Division of Rheumatology, Department of Internal Medicine, College of Medicine, Inha University, Incheon, Korea.
Korean J Intern Med. 2023 Nov;38(6):912-922. doi: 10.3904/kjim.2023.080. Epub 2023 Oct 23.
BACKGROUND/AIMS: We investigated the effect of rituximab on systemic bone metabolism in patients with seropositive rheumatoid arthritis (RA).
Twenty seropositive patients with RA were enrolled and administered one cycle of rituximab. If RA became active for > 6 months after the first rituximab cycle, a second cycle was initiated; otherwise, no additional treatment was administered. Patients were divided into two groups according to the number of rituximab treatment cycles.
In patients treated with a second cycle, the total hip bone mineral density (BMD) was clinically low, whereas the serum levels of receptor activator of nuclear factor kappa-B ligand (RANKL) were increased at 12 months. BMD in patients treated with one cycle did not change at 12 months, whereas serum RANKL levels decreased at all time points. DAS28 activity improved in both groups from baseline to 4 months; however, from 4 to 12 months, DAS28 activity worsened in the develgroup with the second cycle but remained stable in the group with one cycle.
Systemic inflammation, reflected by increased disease activity, may be responsible for the increase in RANKL levels, which causes systemic bone loss in rituximab-treated patients with RA. Although rituximab affects inflammation, it does not seem to alter systemic bone metabolism in RA.
背景/目的：我们研究了利妥昔单抗对血清阳性类风湿关节炎（RA）患者全身骨代谢的影响。
共纳入 20 例血清阳性的 RA 患者，并接受一个周期的利妥昔单抗治疗。如果第一个利妥昔单抗周期后 6 个月以上 RA 仍活跃，则开始第二个周期；否则，不进行额外治疗。根据利妥昔单抗治疗周期的数量将患者分为两组。
在接受第二个周期治疗的患者中，总髋骨矿物质密度（BMD）临床较低，而核因子κB 受体激活剂配体（RANKL）的血清水平在 12 个月时升高。接受一个周期治疗的患者在 12 个月时 BMD 没有变化，而血清 RANKL 水平在所有时间点均下降。两组患者的 DAS28 活动度均从基线到 4 个月改善；然而，从 4 个月到 12 个月，第二个周期组的 DAS28 活动度恶化，但第一个周期组保持稳定。
全身性炎症，反映为疾病活动度增加，可能是导致 RANKL 水平升高的原因，从而导致接受利妥昔单抗治疗的 RA 患者发生全身性骨质流失。尽管利妥昔单抗影响炎症，但它似乎不会改变 RA 患者的全身骨代谢。
