Increase in bone mineral density of patients with rheumatoid arthritis treated with anti-TNF-{alpha} antibody: a prospective open-label pilot study

[Guest guest]

Rheumatology (Oxford). 2005 Nov 1; [Epub ahead of print]

Increase in bone mineral density of patients with rheumatoid

arthritis treated with anti-TNF-{alpha} antibody: a prospective open-

label pilot study.

Lange U, Teichmann J, Muller-Ladner U, Strunk J.

Kerckhoff Clinic and Foundation, Department of Rheumatology, Clinical

Immunology and Osteology, Bad Nauheim, University of Giessen,

Giessen, Germany.

Objective. To determine the changes in bone mineral density (BMD) in

patients with rheumatoid arthritis (RA; without osteoporosis) treated

with infliximab. Methods. Twenty-six patients (19 women, seven men)

aged 54.2 yr (range 27-75), with persistently active RA despite a

high dose of non-steroidal anti-inflammatory drugs and/or treatment

with methotrexate or leflunomide, were studied. Mean duration of

disease was 9.8 yr. Patients receiving or having received

bisphosphonates or hormone replacement therapy were excluded. The

patients were treated with 3.5 mg/kg infliximab at weeks 0, 2, 6 and

then every 6-8 weeks. Lumbar and femoral BMD was measured by dual-

energy X-ray absorptiometry at baseline and 12 months later. Serum

osteocalcin and serum crosslaps were measured at baseline (week 0)

and after 12 months. Twelve patients were taking calcium (1 g/day)

and vitamin D (800 IU/day). Twenty patients were receiving

methotrexate (mean dose 12.5 mg/day), six patients were receiving

leflunomide (mean dose 20 mg/day) and nine patients were

concomitantly receiving corticosteroids at a mean daily dose of 10

mg. Results. After 12 months of infliximab therapy, there was a

significant increase in BMD in the spine (BMD, P<0.001; T-score,

P<0.001; Z-score, P<0.001) and the femoral neck (BMD, P<0.001; T-

score, P<0.001; Z-score, P<0.01). With regard to the root mean square

average, there was a significant increase in BMD at the left femoral

neck (11.6% for a root mean square of 6%) but only a trend towards

improvement in the spine (2.7% for a root mean square of 4%) during

the study period. There was a significant increase in osteocalcin

serum levels between baseline and after 12 months (P<0.01) and a

significant decrease in the marker for bone resorption (P<0.01) but

no change in serum calcium was observed. However, the changes in

markers of bone metabolism and BMD were not correlated. Conclusion.

The data support the hypothesis that anti-TNF therapy may exert

beneficial effects on bone metabolism in RA patients.

PMID: 16263785 [PubMed - as supplied by publisher]