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Zoledronic acid does not reduce MRI erosive progression in PsA but may suppress bone oedema: the Zoledronic Acid in Psoriatic Arthritis (ZAPA) Study
  1. Fiona McQueen1,2,
  2. Richard Lloyd1,
  3. Anthony Doyle1,2,
  4. Elizabeth Robinson1,
  5. Maria Lobo2,
  6. Melissa Exeter2,
  7. William J Taylor3,4,
  8. Peter Jones1,
  9. Ian R Reid1,2,
  10. Nicola Dalbeth1,2
  1. 1Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
  2. 2Auckland District Health Board, Auckland, New Zealand
  3. 3University of Otago, Wellington, New Zealand
  4. 4Hutt Valley District Health Board, Lower Hutt, New Zealand
  1. Correspondence to Professor Fiona McQueen, Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand; f.mcqueen{at}


Background The effect of zoledronic acid (ZA) on articular bone in patients with psoriatic arthritis (PsA) was investigated using MRI.

Methods Patients with erosive PsA were randomised to receive 3-monthly infusions of ZA or placebo for 1 year. An additional ‘tests alone’ group received no infusions. Clinical assessments and MRI scans were performed at baseline and 1 year.

Results Paired 1.5T MRI scans were available in 22 patients including 6 who received ZA and 16 who did not (non-ZA = 6 placebo + 10 ‘tests alone’ patients). The Disease Activity Score (28 swollen and tender joints, C reactive protein fell over 12 months to a greater degree in patients on ZA than in non-ZA patients (−1.6 vs −0.3, p=0.023). The MRI bone oedema score decreased in the ZA group (15.5 to 8.5) but increased in the non-ZA group (14.0 to 18.0) (p= 0.0056) with regression of bone oedema at 13.5% of sites in ZA patients vs 1.3% in non-ZA patients (p = 0.0073) and progression in 1.3% of sites in ZA patients vs 6.9% in non-ZA patients (p = 0.072). There was no difference between groups in change in MRI erosion score.

Conclusions In this pilot study ZA reduced the progression of MRI bone oedema, indicating probable suppression of osteitis concordant with reduction in clinical measures of disease activity.

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  • Funding This investigator-initiated study was funded by the Auckland Medical Research Foundation. Novartis supplied the study drug and an unrestricted educational grant. Richard Lloyd (biomedical science student) was sponsored by this grant for a summer studentship.

  • Ethics approval This study was conducted with the approval of the New Zealand Multiregion Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.