Background Generalized bone loss and an increased risk of fractures are regarded as complications in rheumatoid arthritis. Variable clinical factors, inflammatory activity, and treatment regimens may contribute to the development of bone loss.
Objectives We evaluated the association between the baseline disease activity and the changes in bone mineral density (BMD) after 1 year of treatment in a cohort of patients with recently diagnosed active rheumatoid arthritis (RA).
Methods A total of 106 (92 women and 14 men) patients with recent onset RA from ASERA cohort were included in this study. Data on patient’s demographic factors, disease activity score in 28 joints (DAS28), and anti-rheumatic drugs were obtained. Baseline and 1 year of follow up BMD in proximal femur sites (i.e., the total femur, femur neck, and trochanter) and lumbar spine were measured with dual energy X-ray absorptiometry. Univariate regression analyses were performed to determine association between clinical parameters and BMD loss after 1 year.
Results The mean age of women and men was 50 ± 11 years and 59 ± 7 years, respectively and 54 patients in 92 women were postmenopausal status. The mean baseline DAS28 was 5.4 ± 1.2 (range; 2.6-8.6) and 30 (28.3%) patients were diagnosed as osteoporosis at baseline. After 1 year of treatment, the mean annualized rates of bone loss in the total femur, femur neck, trochanter, and L-spine were -1.41%/yr, -1.31%/yr, -2.07%/yr, and -0.78%/yr, respectively. Age, smoking, menopause, and high DAS28 were associated with prominent BMD loss in femur neck. Higher cumulative dose of corticosteroids was associated with significant bone loss in the spine and femur. The use of bisphosphonate had no significant protected effect against BMD loss in one year of treatment.
Conclusions High baseline disease activity and increased dose of steroids are significantly associated with accelerated BMD loss in patients with active RA. Our findings suggest that suppression of inflammation at the initial treatment might reduce the bone loss and limited use of steroids can be essential for bone preservation.
Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis. Annals of the rheumatic diseases (2008). 67(6). 823-8
Disclosure of Interest None Declared