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Bone loss in active early rheumatoid arthritis patients treated with infliximab and methotrexate compared with methotrexate treatment alone. Explorative analysis from a twelve-month randomized, double blind, placebo-controlled study
  1. G Haugeberg (glenn.haugeberg{at}sshf.no)
  1. Sørlandet Hospital, Norway
    1. P G Conaghan (p.conaghan{at}leeds.ac.uk)
    1. University of Leeds, United Kingdom
      1. M Quinn
      1. University of Leeds, United Kingdom
        1. P Emery (p.emery{at}leeds.ac.uk)
        1. University of Leeds, United Kingdom

          Abstract

          Objective: To examine the effect of infliximab plus methotrexate (MTX) compared with placebo plus MTX on bone loss in early rheumatoid arthritis (RA) patients in a double blind randomised study design. Further to explore the associations between bone loss and markers of RA disease.

          Methods: All 20 RA patients (ten patients in each treatment group) had active, early RA. Bone mineral density (BMD) was assessed at hand, lumbar spine (L2-4) and hip by dual energy x-ray absorptiometry (DXA) at baseline and 12 months follow-up. Clinical data was collected at regular visits.

          Results: BMD loss was significantly reduced in the infliximab group compared with the placebo group at femoral neck (-0.35% vs. -3.43%, P=0.01) and total hip (-0.23% vs. -2.62%, P=0.03) but not at hand (-2.09% vs. -2.82%, P=0.82) and spine (-0.75% vs. -1.77%, P=0.71). Measures of disease process and joint damage were found to be independently associated with bone loss.

          Conclusions: This study provides strong evidence of a causal link between inflammation and bone loss in RA. The anti-inflammatory effect of infliximab was potent enough to arrest inflammatory bone loss at hip but not at spine and hand.

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