7 (3.4-17.5), versus 2.6 (1.07-6.3) in MTX +LP and 6.4 (2.2-17.9) in NSAD treated group. After controlling for age and DD the adjusted OR values decreased respectively to 4.07 (1.43-11.5); 1.2 (0.36-3.9); and 4.1 (1.2-13.8). The risk of LSOP after adjustment for age and DD decreased to nonsignificant levels in all groups.
Conclusions These findings indicated that treatment of RA with LP alone significantly increase the risk of FNOP compared with nontreated patients and treatment with combination of MTX+LP excert a protective effect against corticosteroid-induced bone loss
Disclosure of Interest None Declared