title: Periarticular and generalised bone loss in patients with early rheumatoid arthritis: influence of alendronate and intra-articular glucocorticoid treatment. Post hoc analyses from the CIMESTRA trial.
abstract: OBJECTIVE
  The aims of this study were to investigate the influence of alendronate and intra-articular betamethasone treatment on bone mineral density (BMD) changes in hand, lumbar spine and femoral neck during 1 year of a treat-to-target study (Cyclosporine, Methotrexate, Steroid in RA (CIMESTRA)).
  
  
  METHODS
  A hundred and sixty patients with early, active rheumatoid arthritis (RA) received methotrexate, intra-articular betamethasone and ciclosporin /placebo-ciclosporin. Patients with Z-score ≤0 also started alendronate 10 mg/day. BMD of the hand (digital x-ray radiogrammetry (DXR-BMDhand)), BMD of lumbar spine and femoral neck (dual x-ray absorptiometry (DXA-BMDlumbar spine and DXA-BMDfemoral neck)) and x-rays of hands, wrists and forefeet (modified Sharp-van der Heijde score) were measured at baseline and 1 year, with complete data available in 107 patients.
  
  
  RESULTS
  The change in BMD in hand, lumbar spine and femoral neck was negatively associated with the dose of intra-articular betamethasone (p<0.01 for all), but the bone loss in hand was modest and in the axial skeleton comparable with that of healthy individuals. Alendronate did not influence changes in DXR-BMDhand, which averaged -2.8%, whereas significant changes were observed in DXA-BMDlumbar spine and DXA-BMDfemoral neck in alendronate-treated patients (1.8% and 0.8%) compared with untreated patients (-1.8% and -2.2%) (p<0.01 and 0.02). Alendronate did not affect the radiographic progression (alendronate-treated patients: 0 (range 0-19), non-alendronate: 0 (0-18)).
  
  
  CONCLUSIONS
  In early active RA, intra-articular betamethasone injections added to disease-modifying antirheumatic drug (DMARD) treatment led to minimal loss of hip and lumbar BMD, and the loss could be prevented by treatment with alendronate. Alendronate treatment did not affect radiographic progression.
authors: Department of Endocrinology, Copenhagen University Hospital, , Hvidovre, Denmark.
authors: T W
authors: TW
authors: Jensen
authors: M S
authors: MS
authors: Hansen
authors: K
authors: K
authors: Hørslev-Petersen
authors: L
authors: L
authors: Hyldstrup
authors: B
authors: B
authors: Abrahamsen
authors: B
authors: B
authors: Langdahl
authors: B
authors: B
authors: Zerahn
authors: J
authors: J
authors: Pødenphant
authors: K
authors: K
authors: Stengaard-Petersen
authors: P
authors: P
authors: Junker
authors: M
authors: M
authors: Østergaard
authors: T
authors: T
authors: Lottenburger
authors: T
authors: T
authors: Ellingsen
authors: L S
authors: LS
authors: Andersen
authors: I
authors: I
authors: Hansen
authors: H
authors: H
authors: Skjødt
authors: J K
authors: JK
authors: Pedersen
authors: U B
authors: UB
authors: Lauridsen
authors: A J
authors: AJ
authors: Svendsen
authors: U
authors: U
authors: Tarp
authors: H
authors: H
authors: Lindegaard
authors: Anne Grethe
authors: AG
authors: Jurik
authors: Aage
authors: A
authors: Vestergaard
authors: M L
authors: ML
authors: Hetland
mesh_terms: D000328:Adult; D000368:Aged; D019386:Alendronate / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001623:Betamethasone / Q000008:administration & dosage*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy / Q000517:prevention & control; D001862:Bone Resorption / Q000517:prevention & control*; D016572:Cyclosporine / Q000627:therapeutic use; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000378:metabolism; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018501:Antirheumatic Agents; D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D016572:Cyclosporine; D001623:Betamethasone; D019386:Alendronate; D008727:Methotrexate
keywords: DXA; DXR; Intra-articular glucocorticoid; alendronate; bone mineral density; early RA; osteoporosis