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Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis
Univ Debrecen, Fac Med, Dept Internal Med, Div Rheumatol, Nagyerde str 98, H-4032 Debrecen, Debrecen, Hungary;Dept Sports Med, Debrecen, Debrecen, Hungary.
Univ Debrecen, Fac Med, Dept Internal Med, Div Rheumatol, Nagyerde str 98, H-4032 Debrecen, Debrecen, Hungary.
Univ Debrecen, Fac Med, Dept Internal Med, Div Rheumatol, Nagyerde str 98, H-4032 Debrecen, Debrecen, Hungary.
Univ Debrecen, Fac Med, Dept Internal Med, Div Rheumatol, Nagyerde str 98, H-4032 Debrecen, Debrecen, Hungary.
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2020 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 39, no 1, p. 167-175Article in journal (Refereed) Published
Abstract [en]

Objectives

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with generalized and localized bone loss. We conducted a comprehensive study using imaging (dual-energy X-ray absorptiometry, DXA) and laboratory biomarkers in order to determine bone health and to study the effects of anti-tumor necrosis factor (TNF) biologics in RA and AS.

Patients and methods

Thirty-six RA and 17 AS patients undergoing 1-year etanercept (ETN) or certolizumab-pegol (CZP) therapy were studied. Bone density was assessed by DXA at baseline and after 12 months. Serum C-reactive protein (CRP), calcium, phosphate, parathyroid hormone (PTH), vitamin D3, osteocalcin, procollagen type I N-propeptide (P1NP), C-terminal telopeptide (βCTX), osteoprotegerin, sclerostin (SOST), Dickkopf-1 (DKK-1), soluble receptor activator nuclear kappa B ligand (sRANKL), and cathepsin K (cathK) levels were determined at baseline and after 6 and 12 months.

Results

TNF-α inhibition was clinically effective. Anti-TNF-α halted further bone loss over 1 year. In general, anti-TNF therapy significantly increased P1NP, SOST levels, and the P1NP/βCTX ratios, while decreased DKK-1 and CathK production at different time points in most patient subsets. In the full cohort and in RA, baseline and/or 12-month bone mineral density (BMD) at multiple sites exerted inverse relationships with CRP and βCTX, and positive correlation with SOST. In AS, L2-4 BMD after 1-year biologic therapy inversely correlated with baseline βCTX, while femoral neck BMD rather showed inverse correlations with CRP.

Conclusions

Anti-TNF therapy slowed down generalized bone loss, in association with clinical improvements, in both diseases. TNF blockade may enhance bone formation and suppress joint destruction. Anti-TNF therapy may act inversely on DKK-1 and SOST. Independent predictors of BMD were SOST and βCTX in RA, whilst CRP in AS.

Place, publisher, year, edition, pages
2020. Vol. 39, no 1, p. 167-175
Keywords [en]
Biologics, Bone loss, DKK-1, Erosion, JAK inhibitors, Osteoporosis, Osteoprotegerin, RANKL, Rheumatoid arthritis, Sclerostin, Spondyloarthritis, Syndesmophyte
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:uu:diva-407442DOI: 10.1007/s10067-019-04771-3ISI: 000511726800021PubMedID: 31522318OAI: oai:DiVA.org:uu-407442DiVA, id: diva2:1416841
Funder
European Social Fund (ESF)Available from: 2020-03-25 Created: 2020-03-25 Last updated: 2020-03-25Bibliographically approved

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