title: Changes in bone mineral density in patients with recent onset, active rheumatoid arthritis.
abstract: OBJECTIVE
  We examined the effects of four different treatment strategies on bone mineral density (BMD) in patients with recently diagnosed, active rheumatoid arthritis (RA) and the influence of disease-related and demographic factors on BMD loss after 1 year of follow-up in the BeSt trial.
  
  
  METHODS
  BMD measurements of the lumbar spine and total hip were performed in 342 patients with recent onset RA at baseline and after 1 year. Multivariable regression analyses were performed to determine independent associations between disease and demographic parameters and BMD loss after 1 year.
  
  
  RESULTS
  Median BMD loss after 1 year was 0.8% and 1.0% of baseline in the spine and the hip, respectively. No significant differences between the treatment groups, including corticosteroids and the anti-tumour necrosis factor-alpha infliximab, were observed with regard to BMD loss after 1 year of treatment. Joint damage at baseline and joint damage progression according to the Sharp-van der Heijde score were independently associated with more BMD loss after 1 year. The use of bisphosphonates independently protected against BMD loss.
  
  
  CONCLUSIONS
  After 1 year of follow-up in the BeSt study, we did not find differences in BMD loss between the four treatment strategies, including high doses of corticosteroids and anti-tumour necrosis factor-alpha. Joint damage and joint damage progression are associated with high BMD loss, which emphasises that BMD loss and erosive RA have common pathways in their pathogenesis.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. m.yuksel@lumc.nl
authors.forename: M
authors.initials: M
authors.lastname: Güler-Yüksel
authors.forename: J
authors.initials: J
authors.lastname: Bijsterbosch
authors.forename: Y P M
authors.initials: YP
authors.lastname: Goekoop-Ruiterman
authors.forename: J K
authors.initials: JK
authors.lastname: de Vries-Bouwstra
authors.forename: H M J
authors.initials: HM
authors.lastname: Hulsmans
authors.forename: W M
authors.initials: WM
authors.lastname: de Beus
authors.forename: K H
authors.initials: KH
authors.lastname: Han
authors.forename: F C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: C F
authors.initials: CF
authors.lastname: Allaart
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010024:Osteoporosis / Q000175:diagnosis* / Q000517:prevention & control; D010384:Pelvic Bones; D012044:Regression Analysis; D012306:Risk; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab