Background Postmenopausal period associated with functional change in different systems, including bone remodeling. We postulated that INITIAL low bone mineral density (BMD) s can influence on mechanism of focal bone erosion formation and radiological progression.
Objectives To evaluate radiological progression in patients with early rheumatoid arthritis ( RA) after 1 year treated with disease modifying anti-rheumatic drugs (DMARDs).
Methods 60 postmenopausal women; age range, 48-81 years; disease duration 21,90 ±10,44 weeks; duration of postmenopause - 5,97±2,13 years, low BMD (L1-L4)-0,95±0,13 g/sm2 were enrolled in this study. Patients were treated by DMARDs: 70,0% methotrexate 18,3% sulfasalazine and 11,7% leflunomide plus 5-10 mg/day prednisolone (3-6 months) plus calcium (1500 mg/day), vitamin D(400-800 ME) and alendronate 70 mg/week. 33 postmenopausal women, age range, 44-73 years with early RA; disease durations 15,40±6, 15 weeks, duration of postmenopause - 6,15±2,12 years, normal BMD (L1-L4)-1,25±0,15 g/sm2 were considered as comparison group. Radiological progression estimated according to the van der Heijde modified Sharp score. Erosion scores (ES), Joint Space Narrowing scores (JSNS) and modifications of Total Sharp scores (mTSS) were included.
Results mTSS through 6 and 12 months in RA patients with low BMD was 19,93 ±6,90-baseline; 30,48 ±14,31 and 35,78 ±14,75 – in 6 and 12 months; р0;6=0,006; р6;12=0,095; p0,12=0,00048. mTSS in RA postmenopausal patients with normal BMD was 13,80 ±6,25-baseline; 25,40 ±11,62 and 30,91 ±6,75 – in 6 and 12 months; р0;6=0,0052; р6;12=0,055; p0,12=0,00048. mTSS with low BMD was significantly higher comparison group patients through 6 and 12 months (р=0,048; р=0,047). We revealed JSNS progression through 6 and 12 months in RA postmenopausal patients with low BMD compared baseline (р0;6=0,0001; р0;12=0,046) and in comparison group (р0;6=0,0031; р0;12=0,0138). Comparison JSNS in RA postmenopausal patients with normal and low BMD through 6 and 12 months was non statistical significantly. ES was significantly higher through 6 and 12 months compared baseline (р0;6=0,0167; р0;12=0,039) and in comparison group was significantly higher through 12 months (р0;6=0,49; р0;12=0,0148). ES with low BMD was significantly higher comparison group through 12 months (р0,12=0,047) Level of ES was significantly higher comparison group patients through 6 and 12). We estimate significantly higher increase erosion rate/year in RA postmenopausal patients with initial low BMD versus comparison group (1,39±0,85 versus 0,61 ±0,65; p=0,037)
Conclusions All of the patients (with initial low and normal BMD) treated with DMARDs and calcium plus vitamin D and alendronate during one year had radiological progression according to mTSS. RA patients with initial low BMD have more significantly higher increase erosion rate/year.
Disclosure of Interest None Declared
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