Source: Europace  |  Posted 8 years ago

An uncoupling effect on bone cells may be on of the reasons why anti-tumour necrosis factor alpha therapy increases bone mineral density (BMD) among patients with spondyloarthropathy (SpA), French clinicians think.

Clinicians at the Rheumatology Department, Rene Descartes University, Paris, and the French government INSERM, Dijon, studied 23 men and 6 women, between the ages of 22 to 68, with persistently active SpA despite treatment with a high dose of non-steroidal anti-inflammatory drug and/or methotrexate or sulfasalazine.

There was a marked range of disease duration among the patients, from 3 to 30 years, with a mean of 13 years. Twenty-five patients were treated with infliximab 5 mg/kg and four with infliximab 3 mg/kg at baseline, and then weeks 2 and 6. This was followed by no infusion in three patients, an additional infusion of infliximab every other month in three patients, and one infusion only in the case of a relapse among the rest of the cohort.

Lumbar and femoral BMD were measured by dual energy X-ray absorptiometry at baseline and at six months. Serum osteocalcin and urinary deoxypyridinoline were measured in 19 patients at weeks baseline and weeks 2 and 24, and in 13 patients at all visits.

At six months, the clinicians found a significant increase in BMD at the spine (3.6%), total hip (2.2%), and trochanter (2.3%). A trend for an increase (1.1%) was observed at the femoral neck. There was an increase in osteocalcin between baseline and the sixth week (third infusion)-median 1.45 micro g/l.

There was no change observed in the marker of bone resorption during the same period, and there were no changes in biochemical markers between baseline and final visits. There was a trend for a correlation between the decrease at six months in erythrocyte sedimentation rate, and lumbar spine BMD change (r(s)=-0.35).