title: Changes in bone mineral density during long-term treatment with adalimumab in patients with rheumatoid arthritis: a cohort study.
abstract: OBJECTIVE
  To investigate the effect of long-term adalimumab treatment on BMD of the lumbar spine, total hip and hands in patients with RA.
  
  
  METHODS
  In 184 established RA patients treated with adalimumab for at least 1 year, BMD measurements of the total hip and lumbar spine were performed using dual-energy X-ray absorptiometry. Metacarpal cortex BMD was measured using digital X-ray radiogrammetry.
  
  
  RESULTS
  After 1 year of treatment, BMD of the hip and lumbar spine remained stable, while BMD of the hands decreased significantly by -1.41% (P < 0.0001). After a mean follow-up of 4.0 (s.d. 1.0) years, mean BMD change per year was -0.58% and 0.07% for the hip and lumbar spine, respectively (overall P-value of hip was <0.0001 and spine was 0.67). Predictors for BMD loss of the hip were anti-CCP positivity, non-use of bisphosphonates at baseline and BMI. In European League Against Rheumatism (EULAR) non-responders at 52 weeks, BMD change of the hip and spine was -1.25% and 1.08%, respectively, for moderate responders -0.61% and -1.87%, respectively, and in EULAR good responders, BMD remained stable: -0.02% and 0.06%, respectively. BMD of the hands decreased in non-, moderate and good responders (-2.85%, -1.47% and -1.26%, respectively).
  
  
  CONCLUSIONS
  In patients with severe, established RA, loss of BMD in the spine was arrested over 4 years of adalimumab treatment, whereas BMD of the hands and hip continued to decrease after 1 and 4 years, respectively. The changes in BMD are related to disease activity, underlining the importance of monitoring disease activity.
authors.affiliation: Department of Rheumatology, Jan van Breemen Research Institute Reade, PO Box 58271, 1040 HG Amsterdam, The Netherlands. c.krieckaert@reade.nl
authors.forename: Charlotte L M
authors.initials: CL
authors.lastname: Krieckaert
authors.forename: Michael T
authors.initials: MT
authors.lastname: Nurmohamed
authors.forename: Gertjan
authors.initials: G
authors.lastname: Wolbink
authors.forename: Willem F
authors.initials: WF
authors.lastname: Lems
mesh_terms: D015502:Absorptiometry, Photon; D000068879:Adalimumab; D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D015519:Bone Density / Q000187:drug effects*; D015331:Cohort Studies; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D010456:Peptides, Cyclic / Q000276:immunology; D013997:Time Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D000068879:Adalimumab