Background/Purpose: Osteoporosis is a well-known extra articular manifestation in rheumatoid arthritis (RA). In RA biologic disease modifying anti rheumatic drugs (DMARDs) has been shown to be superior to synthetic DMARDs to reduce bone destruction including generalized bone loss. Our aim was primarily to study short- and long term changes in bone mineral density (BMD) at hip and lumbar spine in patients with early RA followed in the biologic treatment era.

Methods: RA patients with early disease diagnosed at an out-patient clinic between 1999 and 2001 were consecutively enrolled in the study. Demographic, disease and treatment data were collected at standard visits. Dual energy X-ray absorptiometry at hip and spine L1-4 was performed at baseline and after 2, 5 and 10 years.

Results: At baseline mean age (SD) in the 92 RA patients was 50.9 (13.3) years, symptom duration 12.4 (6.7) months, 62.0% were women, 66.3% were RF positive and 65.9%% were CCP positive. In the first 2 years ever use of biologic DMARDs was 18.5%, synthetic DMARDs 91.3% and prednisolone 62.0% whereas the figures for the subsequent 8 years were 62.6%, 51.4% and 89.2%, respectively. Baseline, mean values for 0-2 years and 2-10 years follow up was for ESR mm/hr 30 (21), 21 (12) and 13 (7), for CRP mg/dl 29 (34), 19 (15) and 8 (7), for DAS28 5.2, 4.2 and 2.9 and for MHAQ 0.68 (0.51), 0.42 (0.30) and 0.27 (0.27). 

The annual rate of BMD loss in the first 2 years and in the subsequent 8 years was at femoral neck -1.00% vs. -0.56%, at total hip -0.96% vs. -0.41% and at spine L1-4 -0.42% vs. 0.00%. The corresponding figures at femoral neck, total hip and spine L1-4 were in men -0.89% vs. -0.29%, -1.01% vs. -0.07% and -0.20% vs. 0.76%, in pre-menopausal women -0.93% vs. -0.39%, -1.20% vs. -0.11% and -0.42% vs. -0.06% and in post-menopausal women -0.75% vs. -0.91%, -0.74% vs. -0.85% and -0.49% vs. -0.61%.

Conclusion: Our study adds evidence that aggressive anti-inflammatory treatment in particular with biologics reduces the rate of bone loss in RA down to a level reported in the general population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/osteoporosis-in-rheumatoid-arthritis-still-a-threat-in-the-biologic-era/