期刊
JOURNAL OF RHEUMATOLOGY
卷 40, 期 10, 页码 1712-1718出版社
J RHEUMATOL PUBL CO
DOI: 10.3899/jrheum.121417
关键词
SPONDYLOARTHRITIS; OSTEOPOROSIS; ANTI-TUMOR NECROSIS FACTOR; BONE MINERAL DENSITY
类别
资金
- EULAR grant
- Belgian Fund for Scientific Research in Rheumatology (FWRO/FRSR)
- European Calcified Tissue Society grant (ECTS)
- Abbott
- MSD
- Pfizer
- UCB
- Roche
- Amgen
- Novartis
- Servier
- Lilly
Objective: To assess the effects on bone mineral density (BMD) of prolonged anti-tumor necrosis factor (anti-TNF) therapy in patients with spondyloarthritis (SpA); to compare the BMD changes to those observed in SpA patients not treated with anti-TNF; and to identify the predictors of these changes. Methods. Fifty-nine patients with SpA according to the European Spondylarthropathy Study Group criteria who were treated with anti-TNF therapy for at least 4 years were included. Thirty-four patients with SpA from an international longitudinal observational study (OASIS cohort) were used as a control group. Lumbar spine and hip BMD were measured by dual-energy x-ray absorptiometry at baseline, after 1 year, and after at least 4 years. Results. Over an average 6.5 years' followup, the increase in BMD was 11.8% (+/- 12.8%) at the lumbar spine (p<0.0001) and 3.6% (+/- 9.3%) at the great trochanter (p=0.0001) in patients treated with anti-TNF. At the lumbar spine, the increase was similar in patients with and those without syndesmophytes. BMD changes were significantly higher in the anti-TNF group than in the control group at lumbar spine (p<0.0001), at femoral neck (p=0.002), and at trochanter (p=0.011), but not at total hip (p=0.062). Multivariate analysis showed that the predictors of lumbar spine BMD changes in the total population were the use of anti-TNF (p<0.0001) and, in the anti-TNF therapy group, the 1-year lumbar spine BMD change (p=0.007). Conclusion. This study shows that prolonged anti-TNF therapy increases lumbar spine and trochanter BMD. This effect should be taken into account before introducing antiosteoporotic treatment in these patients.
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