%0 Journal Article
%T Disease Activity and Bone Mineral Density of MCP Joints in Patients with Rheumatoid and Psoriatic Arthritis: Is There a Correlation?〞A Study in Patients Treated with Methotrexate and an Anti-TNF汐 Agent
%A Ilaria Bertoldi
%A Georgios Filippou
%A Carlo Alberto Scir豕
%A Valentina Picerno
%A Valentina di Sabatino
%A Antonella Adinolfi
%A Serena Pierguidi
%A Mauro Galeazzi
%A Bruno Frediani
%J ISRN Rheumatology
%D 2013
%R 10.1155/2013/708323
%X Background. Bone damage in rheumatoid arthritis (RA) and in psoriatic arthritis (PsA) includes an accelerated bone mineral density (BMD) reduction. The objective was to evaluate BMD variations of the metacarpophalangeal joints (MCPs) in patients starting treatment with methotrexate (MTX) or etanercept. Methods. Patients affected by RA or PsA with hand joints involvement and with moderate or high disease activity, were enrolled in this study. All patients underwent clinical examination, laboratory exams, and a DXA scan of the most affected hand, as assessed with an ultrasound examination at the baseline, at the time of enrolment and after 1, 3, 6, and 12 months. Patients non-responders to MTX received combination therapy, while patients with no previous treatment initiated MTX. Results. 22 patients were enrolled. In both RA and PsA groups, BMD increased independently of the treatment. However, in the patients affected by RA, a slight BMD decrease was observed at the last checkup. Globally, the BMD variations of the MCPs were strongly correlated with the disease activity. At the reduction of DAS28, the scores corresponded an increase of BMD. Conclusions. MCPs BMD is inversely correlated to disease activity. BMD increase seems to be correlated with the response to treatment and not with the drug itself. 1. Introduction Bone damage in rheumatoid arthritis (RA) and in psoriatic arthritis (PsA) includes joint damage and accelerated bone mineral density (BMD) reduction [1], both at a local and generalised level. Bone damage is caused by an increased osteoclast activity and decreased osteoblast activation. This is mostly mediated by tumor necrosis factor (TNF)-汐, interleukin (IL)-1, IL-6, IL-17, and receptor activator of nuclear factor kappa B ligand (RANKL) [2每5]. The erosion represents the final result of this process [6, 7] and it can be considered the central feature of bone damage of both RA and PsA, although in PsA there are significant differences when compared with RA, with a pattern characterised by concurrent erosions and new bone formation [8每10]. However, bone in the proximity of inflamed joints is susceptible to BMD reduction and it precedes erosive damage on X-ray [11每16]. Dual energy X-ray absorptiometry (DEXA, DXA) is the gold standard for measuring BMD [17]. Previous clinical studies demonstrated an association between hand BMD and RA severity, including disease activity, functional impairment and joint destruction [11每16, 18每22]. However, only a little data is available on the association between hand BMD reduction and disease activity in
%U http://www.hindawi.com/journals/isrn.rheumatology/2013/708323/