Division of Rheumatology, College of Medicine, Inha University, Incheon, Republic of Korea.
Occupational and Environmental Medicine, College of Medicine, Inha University, Incheon, Republic of Korea.
Clin Exp Rheumatol. 2021 Jan-Feb;39(1):125-131. doi: 10.55563/clinexprheumatol/j6zhfm. Epub 2020 Apr 9.
We aimed to investigate how systemic bone metabolism was affected after 1 year of treatment with tumour necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) patients.
A total of 29 seropositive RA patients not treated for osteoporosis were enrolled and TNF inhibitors were administered for a year. Bone mineral density (BMD) at the lumbar spine, femur neck, and total hip was measured at baseline and 12 months after anti-TNF treatment. Blood samples were collected at baseline and 6 and 12 months after anti-TNF treatment and osteoclasts were cultured on bone slices. Weight was the strongest factor influencing systemic bone loss. Patients were categorised into two groups: obese (body mass index (BMI) ≥25 kg/m2) and non-obese (BMI <25 kg/m2).
All patients showed decreased BMD at all sites. The obese group showed relatively little change in BMD, although the non-obese group showed significant decreases in BMD at all sites after 1 year of treatment with TNF inhibitors. Resorption pits created by osteoclasts decreased at 6 months and increased at 12 months in the non-obese group, while the obese group presented with steadily decreasing sizes of resorption pits at all-time points. Levels of receptor activator of nuclear factor kappa B ligand were significantly decreased at 12 months compared to baseline in the obese group, while they were increased in the non-obese group.
One year of treatment with TNF inhibitors failed to halt systemic bone loss in RA patients, but obesity may have protective effects against bone loss.
我们旨在研究类风湿关节炎（RA）患者接受肿瘤坏死因子（TNF）抑制剂治疗 1 年后全身骨代谢的变化。
共纳入 29 例未经骨质疏松治疗的血清阳性 RA 患者，并接受 TNF 抑制剂治疗 1 年。在基线和抗 TNF 治疗 12 个月时测量腰椎、股骨颈和全髋关节的骨密度（BMD）。在基线和抗 TNF 治疗 6 个月和 12 个月时采集血样，并在骨切片上培养破骨细胞。体重是影响全身骨丢失的最强因素。患者分为两组：肥胖组（BMI≥25 kg/m2）和非肥胖组（BMI<25 kg/m2）。
所有患者的所有部位 BMD 均降低。肥胖组 BMD 变化相对较小，而非肥胖组在接受 TNF 抑制剂治疗 1 年后所有部位的 BMD 均显著降低。在非肥胖组中，破骨细胞形成的吸收窝在 6 个月时减少，12 个月时增加，而肥胖组在所有时间点的吸收窝大小均呈持续减小趋势。与基线相比，肥胖组在 12 个月时的核因子κB 受体激活物配体水平显著降低，而非肥胖组则升高。
TNF 抑制剂治疗 1 年未能阻止 RA 患者的全身骨丢失，但肥胖可能对骨丢失具有保护作用。
