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.