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Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis
  1. M Güler-Yüksel (m.yuksel{at}lumc.nl)
  1. Leiden University Medical Center, Netherlands
    1. J Bijsterbosch (j.bijsterbosch{at}lumc.nl)
    1. Leiden University Medical Center, Netherlands
      1. Y PM Goekoop-Ruiterman (y.p.m.goekoop{at}lumc.nl)
      1. Leiden University Medical Center, Netherlands
        1. J K de Vries-Bouwstra (j.k.de_vries-bouwstra{at}lumc.nl)
        1. Leiden University Medical Center, Netherlands
          1. H MJ Hulsmans (h.hulsmans{at}hagaziekenhuis.nl)
          1. Haga hospital, Netherlands
            1. W M de Beus (beuwil{at}mchaaglanden.nl)
            1. Medical Center Haaglanden, Netherlands
              1. K H Han (hank{at}mcrz.nl)
              1. Medical Center Rijnmond-Zuid, Netherlands
                1. F C Breedveld (f.c.breedveld{at}lumc.nl)
                1. University Hospital Leiden, Netherlands
                  1. B AC Dijkmans (bac.dijkmans{at}vumc.nl)
                  1. VU Medical Center, Netherlands
                    1. C F Allaart (c.f.allaart{at}lumc.nl)
                    1. LUMC, Netherlands
                      1. W F Lems (wf.lems{at}vumc.nl)
                      1. VU Medical Center, Netherlands

                        Abstract

                        Objectives: We examined the effects of four different treatment strategies on bone mineral density (BMD) in patients with recently diagnosed, active rheumatoid arthritis (RA) and the influence of disease-related and demographic factors on BMD loss after 1 year of follow-up in the BeSt trial.

                        Methods: BMD measurements of the lumbar spine and total hip were performed in 342 recently diagnosed RA patients at baseline and after 1 year. Multivariable regression analyses were performed to determine independent associations between disease and demographic parameters and BMD loss after 1 year.

                        Results: Median BMD loss after 1 year was 0.8% and 1.0% of baseline in the spine and the hip, respectively. No significant differences between treatment groups, including corticosteroids and the anti-TNFα infliximab, were observed with regard to BMD loss after 1 year of treatment. Joint damage at baseline and joint damage progression according to the Sharp-van der Heijde score were independently associated with more BMD loss after 1 year. The use of bisphosphonates independently protected against BMD loss.

                        Conclusion: After 1 year of follow-up in the BeSt study, we did not find differences in BMD loss between the four treatment strategies, including high dose of corticosteroids and anti-TNFα. Joint damage and joint damage progression are predictors of high BMD loss, which emphasizes that BMD loss and erosive RA have common pathways in their pathogenesis.

                        • bone mineral density
                        • corticosteroids
                        • early rheumatoid arthritis
                        • infliximab

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