Session Type: Abstract Submissions (ACR)
Background/Purpose: Periarticular bone loss is an early feature of both psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Digital X-ray radiogrammetry (DXR) is a sensitive method for quantifying changes in periarticular bone mineral density (DXR-BMD) in the early phase of the disease. Only a few studies have examined the effect of anti-rheumatic drugs on hand bone loss as measured by DXR in RA and even less in PsA. To our knowledge there is no prospective study designed for capturing differences in hand bone loss between recent onset PsA and RA patients following intervention with anti-rheumatic treatments.
The aim of this study was to: (1) investigate DXR-BMD changes in early PsA and RA prior to and 3 and 12 months after introducing an anti-rheumatic drug; and (2) to explore associations between disease-related variables and DXR-BMD.
Methods: Recent-onset (<12 months), treatment naive PsA and RA patients with active disease were recruited. Hand BMD was assessed by DXR calculated from digitized radiographs (Sectra, Sweden) measuring the cortical thickness of the 2nd, 3rd and 4th metacarpal bones. Mean DXR-BMD (mg/cm2) values and changes from baseline in DXR-BMD (mg/cm2/month) were calculated and compared between the two groups at baseline, 3 and 12 months. Clinical parameters were correlated with DXR-BMD including ESR, CRP, TJC, SJC, DAS28-CRP4v and HAQ.
Results: 64 patients (31 PsA, 33 RA) were included with median age 43 years (18-71). 96.6% of the patients were commenced on a DMARD therapy (93.2% methotrexate) at baseline; 18.6% of the patients (12.1% of RA; 19% of PsA) were also started on a TNF inhibitor.
Mean DXR-BMD was significantly higher in PsA at 12 months compared to 3 months (p=0.0137). In contrast mean DXR-BMD was lower in RA at both 3 and 12 months compared to baseline (p=0.0347 and p=0.0302) and at 12 months compared to 3 months (p=0.0159). Highly elevated bone loss (>2.5 mg/cm2/month) was only present in the RA cohort (6%). Changes from baseline and 3 months to 12 months were significantly less marked in PsA compared to RA (p=0.0084 and p=0.004). Similarly, comparing treatment responders only, changes from baseline to 12 months were less marked in the PsA responder group (p=0.0209). Disease activity scores were lower in PsA than in RA at all time points reaching significance at baseline and 3 months. ESR, CRP, TJC, SJC, DAS28-CRP4v and HAQ improved significantly in both diseases during the study. Mean DXR-BMD correlated with ESR at 3 months in PsA (r = -0.59; p= 0.013) and with CRP at baseline in RA (r = -0.448; p= 0.025). Similarly, significant inverse correlations were found between mean DXR-BMD and ESR and CRP at baseline in the entire group.
Conclusion: Hand bone loss is arrested by 12 months of intervention of appropriate DMARD therapy in PsA but not in RA. Higher disease activity is associated with accelerated cortical bone loss in both diseases. Changes in DXR-BMD were less marked in PsA supporting the hypothesis of different pathogenetic mechanisms being involved in hand bone resorption/formation balance in PsA.
Abbott Laboratories Ireland,
E. J. Heffernan,
O. M. FitzGerald,
Abbott Laboratories Ireland, Bristol-Myers Squibb,
Abbott Laboratories Ireland, UCB,
Abbott Laboratories Ireland,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hand-bone-loss-is-arrested-in-early-psoriatic-arthritis-but-not-in-rheumatoid-arthritis-following-anti-rheumatic-treatment-assessed-by-digital-x-ray-radiogrammetry/