Bone Anabolic Changes Progress in Psa Patients Despite Treatment with Methotrexate or Tumour Necrosis Factor Inhibitors

Stephanie Finzel¹, Sebastian Kraus¹, Sarah Schmidt¹, Axel J. Hueber², Juergen Rech³, Klaus Engelke⁴, Matthias Englbrecht¹ and Georg Schett¹, ¹Dept of Medicine 3, Rheumatology and Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ²Department of Internal Medicine 3 and Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany, ³Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany, ⁴Institute of Medical Physics, University of Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Computed tomography (CT), methotrexate (MTX), osteophytosis, psoriatic arthritis and tumor necrosis factor (TNF)

Session Information

Title: Imaging of Rheumatic Diseases III: Computed Tomography

Session Type: Abstract Submissions (ACR)

Background/Purpose: To investigate whether methotrexate (MTX) or tumour necrosis factor inhibition (TNFi) affect osteophyte formation in patients with psoriatic arthritis (PsA).

Methods: 41 patients with PsA were examined for the presence of osteophytes and erosions at the metacarpophalangeal joints by high-resolution µCT imaging. The size of each individual lesion was quantified at baseline and 1-year follow-up in PsA patients treated with TNFi (N=28) or methotrexate (N=13). Groups were comparable for age, sex, disease duration and activity and baseline burden of osteophytes.

Results: In total, 415 osteophytes (TNFi: N= 284, MTX: N= 131) were detected. Osteophyte size increased significantly from baseline to follow-up in the TNFi group (mean ± SEM change: +0.23 ± 0.02 mm; p<0.0001) and the MTX group (+0.27 ± 0.03 mm, p<0.0001). In both treatment groups, the majority of osteophytes showed progression (TNFi: 54.3% MTX: 61.1%), whereas regression of lesions was rare (less than 10%). In contrast to osteophytes, clinical disease activity decreased in both groups of PsA patients and erosions showed an arrest of progression in both groups.

Conclusion: Osteophytes progress in PsA patients treated with either MTX or TNFi. These data provide first evidence that pathologic bone formation in the appendicular skeleton of patients with PsA is not affected by current anti-rheumatic treatment strategies.

Disclosure:

S. Finzel,
None;

S. Kraus,
None;

S. Schmidt,
None;

A. J. Hueber,
None;

J. Rech,
None;

K. Engelke,
None;

M. Englbrecht,
None;

G. Schett,
None.

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