Background Glucocorticoids (GCs) are frequently used in the treatment of Rheumatoid Arthritis (RA). Studies in humans about the effects on bone turnover markers and modulators are poor, and results are discordant and controverse, probably because conducted with different doses and underlying diseases.
Objectives To evaluate changes in serum bone turnover markers and Wnt inhibitors at 7- and 30-days after initiation of low dose GCs treatment of early RA.
Methods 27 adult patients suffering from early RA were prospectively enrolled. Blood tests including C-Reactive Protein (CRP), amino-terminal propeptide of type 1 procollagen (P1NP, marker of bone formation), carboxy-terminal telopeptide of type 1 collagen (CTX, marker of bone resorption), Sclerostin, and Dickkopf-related protein 1 (DKK1) were detected at baseline and 7 and 30 days after starting low dose of GC (methylprednisolone 4 mg/day).
Results At baseline we observed a significant positive correlation between CRP and DKK1 serum levels (r=0,63; p<0,05) and between DKK1 and CTX serum levels (r =0,38; p<0,05). A significant decrease in serum levels of CRP, P1NP, and Sclerostin was observed after 7 and 30 days of GC treatment (p<0,05). About DKK1, it has been detected a not significant tendency to decrease after starting GC. CTX serum levels showed no significant changes.
Conclusions This study has shown that a low dose GC treatment might have complex and conflicting short-term effects on bone metabolism in early RA (a reduction of bone formation, without increase of bone resorption), different from those observed with higher dose, in other diseases or in healthy subjects. The observed decrease in P1NP and Sclerostin serum levels might mean that also low dose of GC could acutely suppress bone formation and induce loss of function and/or number of osteocytes.
Disclosure of Interest None declared
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