RT Journal Article
SR Electronic
T1 Periarticular and generalised bone loss in patients with early rheumatoid arthritis: influence of alendronate and intra-articular glucocorticoid treatment. Post hoc analyses from the CIMESTRA trial
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1123
OP 1129
DO 10.1136/annrheumdis-2012-203171
VO 73
IS 6
A1 T W Jensen
A1 M S Hansen
A1 K Hørslev-Petersen
A1 L Hyldstrup
A1 B Abrahamsen
A1 B Langdahl
A1 B Zerahn
A1 J Pødenphant
A1 K Stengaard-Petersen
A1 P Junker
A1 M Østergaard
A1 T Lottenburger
A1 T Ellingsen
A1 L S Andersen
A1 I Hansen
A1 H Skjødt
A1 J K Pedersen
A1 U B Lauridsen
A1 A J Svendsen
A1 U Tarp
A1 H Lindegaard
A1 Anne Grethe Jurik
A1 Aage Vestergaard
A1 M L Hetland
A1 the Cimestra study group
YR 2014
UL http://ard.bmj.com/content/73/6/1123.abstract
AB Objectives The aims of this study were to investigate the influence of alendronate and intra-articular betamethasone treatment on bone mineral density (BMD) changes in hand, lumbar spine and femoral neck during 1 year of a treat-to-target study (Cyclosporine, Methotrexate, Steroid in RA (CIMESTRA)). Patients and methods A hundred and sixty patients with early, active rheumatoid arthritis (RA) received methotrexate, intra-articular betamethasone and ciclosporin /placebo-ciclosporin. Patients with Z-score ≤0 also started alendronate 10 mg/day. BMD of the hand (digital x-ray radiogrammetry (DXR-BMDhand)), BMD of lumbar spine and femoral neck (dual x-ray absorptiometry (DXA-BMDlumbar spine and DXA-BMDfemoral neck)) and x-rays of hands, wrists and forefeet (modified Sharp-van der Heijde score) were measured at baseline and 1 year, with complete data available in 107 patients. Results The change in BMD in hand, lumbar spine and femoral neck was negatively associated with the dose of intra-articular betamethasone (p<0.01 for all), but the bone loss in hand was modest and in the axial skeleton comparable with that of healthy individuals. Alendronate did not influence changes in DXR-BMDhand, which averaged −2.8%, whereas significant changes were observed in DXA-BMDlumbar spine and DXA-BMDfemoral neck in alendronate-treated patients (1.8% and 0.8%) compared with untreated patients (–1.8% and –2.2%) (p<0.01 and 0.02). Alendronate did not affect the radiographic progression (alendronate-treated patients: 0 (range 0–19), non-alendronate: 0 (0–18)). Conclusions In early active RA, intra-articular betamethasone injections added to disease-modifying antirheumatic drug (DMARD) treatment led to minimal loss of hip and lumbar BMD, and the loss could be prevented by treatment with alendronate. Alendronate treatment did not affect radiographic progression.