Background Adalimumab (ADA) has shown significant efficacy in the treatment of arthritis, spondylitis, and skin lesions in psoriatic arthritis (PsA) patients. Although therapeutic benefits have been published, little information has been reported regarding bone mineral density and metabolism during treatment.
Objectives We investigated whether ADA treatment modifies bone density (BMD) and metabolism in PsA patients in clinical practice.
Methods From March 2010 to December 2012, twenty-three patients were eligible for the study (male 19, female 4), and the average age and affected period (psoriasis/psoriatic arthritis) were 46.5±9.6 years old and 16.2±10.1/5.7±6.0years, respectively.
Methods Patients were segmented into Spondylitis (SP) group (18/23 cases) according Moll and Wright Criteria were extracted and compared with the others (peripheral (PE)group: 5/23 cases).
BMD (%YAM: young adult mean) of lumbar vertebrae and left side of the femoral neck/total proximal femur on dual-energy X-ray absorptiometry (DXA) were measured at baseline and 52 weeks after treatment. Bone metabolic markers (Tartrate-resistant acid phosphatase 5b (TRACP-5b), serum bone alkaline phosphatase (BAP), serum Calcium, undercarboxylated osteocalcin (ucOC)) were measured at baseline and 24 and 52 weeks after treatment.
The last observation carried forward (LOCF) method was used for the analysis. Wilcoxon signed rank test was used and significance level was set at 0.05.
Results In this study, there were two osteoporosis (with previous vertebral compression fracture; under bisphosphonate administration) and two osteopenia (no treatment). Osteoporosis patients were all male and SP group. Osteopenia patients were male/SP group and male/PE group. The mean %YAM in lumbar vertebrae increased significantly from 95.1±9.6% at base line to 96.7±10.0% at week 52 (p=0.0238). Specifically, the SP group increased significantly from 93.8±10.3% at base line to 95.8±11.2% at week 52 (p=0.0181).
No significant changes were observed in the mean value of %YAM in left side of the femoral neck (baseline/52w: 92.4±11.5/93.2±11.6). Specifically, the SP group increased significantly from 90.9±11.6% at base line to 92.7±11.7% at week 52 (p=0.0173).
No significant changes were observed in the mean value of %YAM in left side of the total proximal femur (baseline/52w: 97.8±11.0/98.5±10.9). Specifically, the SP group increased significantly from 96.8±11.4% at base line to 97.9±10.9% at week 52 (p=0.0457).
The mean ucOC increased significantly from 3.3±2.0/3.43±2.21 at baseline to 4.6±2.8/4.90±3.01 at week 52 (p=0.0333/0.0364) in all patients and the SP group. The mean TRACP-5b of the SP group decreased from 302.2±61.7 at baseline to 246.8±95.3 at week 52, whereas no significant difference was observed 303.1±81.0 at week 24.
Conclusions BMD in lumbar vertebrae, left side of the femoral neck and total proximal femur in the spondylitis (SP)group of PsA patients significantly increased during ADA treatment.
But, no significant changes were observed in peripheral (PE) group.
Disclosure of Interest None declared