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AB1063 The use of glucocorticosteroids does not dismiss the lumbar bone mineral density in patients with rheumatoid arthritis, prospective study
  1. J. Del Pino1,
  2. R. Pedrero2,
  3. R. Lopez-Gonzalez1,
  4. C. Montilla-Morales1,
  5. S. Gomez-Castro1,
  6. M.D. Sanchez-Gonzalez1,
  7. C. Hidalgo-Calleja1,
  8. P. García-Talavera3
  1. 1Rheumatology
  2. 2Medicine
  3. 3Nuclear Medicine, Hospital Universitario De Salamanca, Salamanca, Spain

Abstract

Background The increase of pro-inflammatory cytoquines plays a relevant role in the loss of bone density which is associated to the Rheumatoid Arthritis (RA). The glucocorticosteroids (GC) are in the base of the treatment and have been described as a losing body mass index (BMI) risk factor, even a small continuing dosage, based in that suggestion it is consider the use of GC in RA patients a combination of risk factor of fracture, which it is reflected in the absolute risk calculator as the FRAX index. There are studies which have compared the use of GC in patients related with healthy control, but there are not studies which related the effect at the BMI of the GC prescription in RA patients.

Objectives To estimate the BMI variation in RA patients treated with GC

Methods Longitudinal study of 69 women with RA, during 5 years. Socio-demographic, clinical and BMI characteristics were recorded, which was measure with dual-emission X-ray absorptiometry technique in two levels total lumbar spine and femoral neck. Descriptive analyses were performed, and was described the predictors of decreased of the BMI in patients treated with GC and/or bisfosfonates (BPS) drugs, a value p<0,05 was consider statistical significance.

Results 100% were women with a mean age of 59.9 years ± 11 years, 13% premenopausal. Related to the drugs: 1) The use of GC was up to 58.2% of the patients, with a mean accumulated dosage of 4.5 grams during a mean time of 2.8 years; only 7.2% received high dosage of GC; 2) Up to 43.5% of the patients had a BPS prescription. Related to the RA: the mean duration was 9.8 years; the HAQ index mean was 1.25 and the mean of the illness activity assessing with the DAS-28 was 3.43.

It was calculated the BMI evolution depending of the basal treatment, GC or/and BPS. It was observed a better BMI improvement in the group of RA patients treated with GC with a p=0.024; it was also an improvement of p=0.001 in the group treated with BPS. The difference between the mean of the group without GC and without BPS -0.024 (p=0.048) and the group with GC and without BPS 0.027 (p=0.0467).

Conclusions The effects of the GC over the pro-inflammatory cytokines of the bone prescribed to get a better control of the RA activity, let to control the effects of the bone loss due to the inflammatory illness, RA. This work shows how the use of GC in the RA patients must not be consider as an aggravated risk factor to the osteoporosis associated to the RA.

Disclosure of Interest None Declared

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