Bone Mineral Density Changes During Treatment of Rheumatoid Arthritis with Disease-modifying-anti-rheumatic Drugs

Background: Bone mineral density (BMD) changes during the course of rheumatoid arthritis (RA). The present study was designed to investigate the status of BMD in patients with RA treated with anti-rheumatic drugs.

Methods: BMD at the femoral neck (FN-BMD) and lumbar spine (LS-BMD) were measured by dual energy x-ray absorptiometry (DXA) method using Norland densitometer. Disease activity (DA) was assessed by calculation of DAS28 score. The patients with at least twice BMD measurements were included and those who received treatment for osteoporosis were excluded. The mean FN-BMD and LS-BMD changes from baseline between the two BMD measurements was determined.

Results: Nineteen patients (17 females, 2 males) with the mean age of 54.5±7.7 years, with mean disease duration of 141.8±58 months were treated for an average period of 2.9±1.9 years. All the patients were treated with low-dose methotrexate (MTX) up to 15 mg/week alone or with combination of hydroxychloroquine and/or sulfasalazine and 5 mg prednisolone daily. At the end of study period, the value of FN-BMD gr/cm2 decreased by - 4.24% (p=0.12) and LS-BMD gr/cm2 by - 6.57% (p=0.009). The mean FN BMD Z-score increased by +7.66% (p=0.64) and LS-BMD Z-score decreased by - 14.7% (p=0.120).

Conclusion: The findings of this study indicate that bone loss in RA continues despite anti-inflammatory treatment. The lower rate of bone loss from FN compared with LS may be attributed to suppression of hip synovitis with anti-inflammatory treatment.