Effect of disease-modifying anti-rheumatic drugs on bone structure and strength in psoriatic arthritis patients

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Abstract

Objectives

To address whether the use of methotrexate (MTX) and biological disease-modifying anti-rheumatic drugs (bDMARDs) impacts bone structure and biomechanical properties in patients with psoriatic arthritis (PsA).

Methods

This is a cross-sectional study in PsA patients receiving no DMARDs, MTX, or bDMARDs. Volumetric bone mineral densities (vBMDs), microstructural parameters, and biomechanical properties (stiffness/failure load) were determined by high-resolution peripheral quantitative CT and micro-finite element analysis in the respective groups. Bone parameters were compared between PsA patients with no DMARDs and those receiving any DMARDs, MTX, or bDMARDs, respectively.

Results

One hundred sixty-five PsA patients were analyzed, 79 received no DMARDs, 86 received DMARDs, of them 52 bDMARDs (TNF, IL-17- or IL-12/23 inhibitors) and 34 MTX. Groups were balanced for age, sex, comorbidities, functional index, and bone-active therapy, while disease duration was longest in the bDMARD group (7.8 ± 7.4 years), followed by the MTX group (4.6 ± 7.4) and the no-DMARD group (2.9 ± 5.2). No difference in bone parameters was found between the no-DMARD group and the MTX group. In contrast, the bDMARD group revealed significantly higher total ( p = 0.001) and trabecular vBMD ( p = 0.005) as well as failure load ( p = 0.012) and stiffness ( p = 0.012). In regression models, age and bDMARDs influenced total vBMD, while age, sex, and bDMARDs influenced failure load and stiffness.

Conclusion

Despite longer disease duration, bDMARD-treated PsA patients benefit from higher bone mass and better bone strength than PsA patients receiving MTX or no DMARDs. These data support the concept of better control of PsA-related bone disease by bDMARDs.

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1938-3) contains supplementary material, which is available to authorized users.

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Most cited references 22

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In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography.

Stéphanie Boutroy, Mary Bouxsein, Francoise Munoz … (2005)

Assessment of trabecular microarchitecture may enhance the prediction of fracture risk and improve monitoring of treatment response. A new high-resolution peripheral quantitative computed tomography (HR-pQCT) system permits in vivo assessment of trabecular architecture and volumetric bone mineral density (BMD) at the distal radius and tibia with a voxel size of 82 microm3. We determined the short-term reproducibility of this device by measuring 15 healthy volunteers three times each. We compared HR-pQCT measurements in 108 healthy premenopausal, 113 postmenopausal osteopenic, and 35 postmenopausal osteoporotic women. Furthermore, we compared values in postmenopausal osteopenic women with (n = 35) and without previous fracture history (n = 78). We conducted a cross-sectional study in a private clinical research center. We took HR-pQCT measurements of the radius and tibia. Femoral neck and spine BMD were measured in postmenopausal women by dual-energy x-ray absorptiometry. Precision of HR-pQCT measurements was 0.7-1.5% for total, trabecular, and cortical densities and 2.5-4.4% for trabecular architecture. Postmenopausal women had lower density, trabecular number, and cortical thickness than premenopausal women (P < 0.001) at both radius and tibia. Osteoporotic women had lower density, cortical thickness, and increased trabecular separation than osteopenic women (P < 0.01) at both sites. Furthermore, although spine and hip BMD were similar, fractured osteopenic women had lower trabecular density and more heterogeneous trabecular distribution (P < 0.02) at the radius compared with unfractured osteopenic women. HR-pQCT appears promising to assess bone density and microarchitecture at peripheral sites in terms of reproducibility and ability to detect age- and disease-related changes.

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Enthesitis: from pathophysiology to treatment

Enrique Soríano, Dennis McGonagle, Georg Schett … (2017)

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Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment.

Ann Oberg, B Riggs, L. Joseph Melton … (2005)

In a population-based cross-sectional study, we examined effects of sex and age on bone microstructure at the wrist using high-resolution 3-D pQCT. Compared with women, men had thicker trabeculae in young adulthood and had less microstructural damage with aging. These findings may contribute to the virtual immunity of men to age-related increases in wrist fractures. Although changes in bone microstructure contribute to fracture risk independently of BMD, it has not heretofore been possible to assess this noninvasively in population-based studies. We used high-resolution 3-D pQCT imaging (voxel size, 89 mum) to define, in a random sample of women (n = 324) and men (n = 278) 21-97 years of age, sex and age effects on bone microstructure at the wrist. Relative to young women (age, 20-29 years), young men had greater trabecular bone volume/tissue volume (BV/TV; by 26%, p = 0.001) and trabecular thickness (TbTh; by 28%, p < 0.001) but similar values for trabecular number (TbN) and trabecular separation (TbSp). Between ages 20 and 90 years, cross-sectional decreases in BV/TV were similar in women (-27%) and in men (-26%), but whereas women had significant decreases in TbN (-13%) and increases in TbSp (+24%), these parameters had little net change over life in men (+7% and -2% for TbN and TbSp, respectively; p < 0.001 versus women). However, TbTh decreased to a greater extent in men (-24%) than in women (-18%; p = 0.010 versus men). Whereas decreases with age in trabecular BV/TV are similar in men and women, the structural basis for the decrease in trabecular volume is quite different between the sexes. Thus, over life, women undergo loss of trabeculae with an increase in TbSp, whereas men begin young adult life with thicker trabeculae and primarily sustain trabecular thinning with no net change in TbN or TbSp. Because decreases in TbN have been shown to have a much greater impact on bone strength compared with decreases in TbTh, these findings may help explain the lower life-long risk of fractures in men, and specifically, their virtual immunity to age-related increases in distal forearm fractures.

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Author and article information

Contributors

Georg Schett: +49913185-35000 , georg.schett@uk-erlangen.de

Journal

Journal ID (nlm-ta): Arthritis Res Ther

Journal ID (iso-abbrev): Arthritis Res. Ther

Title: Arthritis Research & Therapy

Publisher: BioMed Central (London )

ISSN (Print): 1478-6354

ISSN (Electronic): 1478-6362

Publication date (Electronic): 3 July 2019

Publication date PMC-release: 3 July 2019

Publication date (Print): 2019

Volume: 21

Electronic Location Identifier: 162

Affiliations

ISNI 0000 0001 2107 3311, GRID grid.5330.5, Department of Internal Medicine 3 - Rheumatology and Immunology, , Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, ; Ulmenweg 18, 91054 Erlangen, Germany

Article

Publisher ID: 1938

DOI: 10.1186/s13075-019-1938-3

PMC ID: 6607518

PubMed ID: 31269973

SO-VID: e75b2753-34a4-4fcc-bd5e-6cd66b7d0603

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 22 March 2019

Date accepted : 10 June 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001659, Deutsche Forschungsgemeinschaft;

Award ID: SPP1468- IMMUNOBONE; DFG-SFB1181-A01; GS

Award Recipient : Georg Schett

Funded by: European Research Council

Award ID: Synergy Grant 4D Nanoscope

Award Recipient : Georg Schett

Funded by: Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie (DE)

Award ID: METARTHROS

Award Recipient : Georg Schett

Funded by: Innovative Medicines Initiative

Award ID: RTCure

Award Recipient : Georg Schett

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: psoriatic arthritis,bone,disease-modifying anti-rheumatic drugs,biological agents,methotrexate,computed tomography

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ScienceOpen disciplines: Orthopedics

Keywords: psoriatic arthritis, bone, disease-modifying anti-rheumatic drugs, biological agents, methotrexate, computed tomography

Effect of disease-modifying anti-rheumatic drugs on bone structure and strength in psoriatic arthritis patients

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Abstract

Objectives

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Electronic supplementary material

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Orthopedics

Most cited references 22

In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography.

Enthesitis: from pathophysiology to treatment

Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment.

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