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J Bone Miner Res. 2019 Jan 28. doi: 10.1002/jbmr.3684. [Epub ahead of print]

Long-term Treatment with TNF-alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis.

Author information

1
Dep Rheumatology, Amsterdam Rheumatology and immunology Centre, Amsterdam, the Netherlands.
2
Department of Rheumatology, Groene hart ziekenhuis, Gouda, the Netherlands.
3
VUmc and Reade, Amsterdam, the Netherlands.
4
Department of Rheumatology, Veterans Administration Hospital (NIMTS), Athens, Greece.

Abstract

Objectives The aim of this cohort study was to evaluate the long term effects of TNF-inhibitors (TNFi) on Bone Mineral Density (BMD) and the incidence of Vertebral Fractures (VFx) in patients with Ankylosing Spondylitis (AS). Method Consecutive patients with active AS with a TNFi treatment duration up to 4 years, with available DXA scans and spine X-rays, were included. BMD (classified according to the WHO criteria for osteoporosis) of hip and lumbar spine, the VFx (classified as a Genant-score > 1/> 20% height loss) and radiological progression (modified stoke ankylosing spondylitis spinal score; mSASSS) scores were performed at baseline and 4 years of TNFi treatment. Results Overall, 135 AS patients were included. At baseline, 40.1% of the patients had a low BMD of the hip and 40.2% of the lumbar spine. This decreased respectively to 38.1% (p = 0.03) with a low hip BMD and 25.3% (p < 0.001) for the lumbar spine after 4 years of TNFi treatment. VFx were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score ≥ 2, was found at baseline in, 3 out of 14 VFx (21.4%) which increased to 7 out of 27 VFx (25.9%) after 4 years. All disease activity parameters, The Ankylosing Spondylitis Disease Activity Scale (ASDAS, both CRP and ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), C-reactive protein and erythrocyte sedimentation rate decreased all significantly (p <0.001). The mean radiological progression (n = 80) increased significantly from a median mSASSS-score of 4.0 (1.5-16.0) at baseline to 6.5 (2.1-22.9) after 4 years of TNFi treatment (p < 0.001). Conclusion Despite the improvement of BMD and well-known decrease in disease activity, we still found new VFx, increase in severity in the number and grade of VFx and radiographic progression during 4 years of treatment with TNFi in AS patients with a long disease duration.

KEYWORDS:

RRE

PMID:
30690799
DOI:
10.1002/jbmr.3684

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