Background/Purpose: To describe effects on bone mineral density (BMD) of treatment according to EULAR guidelines with a methotrexate-based tight control strategy including 10 mg prednisone daily versus the same strategy without prednisone in early rheumatoid arthritis (RA) patients, who received preventive therapy for osteoporosis.

Methods: Early RA patients were included in the CAMERA-II trial: a randomized, placebo-controlled, double-blind two-year trial, in which effects of addition of 10 mg prednisone daily to a methotrexate-based tight control strategy were studied. All patients received calcium, and a bisphosphonate. Disease activity was assessed every four weeks. X-rays of hands and feet and dual-energy X-ray absorptiometry of lumbar spine and left hip were performed at baseline, and after one and two years of treatment.

Results: The BMD increased significantly over time in both treatment groups at the lumbar spine with a mean of 2.6 percent during the first year (p < 0.001), but not at the hip; at none of the time points the BMD differed significantly between the prednisone and placebo group. Higher age and lower weight at baseline, and higher disease activity scores during the trial, but not glucocorticoid therapy, were associated with a lower BMD at both the lumbar spine and the hip in mixed model analyses.

Conclusion: Addition of 10 mg prednisone daily to a methotrexate-based tight control strategy does not lead to bone loss in early RA patients on bisphosphonates. A small increase in lumbar BMD during the first year of treatment was found, regardless of the use of glucocorticoids.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-changes-in-bone-mineral-density-different-between-groups-of-early-rheumatoid-arthritis-patients-treated-according-to-a-tight-control-strategy-with-or-without-prednisone-if-osteoporosis-prophylaxi/