title: Hand bone loss in early rheumatoid arthritis during a methotrexate-based treat-to-target strategy with or without adalimumab-a substudy of the optimized treatment algorithm in early RA (OPERA) trial.
abstract: This study aims to investigate 1-year hand bone loss (HBL1-year) in early rheumatoid arthritis (RA) patients treated with a methotrexate (MTX) and intra-articular triamcinolone treat-to-target strategy +/- adalimumab and to determine if HBL6monthsis associated with radiographic progression after 2 years. In a clinical trial (OPERA) of 180 treatment-naive early RA patients, bone mineral density (BMD) was estimated from hand radiographs with digital X-ray radiogrammetry (DXR) at baseline, after 6 (n = 90) and 12 months (n = 70) of follow-up. Baseline and 2-year radiographs were scored according to the Sharp/van der Heijde method. Baseline characteristics and HBL6months(0-6 months changes in DXR-BMD) were investigated as predictors of structural damage by univariate linear (∆ total Sharp/van der Heijde score (TSS) as dependent variable) and logistic (+/-radiographic progression (∆TSS >0) as dependent variable) regression analyses. Variables with p < 0.10 were included in multivariable models. In 70 patients with available HBL1-yeardata, HBL1-yearwas median (interquartile range (IQR)) -1.9 (-3.3; -0.26 mg/cm2) in the MTX + placebo group and -1.8 (-3.6; 0.06) mg/cm2in the MTX + adalimumab group, p = 0.98, Wilcoxon signed-rank. Increased HBL (compared to general population reference values) was found in 26/37 and 23/33 patients in the MTX + placebo and MTX + adalimumab groups, chi-squared = 0.99. In 90 patients with HBL6monthsdata and 2-year radiographic data, HBL6monthswas independently associated with ∆TSS after 2 years (β = -0.086 (95% confidence interval = -0.15; -0.025) TSS unit/mg/cm2increase, p = 0.006) but not with presence of radiographic progression (∆TSS >0) (OR 0.96 (0.92-1.0), p = 0.10). In early RA patients treated with a methotrexate-based treat-to-target strategy, the majority of patients had increased HBL1-year, irrespective of adalimumab; HBL6monthswas independently associated with ∆TSS after 2 years.
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark. lykke@oernbjerg.dk.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. lykke@oernbjerg.dk.
authors.forename: L M
authors.initials: LM
authors.lastname: Ørnbjerg
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Østergaard
authors.affiliation: Department of Endocrinology, Hvidovre Hospital, Copenhagen, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Jensen
authors.affiliation: King Christian X Hospital for Rheumatic Diseases, South Jutland Hospital, Gråsten, Denmark.|Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Hørslev-Petersen
authors.affiliation: Department of Rheumatology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Stengaard-Pedersen
authors.affiliation: Department of Rheumatology C, Odense University Hospital, Odense, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Junker
authors.affiliation: Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Ellingsen
authors.affiliation: Department of Medicine, Vejle Regional Hospital, Vejle, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Ahlquist
authors.affiliation: Department of Rheumatology C, Odense University Hospital, Odense, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Lindegaard
authors.affiliation: Department of Rheumatology, Vendsyssel Hospital, Hjørring, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Linauskas
authors.affiliation: Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Schlemmer
authors.affiliation: Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
authors.forename: M Y
authors.initials: MY
authors.lastname: Dam
authors.affiliation: Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: I
authors.initials: I
authors.lastname: Hansen
authors.affiliation: Department of Medicine, Vejle Regional Hospital, Vejle, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Lottenburger
authors.affiliation: Department of Rheumatology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C G
authors.initials: CG
authors.lastname: Ammitzbøll
authors.affiliation: Department of Rheumatology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Jørgensen
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
authors.forename: S B
authors.initials: SB
authors.lastname: Krintel
authors.affiliation: King Christian X Hospital for Rheumatic Diseases, South Jutland Hospital, Gråsten, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Raun
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.|Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Hetland
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Slot
authors.affiliation: Department of Rheumatology, Odense University Hospital, Svendborg, Denmark.
authors.forename: Lars Kjær
authors.initials: LK
authors.lastname: Nielsen
authors.affiliation: Copenhagen Center for Arthritis Research and the DANBIO registry, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Skjødt
authors.affiliation: Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Majgaard
authors.affiliation: Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
authors.forename: Tove
authors.initials: T
authors.lastname: Lorenzen
authors.affiliation: Department of Medicine, Vejle Regional Hospital, Vejle, Denmark.
authors.forename: Hans Christian
authors.initials: HC
authors.lastname: Horn
authors.affiliation: Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.affiliation: Department of Rheumatology, Viborg Regional Hospital, Viborg, Denmark.
authors.forename: Inger Lauge
authors.initials: IL
authors.lastname: Johansen
authors.affiliation: Department of Rheumatology, Randers Regional Hospital, Randers, Denmark.
authors.forename: Peter Mosborg
authors.initials: PM
authors.lastname: Pedersen
authors.affiliation: Department of Rheumatology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: Natalia
authors.initials: N
authors.lastname: Manilo
authors.affiliation: Department of Rheumatology, Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark.
authors.forename: Henning
authors.initials: H
authors.lastname: Bliddal
mesh_terms: D015502:Absorptiometry, Photon; D000068879:Adalimumab / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000465:Algorithms; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000175:diagnosis*; D003718:Denmark; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D050276:Hand Bones / Q000000981:diagnostic imaging*; D006801:Humans; D016014:Linear Models; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D012720:Severity of Illness Index
chemical_list: D018501:Antirheumatic Agents; D000068879:Adalimumab; D008727:Methotrexate
keywords: Adalimumab; Digital X-ray radiogrammetry; Hand bone loss; Rheumatoid arthritis