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Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis
  1. M Güler-Yüksel1,
  2. J Bijsterbosch1,
  3. Y P M Goekoop-Ruiterman1,
  4. J K de Vries-Bouwstra2,
  5. H M J Hulsmans3,
  6. W M de Beus4,
  7. K H Han5,
  8. F C Breedveld1,
  9. B A C Dijkmans2,6,7,
  10. C F Allaart1,
  11. W F Lems2,6,7
  1. 1
    Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2
    Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
  3. 3
    Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
  4. 4
    Department of Rheumatology, Medical Center Haaglanden, The Hague, The Netherlands
  5. 5
    Department of Rheumatology, Medical Center Rijnmond-Zuid, Rotterdam, The Netherlands
  6. 6
    Department of Rheumatology, Slotervaart Hospital, Amsterdam, The Netherlands
  7. 7
    Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  1. M Güler-Yüksel, MD, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands; m.yuksel{at}


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 patients with recent onset RA 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 the treatment groups, including corticosteroids and the anti-tumour necrosis factor-α 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.

Conclusions: 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 doses of corticosteroids and anti-tumour necrosis factor-α. Joint damage and joint damage progression are associated with high BMD loss, which emphasises that BMD loss and erosive RA have common pathways in their pathogenesis.

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  • Funding: The BeSt trial was supported by a grant of the Dutch College for Health Insurance Companies (CVZ). Schering Plough and Centocor provided additional funding. The funding sources were not involved in the design of the study, the collection, analysis and interpretation of the data, the writing of the report or the decision to submit the paper for publication.

  • Competing interests: FCB did a paid expert testimony for Centocor in 1996 and was a paid speaker in a Schering Plough sponsored symposia. CFA was a paid speaker in a Schering Plough sponsored symposium in 2006.