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Decreased Urinary Excretion of Pyridinoline and Deoxypyridinoline Observed During Infliximab Treatment in Patients With Rheumatoid Arthritis

Decreased urinary levels of pyridinoline (PYR) and deoxypyridinoline (DPYR) seen during infliximab treatment could suggest the drug has a beneficial effect on patients with active rheumatoid arthritis, according to Polish researchers.

"The changes in bone metabolism in reaction to treatment are predominantly mediated by therapy-induced reduction of disease activity," report Lidia Ostanek, MD, and colleagues, Department of Rheumatology, Pomeranian Medical University, Poland.

The investigators observed that elevated concentrations of bone resorption markers in urine are associated with an increase in the inflammatory process or a high rate of bone turnover such as occurs in osteoporosis, osteoarthritis or erosive joint destruction.

In the present study 12 women and 5 men with a mean age of 41.3 years and diagnosed with active rheumatoid arthritis received 3 mg/kg body weight of infliximab intravenously at baseline and at week 4. Thereafter infliximab infusions were administered every 8 weeks until the end of the 9-month study.

Concentrations of PYR and DPYR were measured from urine samples. Erythrocyte sedimentation rates (ESR) and c-reactive protein (CRP) levels were assessed from blood samples.

Both ESR and CRP had decreased significantly as a result of 9 months of infliximab therapy.

Baseline PYR and DPYR concentrations were 116.8 nmol/mmol creatinine and 15.4 nmol/mmol creatinine, respectively. Both PYR and DPYR concentrations were significantly reduced at 9 months compared to baseline to 91.8 nmol/mmol creatinine for PYR and 11.4 nmol/mmol creatinine for DPYR.

Over the 9-month study period, excreted PYR correlated with the number of swollen joints (R = .52, P < .01), morning stiffness (R = .55, P < .01), ESR (R = .35, P < .05) and CRP (R = .32, P < .05).

DPYR correlated with the number of swollen joints (R = .4, P < .01), tender joints (R = .36, P < .05) and duration of morning stiffness (R = .39, P < .01).

"The measurement of urinary excretion of PYR and DPYR may give insight into bone metabolism and help us better understand the actual changes in bone and cartilage caused by RA and its treatment," the authors conclude.


Clin Rheumatol 2004 Jun;23(3):214-7. Epub 2004 Feb 26 "The urinary excretion of pyridinoline and deoxypyridinoline during rheumatoid arthritis therapy with infliximab"

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