Objectives To describe effects on bone mineral density (BMD) of 10 mg prednisone daily in patients with early rheumatoid arthritis (RA), who were treated according to a methotrexate-based tight control strategy and received preventive therapy for osteoporosis.
Methods Early RA patients were included in the CAMERA-II trial: a randomized, placebo-controlled, double-blind two-year trial, in which the effects of addition of 10 mg prednisone daily to a methotrexate-based tight control strategy were studied. All patients received calcium, vitamin D, and a bisphosphonate. Disease activity was assessed every four weeks. X-rays of hands and feet and dual-energy X-ray absorptiometry of lumbar spine and left hip were performed at baseline, and at one and two years of treatment.
Results The standardized BMD (sBMD) increased significantly over time in both treatment groups in the lumbar spine (p<0.001), but not in the hip; at none of the time points sBMD differed significantly between the prednisone and placebo group. Higher age and lower weight at baseline, and higher disease activity scores during the trial, but not glucocorticoid therapy, were associated with a lower sBMD at the lumbar spine as well as the hip in mixed model analyses.
Conclusions Addition of 10 mg prednisone daily from start of therapy to a methotrexate-based tight control strategy does not lead to bone loss in early RA patients on adequate preventive treatment for osteoporosis. A small increase in lumbar BMD during the first year of treatment was found, regardless of the use of glucocorticoids.
Disclosure of Interest None Declared