Güler-Yüksel M, Bijsterbosch J, Goekoop-Ruiterman Y P M, de Vries-Bouwstra J K, Hulsmans H M J, de Beus W M, Han K H, Breedveld F C, Dijkmans B A C, Allaart C F, Lems W F
Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Ann Rheum Dis. 2008 Jun;67(6):823-8. doi: 10.1136/ard.2007.073817. Epub 2007 Jul 20.
We examined the effects of four different treatment strategies on bone mineral density (BMD) in patients with recently diagnosed, active rheumatoid arthritis (RA) and the influence of disease-related and demographic factors on BMD loss after 1 year of follow-up in the BeSt trial.
BMD measurements of the lumbar spine and total hip were performed in 342 patients with recent onset RA at baseline and after 1 year. Multivariable regression analyses were performed to determine independent associations between disease and demographic parameters and BMD loss after 1 year.
Median BMD loss after 1 year was 0.8% and 1.0% of baseline in the spine and the hip, respectively. No significant differences between the treatment groups, including corticosteroids and the anti-tumour necrosis factor-alpha infliximab, were observed with regard to BMD loss after 1 year of treatment. Joint damage at baseline and joint damage progression according to the Sharp-van der Heijde score were independently associated with more BMD loss after 1 year. The use of bisphosphonates independently protected against BMD loss.
After 1 year of follow-up in the BeSt study, we did not find differences in BMD loss between the four treatment strategies, including high doses of corticosteroids and anti-tumour necrosis factor-alpha. Joint damage and joint damage progression are associated with high BMD loss, which emphasises that BMD loss and erosive RA have common pathways in their pathogenesis.
我们在BeSt试验中研究了四种不同治疗策略对近期诊断为活动期类风湿关节炎（RA）患者骨矿物质密度（BMD）的影响，以及疾病相关因素和人口统计学因素对随访1年后BMD丢失的影响。
对342例近期发病的RA患者在基线和1年后进行腰椎和全髋部的BMD测量。进行多变量回归分析以确定疾病和人口统计学参数与1年后BMD丢失之间的独立关联。
1年后脊柱和髋部BMD丢失的中位数分别为基线的0.8%和1.0%。在治疗1年后的BMD丢失方面，未观察到包括皮质类固醇和抗肿瘤坏死因子-α英夫利昔单抗在内的治疗组之间存在显著差异。基线时的关节损伤以及根据Sharp-van der Heijde评分的关节损伤进展与1年后更多的BMD丢失独立相关。双膦酸盐的使用可独立预防BMD丢失。
在BeSt研究随访1年后，我们未发现包括高剂量皮质类固醇和抗肿瘤坏死因子-α在内的四种治疗策略在BMD丢失方面存在差异。关节损伤和关节损伤进展与高BMD丢失相关，这强调了BMD丢失和侵蚀性RA在发病机制上有共同途径。
