Department of Rheumatology, St, Olavs Hospital, 7006 Trondheim, Norway.
BMC Musculoskelet Disord. 2011 Feb 27;12:54. doi: 10.1186/1471-2474-12-54.
Anti-TNF therapy has been shown to reduce radiographic joint damage in rheumatoid arthritis (RA) independent of clinical response. This has previously not been examined for periarticular bone loss, the other characteristic feature of bone involvement in RA.The objective of this study was to examine if treatment with the TNF-α inhibitor adalimumab also could reduce periarticular bone loss in RA patients independent of disease activity.
RA patients were recruited from the PREMIER study and included 214 patients treated with methotrexate (MTX) plus adalimumab and 188 patients treated with MTX monotherapy. Periarticular bone loss was assessed by digital X-ray radiogrammetry metacarpal cortical index (DXR-MCI). Change in DXR-MCI was evaluated in patients with different levels of clinical response, as assessed by changes in DAS28 score at 52 weeks and in mean C-reactive protein (CRP) levels during follow-up.
In the MTX group, there was a greater median DXR-MCI loss among patients with moderate and high disease activity compared to those in remission or with low disease activity (-3.3% vs. -2.2%, p = 0.01). In contrast, periarticular bone loss was independent of disease activity (-1.9% vs. -2.4%, p = 0.99) in the combination group. In the MTX group patients with a mean CRP of ≥ 10 mg/l lost significantly more DXR-MCI than patients with low CRP (-3.1% vs. -1.9%, p <0.01) whereas in the combination group no significant differences between the two CRP groups was seen (-2.4% vs. -2.0%, p = 0.48).
Adalimumab in combination with MTX reduces periarticular bone loss independently of clinical response. These results support the hypothesis that TNF-α stimulates the osteoclast not only by the inflammatory pathway but do also have a direct effect on the osteoclast.
ClinicalTrials (NCT): NCT001195663.
抗 TNF 治疗已被证明可减少类风湿关节炎 (RA) 的放射学关节损伤，而与临床反应无关。这以前并未检查过关节周围骨丢失，这是 RA 骨骼受累的另一个特征。本研究的目的是检查 TNF-α 抑制剂阿达木单抗是否也可以减少 RA 患者的关节周围骨丢失，而与疾病活动无关。
从 PREMIER 研究中招募 RA 患者，包括 214 例接受甲氨蝶呤 (MTX) 加阿达木单抗治疗的患者和 188 例接受 MTX 单药治疗的患者。通过数字 X 射线放射照相术掌骨皮质指数 (DXR-MCI) 评估关节周围骨丢失。根据 52 周时 DAS28 评分的变化和随访期间平均 C 反应蛋白 (CRP) 水平评估不同临床反应水平的患者的 DXR-MCI 变化。
在 MTX 组中，与缓解或疾病活动度低的患者相比，中高度疾病活动患者的中位数 DXR-MCI 丢失更大 (-3.3%比-2.2%，p = 0.01)。相比之下，联合组的关节周围骨丢失与疾病活动无关 (-1.9%比-2.4%，p = 0.99)。在 MTX 组中，CRP 水平≥ 10 mg/l 的患者的 DXR-MCI 丢失明显高于 CRP 水平低的患者 (-3.1%比-1.9%，p <0.01)，而联合组中两组之间的 CRP 差异无统计学意义 (-2.4%比-2.0%，p = 0.48)。
阿达木单抗联合 MTX 可减少与临床反应无关的关节周围骨丢失。这些结果支持 TNF-α 通过炎症途径刺激破骨细胞的假说，也对破骨细胞有直接作用。
ClinicalTrials (NCT): NCT001195663.
