title: A 1-year case-control study in patients with rheumatoid arthritis indicates prevention of loss of bone mineral density in both responders and nonresponders to infliximab.
abstract: The goal of the present study was to record changes in bone mineral density (BMD) and markers of bone turnover in patients with rheumatoid arthritis (RA) who were treated with methotrexate combined (or not combined) with infliximab. Included were 90 patients with RA who required anti-TNF-alpha therapy with infliximab because of persistent active disease despite treatment with methotrexate. The historical control group included 99 patients with RA who were treated with methotrexate at a time when anti-TNF-alpha treatment was not yet available. Lumbar and femoral neck BMD was measured using dual energy X-ray absorptiometry at baseline and 1 year later. Osteocalcin, C-terminal cross-linked telopeptide of type I collagen, parathyroid hormone and 25-hydroxycholecalciferol were measured in plasma at baseline and 1 year later. At 1 year BMD had decreased in the control group at spine (P < 0.01) and femoral neck (P < 0.001). In contrast, BMD at spine and femoral neck did not change after 1 year of infliximab treatment. At the same time point, no change in bone remodelling markers was observed. No association was observed between clinical response and changes in BMD, indicating that even those who did not respond clinically did not lose bone over a 1-year period. These data confirm the BMD decrease observed in RA patients treated with methotrexate alone. This bone loss was prevented by infliximab therapy. Importantly, this beneficial effect was also observed in apparent nonresponders.
authors.affiliation: Hospices Civils de Lyon-bioMérieux Research Unit on Rheumatoid Arthritis, Hopital Edouard Herriot, place d'Arsonval, 69437 Lyon Cedex 03, France. hubertmarotte@tele2.fr.
authors.forename: Hubert
authors.initials: H
authors.lastname: Marotte
authors.forename: Beatrice
authors.initials: B
authors.lastname: Pallot-Prades
authors.forename: Laurent
authors.initials: L
authors.lastname: Grange
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Christian
authors.initials: C
authors.lastname: Alexandre
authors.forename: Pierre
authors.initials: P
authors.lastname: Miossec
mesh_terms: D015502:Absorptiometry, Photon; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects*; D016022:Case-Control Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D010281:Parathyroid Hormone; D015675:Osteocalcin; D000069285:Infliximab; D008727:Methotrexate