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FRI0535 Hand Bone Loss in Early Rheumatoid Arthritis Is Independent of Adalimumab Treatment. A Substudy of The Optimized Treatment Algorithm in Early RA (Opera) Trial
  1. L.M. Ørnbjerg1,
  2. M. Østergaard1,
  3. T. Jensen2,
  4. K. Hørslev-Petersen3,
  5. K. Stengaard-Pedersen4,
  6. P. Junker5,
  7. T. Ellingsen6,
  8. P. Ahlquist7,
  9. H. Lindegaard5,
  10. A. Linauskas8,
  11. A. Schlemmer9,
  12. M.Y. Dam6,
  13. I. Hansen10,
  14. T. Lottenburger11,
  15. C.G. Ammitzbøll4,
  16. A. Jørgensen4,
  17. S. Krintel1,
  18. J. Raun3,
  19. M. Hetland1
  1. 1Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet
  2. 2Department of Endocrinology, Hvidovre Hospital, Copenhagen
  3. 3King Christian X Hospital for Rheumatic Diseases, South Jutland Hospital, Gråsten
  4. 4Department of Rheumatology, Aarhus University Hospital, Aarhus
  5. 5Department of Rheumatology, Odense University Hospital, Odense
  6. 6Diagnostic Centre, Silkeborh Regional Hospital, Silkeborg
  7. 7Department of Medicine, Vejle Regional Hospital, Vejle
  8. 8Department of Rheumatology, Vendsyssel Hospital, Hjørring
  9. 9Department of Rheumatology, Aalborg University Hospital, Aalborg
  10. 10Department of Rheumatology, Viborg Regional Hospital, Viborg
  11. 11Department of Rheumatology, Vejle Regional Hospital, Vejle, Denmark


Background Rheumatoid arthritis (RA) is characterised by progressive destruction of joint bone and loss of periarticular bone mineral. Hand bone loss (HBL) measured by Digital X-ray Radiogrammetry (DXR) has been proposed as a sensitive outcome measure for treatment effect and as a potential predictor of subsequent radiographic progression in RA patients.

Objectives To investigate the effect of adding adalimumab to a methotrexate and intra-articular triamcinolone treat-to-target strategy on one-year HBL (HBLone-year) in early RA and to determine if HBL6months is associated with radiographic progression after two years.

Methods In a clinical trial (OPERA) of 180 treatment-naive early RA patients (1), bone mineral density (BMD) was estimated from hand radiographs with Digital X-ray radiogrammetry (DXR) at baseline, after 6 months (n=90) and 12 months (n=70) of follow-up. Baseline and two-year radiographs were scored according to the Sharp/van der Heijde method. Baseline characteristics and HBL6months (0–6 months changes in DXR-BMD) were investigated as predictors of structural damage by univariate linear (ΔTotal Sharp/van der Heijde Score (TSS) as dependent variable) and logistic (+/− radiographic progression (ΔTSS>0) as dependent variable) regression analyses. Variables with p<0.10 were included in multivariable models.

Results In 70 patients with available HBLone-year data, HBLone-year was median (InterQuartileRange (IQR)) -1.9 (-3.3; -0.26 mg/cm2) in the placebo-group and -1.8 (-3.6; 0.06) mg/cm2 in the adalimumab-group, p=0.98,Mann Whitney. Increased HBL (compared to general population reference values (2)) was found in 26/37 and 23/33 patients in the placebo- and adalimumab-groups, Chi-sq=0.99. In 90 patients with HBL6months data and two-year radiographic data, HBL6months was independently associated with ΔTSS after two years (β=-0.086 (95% Confidence Interval= -0.15; -0.025) TSS unit/mg/cm2 increase,p=0.006), and borderline associated with presence of radiographic progression (ΔTSS>0) (OR 0.96 (0.92–1.0), p=0.10).

Conclusions In early RA, adding adalimumab to a methotrexate-based treat-to-target strategy had no impact on HBLone-year, which was increased in both treatment groups. HBL6months was independently associated with ΔTSS after two years.

  1. Hørslev-Petersen et al. Ann Rheum Dis. 2015 doi: 10.1136/annrheumdis-2015-208166.

  2. Ørnbjerg LM et al. [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10).

Disclosure of Interest L. Ørnbjerg: None declared, M. Østergaard Grant/research support from: Abbvie, BMS, Boehringer-Ingelheim, Eli Lilly, Janssen, Merck, Pfizer, Roche, UCB, Celgene, Sanofi, Regeneron, Novartis, T. Jensen: None declared, K. Hørslev-Petersen Grant/research support from: Abbvie, Meda, Roche, K. Stengaard-Pedersen Grant/research support from: Meda, Abbvie, Roche, Speakers bureau: UCB, Pfizer, P. Junker: None declared, T. Ellingsen: None declared, P. Ahlquist: None declared, H. Lindegaard Grant/research support from: Boehringer Ingelheim, A. Linauskas: None declared, A. Schlemmer Grant/research support from: Abbvie, Roche, MSD, M. Dam: None declared, I. Hansen: None declared, T. Lottenburger: None declared, C. Ammitzbøll: None declared, A. Jørgensen: None declared, S. Krintel: None declared, J. Raun: None declared, M. Hetland: None declared

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