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Vol. 147. Issue 2.
Pages 56-62 (July 2016)
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Vol. 147. Issue 2.
Pages 56-62 (July 2016)
Original article
DOI: 10.1016/j.medcle.2016.09.005
Effect of tumour necrosis factor α blockade on bone metabolism in chronic inflammatory joint diseases
Efecto del bloqueo del factor de necrosis tumoral α sobre el metabolismo óseo en las enfermedades inflamatorias articulares crónicas
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Francisco Javier Aguilar del Reya,
Corresponding author
fjaguilarrey@yahoo.es

Corresponding author.
, Rosa García Portalesa, Manuel Haro Ligera, José Rodríguez Andreua, José Luis Casals Sáncheza, Rita Pérez Gonzálezb
a Servicio de Reumatología, Hospital Clínico Virgen de la Victoria, Málaga, Spain
b Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud (FIMABIS), Málaga, Spain
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Figures (2)
Tables (4)
Table 1. Tumour necrosis antifactor drug α used in the study.
Table 2. Clinical characteristics of patients, globally and by clinical entities.
Table 3. Baseline and final results of the different parameters analyzed globally and by disease.
Table 4. Baseline and final results of bone remodelling markers, both globally and by disease groups.
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Abstract
Background and objective

To evaluate the effect of anti-TNF treatments on bone mineral density (BMD), bone remodelling markers (BRM) and receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in patients with chronic inflammatory joint diseases.

Methods

A longitudinal prospective study was performed under clinical practice conditions on 31 patients diagnosed of rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis who had received treatment with anti-TNF alpha drugs for one year. BMD, OPG and RANKL soluble form (sRANKL) were studied at the onset and end of the study. During the study (0, 3, 6, 9 and 12 month), disease activity (SDAI, BASDAI and CRP), functional capacity (HAQ, BASFI), BRM and vitamin D were studied.

Results

BMD was not modified after one year of treatment. The patients who took corticosteroids had a mean bone mass loss of 3% in the lumbar spine (±1.6, p=.02). In regards to the BRM, did not experience significant changes over the course of the study. Disease activity, both SDAI (p=.002) and BASDAI (p=.002), decreased. OPG was maintained without changes during the year of treatment while both the sRANKL (0.28±0.22, p=.013) and sRANKL/OPG ratio significantly decreased (0.04±0.03, p=.031).

Conclusion

The patients being treated with anti-TNF did not present with a significant loss of DMO during the study (one year), at the same time experiencing an improvement in disease activity. This protection has been clearer in the responding patients.

Keywords:
Bone mineral density
Bone remodelling markers
Osteoprotegerin
Receptor activator of nuclear kappa-beta
Anti-tumour necrosis factor
Chronic inflammatory joint disease
Resumen
Fundamento y objetivo

Evaluar el efecto de los tratamientos anti-TNF sobre la densidad mineral ósea (DMO), los marcadores de remodelado óseo (MRO) y la ratio receptor activator for nuclear factor κB ligand (RANKL, «ligando del receptor activador del factor nuclear κB»)/osteoprotegerina (OPG) en los pacientes con enfermedades inflamatorias articulares crónicas.

Métodos

Estudio longitudinal prospectivo en condiciones de práctica clínica sobre 31 pacientes diagnosticados de artritis reumatoide, artropatía psoriásica y espondilitis anquilosante que estuvieron durante un año en tratamiento con fármacos anti-TNF alfa. Al inicio y al final del estudio se evaluaron la DMO, la OPG y la forma soluble de RANKL (sRANKL), y durante el estudio (0, 3, 6, 9 y 12 meses), la actividad de la enfermedad (SDAI, BASDAI y PCR), la capacidad funcional (HAQ, BASFI), los MRO y la vitamina D.

Resultados

La DMO no se modificó después de un año de tratamiento. Los pacientes que consumieron corticoides tuvieron una pérdida media de masa ósea del 3% en el raquis lumbar (±1,6, p=0,02). En cuanto a los MRO, no experimentaron cambios significativos a lo largo del estudio. Disminuyó la actividad de la enfermedad, tanto SDAI (p=0,002) como BASDAI (p=0,002). La OPG se mantuvo sin cambios durante el año de tratamiento, mientras que disminuyeron significativamente tanto el sRANKL (0,28±0,22, p=0,013) como la ratio sRANKL/OPG (0,04±0,03, p=0,031).

Conclusión

Los pacientes en tratamiento con anti-TNF no presentaron una pérdida de DMO significativa durante el seguimiento (un año), a la vez que experimentaron una mejora de la actividad de la enfermedad. Estos resultados han sido más evidentes en los pacientes respondedores.

Palabras clave:
Densidad mineral ósea
Marcadores de remodelado óseo
Osteoprotegerina
Ligando del receptor activador del factor nuclear kappa-beta
Anti-factor de necrosis tumoral
Enfermedad inflamatoria articular crónica

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