Background/Purpose:

Rheumatoid arthritis is the most common joint inflammatory disease associated with an increased risk of bone fractures. The standard of therapeutic strategy is to achieve remission of the disease, which may require a combination of treatment including anti-TNFa therapy and long-term glucocorticoids (GC). While the former has already shown a beneficial effect on bone loss in RA patients, use of GC has two paradoxical effects: it can effectively reduce arthritis and inflammation-induced bone loss while it can also impair bone remodelling balance which results in bone loss. Moreover, GC-induced bone fragility may occur rapidly suggesting deleterious effects on the cortical envelope together with reduced trabecular bone volume. The objective of this study was to assess the effects of GC persistence in RA patients with TNFa blockers on cortical porosity.

Methods:

In this pilot study, we selected a group of RA patients in the mid-age range, excluding those below 18 and above 65 years old, with neither concomitant bone disease nor endocrinopathy, to avoid any alteration of bone status unrelated to RA. We enrolled 6 RA patients requiring anti-TNFa therapy because of a methotrexate non-responding disease.

Porosity was assessed by High Resolution Peripheral Quantitative Computerized Tomography (HRpQCT) on radius at the diaphysis site before, 6 and 12 months after introducing anti-TNFa therapy. At the same time, bone mineral density (BMD) was assessed at the radial distal site.

Results:

These 8 RA patients (4 men and 4 women) shared the usual characteristic of RA patients with a median age of 49.5 years (range: 35.8-62.4), median disease duration of 3 years (1-11), and a median DAS28 of 4.8 (3.9-6.1) with elevated biological inflammation (ESR: 25 mm/hr (9-68) and CRP at 27.1 mg/L (3-68). Rheumatoid factor and ACPA were present in 71%. Four of the 8 RA patients received GC therapy at the inclusion.

While BMD remained stable under treatment, we observed an increasing of cortical porosity between baseline and 12 month (P<0.05). Doses of GC therapy during the 6 last months correlated with the increasing of porosity in the same time (P=0.042; R=0.653), whereas we observe no correlation during the 6 first months (P=0.34; R=0.122). 

Conclusion:

Despite the small sample size of this pilot study, the strong difference between the 2 periods infers that the anti-inflammatory effects of GC participate to the beneficial effects of therapy on bone while persistence of GC on the long term contribute to bone damage with increasing cortical porosity.

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« Back to ACR/ARHP Annual Meeting 2013

ACR Meeting Abstracts - https://acrabstracts.org/abstract/negative-effect-of-glucocorticoids-persistence-therapy-on-porosity-in-rheumatoid-arthritis-patients-treated-with-tnf%ce%b1-blockers/