Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Zoledronic Acid Does Not Reduce Erosive Progression in PsA but May Suppress MRI Bone Oedema.

Lloyd3,  Richard, Doyle3,  Anthony, Dalbeth3,  Nicola, Lobo1,  Maria, Robinson5,  Elizabeth, Taylor6,  William, Jones2,  Peter

Auckland District Health Board
QEHealth
Univ of Auckland
Univ of Auckland Sch of Med, Auckland, New Zealand
University of Auckland
University of Otago

Magnetic resonance imaging (MRI) can reveal bone pathology in psoriatic arthritis (PsA). Zoledronic acid (ZA) inhibits osteoclast maturation, recruitment to sites of bone resorption and mature osteoclast function. We sought to investigate its effect on bone pathology in PsA using MRI scanning.

Methods:

26 PsA patients (mean age 49 yrs, disease duration 15 yrs) received either 4mg of zoledronic acid (ZA) IV 3 monthly for 1 year or placebo in a blinded manner. A second control group received MRI scans alone (no drug/placebo due to patient concern about risk of side-effects). Paired baseline and 1 year 1.5T MRI scans of the dominant wrist and fingers, using sequences as published (1), were available in 6 ZA and 16 non-ZA (6 placebo) patients for further analysis.

Results:

Median MRI erosion scores increased over 12 months but did not differ between groups (ZA group, 35.0 to 39.5; non-ZA group 44.5 to 45.5). However, bone edema scores decreased in the ZA group (15.5 to 8.5) but increased in the non-ZA group (14.0 to 18.0) (p= 0.0056). A site-by-site analysis (maximum of 38 sites for bone oedema and erosion per patient) revealed regression of bone edema at 13.5% of sites in the ZA group compared with 1.3% of sites in the non-ZA group (p = 0.0073) and progression in 1.3% ZA patients compared with 6.9% non-ZA patients (p = 0.072). For bone erosion there was progression at 5.5% of sites in the ZA patients compared with 5.3% in non-ZA patients and regression in 2.6% and 0% of sites respectively (p = NS for all). Bone sites are shown coded as follows: bone edema regression (red), progression (green) and no change (yellow) in 1) a ZA patient and 2) a non-ZA patient.

Conclusions:

In this pilot study, there was no evidence that ZA influenced the progression of bone erosions in PsA. However, bone edema scores and number of involved sites fell over 1 year in ZA-treated patients, indicating potential suppression of osteitis. Further studies may be indicated to explore the therapeutic effect of ZA in PsA.

1)Tan,  et al. Arthritis Research & Therapy.. 2003;24(11):11(1):R2, 2009.

To cite this abstract, please use the following information:
Lloyd, Richard, Doyle, Anthony, Dalbeth, Nicola, Lobo, Maria, Robinson, Elizabeth, Taylor, William, et al; Zoledronic Acid Does Not Reduce Erosive Progression in PsA but May Suppress MRI Bone Oedema. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1372
DOI: 10.1002/art.29138

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