A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass

Data from 116 patients in our early arthritis register were analyzed (90 women; median age, 52.5 years, interquartile range (IQR, 38.5-66); 6-month median disease duration at entry (IQR, 4-9)). In this register, the clinical and treatment information was recorded systematically, including the cumulative GC dose. Lumbar spine, hip, and forearm bone-mineral density (BMD) measurements were performed at entry and after a 2-year follow-up. A multivariate analysis was performed to establish the variables associated with the use of GCs, as well as those associated with variations in BMD.Of the patients with early arthritis studied, 67% received GCs during the 2-year follow-up. GCs were more frequently prescribed to elderly patients, those with higher basal disease activity and disability, and patients with positive rheumatoid factor. When adjusted for these variables, GCs were less frequently prescribed to female patients. The use of GCs was associated with an increase of BMD in the ultradistal region of the forearm, although it induced a significant loss of BMD in the medial region of the forearm. No relevant effect of GC was noted on the BMD measured at other locations.The frequent use of GCs as a "bridge therapy" in patients with early arthritis does not seem to be associated with relevant loss of bone mass. Moreover, cumulative GC administration might be associated with an increase of juxtaarticular BMD.Rheumatoid arthritis (RA) is a systemic and chronic inflammatory disease that has been associated with disability, the existence of comorbidities, and decreased life expectancy [1,2]. The use of glucocorticoids (GCs) to treat RA offers rapid antiinflammatory effects and the capacity to arrest radiologic progression [3-6]. However, long-term GC use may cause multiple adverse events, even at low doses [7,8]. Therefore, an individual evaluation is required to establish the best risk/benefit ratio for their prescription [9,10].One of the most striking side effects of this d