Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Hand Bone Mineral Density (BMD) Loss Is Significantly Associated with the Level of Disease Activity in Patients with Rheumatoid Arthritis (RA)
Guler-Yuksel1, M., Klarenbeek1, N.B., Grillet2, B.A.M., Speyer3, I., Huizinga1, T.W.J., Dijkmans4, B. A. C., Allaart1, C.F.
To investigate the differences in changes in hand BMD after 1 year between RA patients with high and low disease activity and patients in remission, with or without anti-rheumatic drugs.
145 patients with active early RA, dynamically treated with anti-rheumatic drugs in a DAS<2.4 steered setting in the BeSt study, were included in this study. The patients were divided in 4 groups based on disease activity level during 1 year follow-up: 1. continuous high disease activity (DAS>2.4), 2. moderate disease activity (1.6<=DAS<=2.4), 3. in remission (DAS<1.6) with anti-rheumatic drugs and 4. drug-free remission. Changes in cortical BMD in metacarpals 24 of both hands after 1 year were measured by digital X-ray radiogrammetry (Sectra, Sweden). Changes in BMD were divided in 3 groups: 1. accelerated BMD loss (>-0.003 gr/cm2), 2. stable BMD (-0.003 to 0.003 gr/cm2) and 3. gain in BMD (>-0.003 gr/cm2).
Multivariate multinomial regression analyses were performed to examine the differences in changes in hand BMD between the 4 different disease activity groups, adjusted for age, sex, body mass index, smoking status, diagnosis duration, baseline BMD and DAS, anti-rheumatic and anti-resorptive (bisphosphonates, calcium, vitamin D and hormone replacement) treatment and presence of rheumatoid factor and anti-CCP.
Patients (68% women, mean age 57 years) had at baseline a mean disease duration of 63 weeks and 3 erosions in hands and feet. The mean BMD loss in patients in remission, with or without drugs, was significantly lower than in patients with moderate or high disease activity (overall p<0.0001, table). The differences in mean BMD loss between patients in remission with and without drugs were not significant, as well as between patients with moderate and high disease activity. On patient level, patients in remission had significant less often accelerated BMD loss and more often gain in BMD than patients with disease activity (overall p=0.003, table). In multivariate analyses patients in remission had significant more often gain in BMD than patients with high disease activity with an OR (95% CI) of 7.7 (1.248) independent of confounders.
Table. Changes in hand BMD, in mean (SD) and divided in 3 groups, after 1 year in patients with high and low disease activity and patients in remission, with or without anti-rheumatic drugs
|Group 1. DAS>2.4||Group 2. 1.6<=DAS<=2.4||Group 3. DAS<1.6 with anti-rheumatic drugs||Group 4. Drug-free DAS<1.6|
|Mean (SD) changes in BMD, % of baseline BMD||-0.031 (0.042)||-0.021 (0.025)||-0.0045 (0.020)||-0.0020 (0.013)|
|Accelerated BMD loss (>-0.003 gr/cm2), %||70.0||70.3||38.7||48.1|
|stable BMD (-0.003 to 0.003 gr/cm2), %||24.0||18.9||29.0||14.8|
|gain in BMD (>-0.003 gr/cm2), %||6.0||10.8||32.3||37.0|
Hand BMD loss is substantially lower in RA patients in continuous remission compared to patients with continuous disease activity. Furthermore one third of the patients in remission are gaining in their hand BMD, suggesting that to stop or prevent inflammatory hand BMD loss the target of treatment should be DAS<1.6.
To cite this abstract, please use the following information:
Guler-Yuksel, M., Klarenbeek, N.B., Grillet, B.A.M., Speyer, I., Huizinga, T.W.J., Dijkmans, B. A. C., et al; Hand Bone Mineral Density (BMD) Loss Is Significantly Associated with the Level of Disease Activity in Patients with Rheumatoid Arthritis (RA) [abstract]. Arthritis Rheum 2009;60 Suppl 10 :357