title: Zoledronic acid does not reduce MRI erosive progression in PsA but may suppress bone oedema: the Zoledronic Acid in Psoriatic Arthritis (ZAPA) Study.
abstract: BACKGROUND
  The effect of zoledronic acid (ZA) on articular bone in patients with psoriatic arthritis (PsA) was investigated using MRI.
  
  
  METHODS
  Patients with erosive PsA were randomised to receive 3-monthly infusions of ZA or placebo for 1 year. An additional 'tests alone' group received no infusions. Clinical assessments and MRI scans were performed at baseline and 1 year.
  
  
  RESULTS
  Paired 1.5T MRI scans were available in 22 patients including 6 who received ZA and 16 who did not (non-ZA = 6 placebo + 10 'tests alone' patients). The Disease Activity Score (28 swollen and tender joints, C reactive protein fell over 12 months to a greater degree in patients on ZA than in non-ZA patients (-1.6 vs -0.3, p=0.023). The MRI bone oedema score 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) with regression of bone oedema at 13.5% of sites in ZA patients vs 1.3% in non-ZA patients (p = 0.0073) and progression in 1.3% of sites in ZA patients vs 6.9% in non-ZA patients (p = 0.072). There was no difference between groups in change in MRI erosion score.
  
  
  CONCLUSIONS
  In this pilot study ZA reduced the progression of MRI bone oedema, indicating probable suppression of osteitis concordant with reduction in clinical measures of disease activity.
authors.affiliation: Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand. f.mcqueen@auckland.ac.nz
authors.forename: Fiona
authors.initials: F
authors.lastname: McQueen
authors.forename: Richard
authors.initials: R
authors.lastname: Lloyd
authors.forename: Anthony
authors.initials: A
authors.lastname: Doyle
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.forename: Maria
authors.initials: M
authors.lastname: Lobo
authors.forename: Melissa
authors.initials: M
authors.lastname: Exeter
authors.forename: William J
authors.initials: WJ
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
authors.forename: Nicola
authors.initials: N
authors.lastname: Dalbeth
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001855:Bone Marrow Diseases / Q000188:drug therapy* / Q000209:etiology; D004164:Diphosphonates / Q000627:therapeutic use*; D018450:Disease Progression; D004487:Edema / Q000188:drug therapy* / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D005384:Finger Joint / Q000473:pathology; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014955:Wrist Joint / Q000473:pathology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid