A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass

Abstract

IntroductionGlucocorticoid (GC)-induced osteoporosis is a frequent complication in patients with rheumatoid arthritis. However, little information exists about the consequences of GC use in patients with early arthritis. Here we describe the variables underlying the use of GC in early arthritis, as well as its effect on bone-mineral density.MethodsData from 116 patients in our early arthritis register were analyzed (90 women; median age, 52.5 years, interquartile range (IQR, 38.5-66); 6-month median disease duration at entry (IQR, 4-9)). In this register, the clinical and treatment information was recorded systematically, including the cumulative GC dose. Lumbar spine, hip, and forearm bone-mineral density (BMD) measurements were performed at entry and after a 2-year follow-up. A multivariate analysis was performed to establish the variables associated with the use of GCs, as well as those associated with variations in BMD.ResultsOf the patients with early arthritis studied, 67% received GCs during the 2-year follow-up. GCs were more frequently prescribed to elderly patients, those with higher basal disease activity and disability, and patients with positive rheumatoid factor. When adjusted for these variables, GCs were less frequently prescribed to female patients. The use of GCs was associated with an increase of BMD in the ultradistal region of the forearm, although it induced a significant loss of BMD in the medial region of the forearm. No relevant effect of GC was noted on the BMD measured at other locations.ConclusionsThe frequent use of GCs as a "bridge therapy" in patients with early arthritis does not seem to be associated with relevant loss of bone mass. Moreover, cumulative GC administration might be associated with an increase of juxtaarticular BMD.

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?

“…Our findings of a minimal impact of GCs on bone and the absence of significant differences between GC and placebo group are in line with results of several earlier studies on BMD in early RA [3, 6, 16, 17, 34]. There were small increases in lumbar sBMD in both the GC and placebo groups, possibly reflecting the effective dampening of the inflammatory process in early RA, especially of pro-inflammatory cytokines such as IL-1 and TNF.…”

Structure and strength of the distal radius in female patients with rheumatoid arthritis: A case-control study

“…The net effect of glucocorticoids on bone in RA patients is difficult to determine. There are a few studies suggesting that although low‐dose glucocorticoids may rapidly decrease markers for bone formation, predisposing subjects to increased bone fragility,41 they also counteract the effect of inflammation on bone and slow the rate of bone loss adjacent to sites of synovitis 42, 43. We found interactions between recent exposure to glucocorticoids and menstrual status in several densitometric and microstructural indices.…”

Alterations of Bone Density, Microstructure, and Strength of the Distal Radius in Male Patients With Rheumatoid Arthritis: A Case-Control Study With HR-pQCT

“…We did not observe significant correlation between use of glucocorticoids, quantified as cumulative dose, cumulative duration or recent exposure, and most indices of bone density and microstructure. The relationship between use of glucocorticoids and bone quality in RA is complicated and is influenced by other disease‐related factors . Although use of low‐dose glucocorticoids may rapidly reduce markers of bone formation, increasing the risk of osteoporosis, it also counteracts the effect of inflammation on the bone, lowering the rate of bone loss, particularly at skeletal sites close to synovitis .…”

“…The relationship between use of glucocorticoids and bone quality in RA is complicated and is influenced by other disease‐related factors . Although use of low‐dose glucocorticoids may rapidly reduce markers of bone formation, increasing the risk of osteoporosis, it also counteracts the effect of inflammation on the bone, lowering the rate of bone loss, particularly at skeletal sites close to synovitis . In a randomized placebo‐controlled trial of patients with recent onset of RA, glucocorticoids decreased the degree of localized hand bone loss .…”