title: Are changes in bone mineral density different between groups of early rheumatoid arthritis patients treated according to a tight control strategy with or without prednisone if osteoporosis prophylaxis is applied?
abstract: Addition of 10 mg prednisone daily to a methotrexate-based tight control strategy does not lead to bone loss in early rheumatoid arthritis (RA) patients receiving preventive treatment for osteoporosis. A small increase in lumbar bone mineral density (BMD) during the first year of treatment was recorded, regardless of use of glucocorticoids.
  
  
  BACKGROUND
  This study aims to describe effects on BMD of treatment according to EULAR guidelines with a methotrexate-based tight control strategy including 10 mg prednisone daily versus the same strategy without prednisone in early RA patients who received preventive therapy for osteoporosis.
  
  
  METHODS
  Early RA patients were included in the CAMERA-II trial: a randomized, placebo-controlled, double-blind 2-year trial, in which effects of addition of 10 mg prednisone daily to a methotrexate-based tight control strategy were studied. All patients received calcium, vitamin D and bisphosphonates. Disease activity was assessed every 4 weeks. Radiographs of hands and feet and dual-energy X-ray absorptiometry of lumbar spine and left hip were performed at baseline and after 1 and 2 years of treatment.
  
  
  RESULTS
  BMD increased significantly over time in both treatment groups at the lumbar spine with a mean of 2.6% during the first year (p<0.001), but not at the hip; at none of the time points did BMD differ significantly between the prednisone and placebo group. Higher age and lower weight at baseline and higher disease activity scores during the trial, but not glucocorticoid therapy, were associated with lower BMD at both the lumbar spine and the hip in mixed-model analyses.
  
  
  CONCLUSIONS
  Addition of 10 mg prednisone daily to a methotrexate-based tight control strategy does not lead to bone loss in early RA patients on bisphosphonates. A small increase in lumbar BMD during the first year of treatment was found, regardless of use of glucocorticoids.
authors.affiliation: Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, The Netherlands. m.c.vandergoes@umcutrecht.nl
authors.forename: M C
authors.initials: MC
authors.lastname: van der Goes
authors.forename: J W G
authors.initials: JW
authors.lastname: Jacobs
authors.forename: M S
authors.initials: MS
authors.lastname: Jurgens
authors.forename: M F
authors.initials: MF
authors.lastname: Bakker
authors.forename: M J
authors.initials: MJ
authors.lastname: van der Veen
authors.forename: J H
authors.initials: JH
authors.lastname: van der Werf
authors.forename: P M J
authors.initials: PM
authors.lastname: Welsing
authors.forename: J W J
authors.initials: JW
authors.lastname: Bijlsma
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000503:physiopathology; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D014409:Tumor Necrosis Factor-alpha; D011241:Prednisone; D008727:Methotrexate