Effects of Biological and Non Biological Agents (Disease Modifying Antirheumatic Drugs) on Bone Mineral Density in a Sample of Rheumatoid Arthritis Patients

Mohammed Hadi Al-Osami,Omar Farooq Al-Azzawi,Israa Mohammed Redia,Faiq Gorial

doi:10.5539/gjhs.v10n6p136

Mohammed Hadi Al-Osami, Omar Farooq Al-Azzawi + Show 2 more

Open Access

https://doi.org/10.5539/gjhs.v10n6p136

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Abstract

BACKGROUND: Osteoporosis is an extra-articular complication of rheumatoid arthritis that results in increased risk of fractures and associated morbidity, mortality, and healthcare costs.OBJECTIVE: To evaluate changes in bone mineral density in a sample of rheumatoid arthritis (RA) patients on biological (anti tumor necrosis factor (TNF) alpha) and non-biological agent disease modifying antirheumatic drugs (DMARDs).PATIENTS &amp; METHODS: A cross sectional study enrolled 60 RA patients diagnosed by rheumatologist according to the 2010 American College of Rheumatology/European League Against Rheumatism (2010 ACR/EULAR) classification criteria for RA. Thirty patient on biological agent (anti TNF alpha) and 30 patient on non-biological agent (DMARD). RA disease-related data wincluded disease duration, disease activity score index of 28 joints (DAS 28) and clinical disease activity index (CDAI), functional class, body mass index and treatment history. vitamin D level were measured in both groups. Bone mineral density was measured by dual energy x-ray absorptiometry of hip and lumber spines for patients. A T –score of equal or less than -2.5 standard deviation that of young healthy adults were taken as osteoporotic and scores between -1 to -2.5 standard deviation was taken as osteopenic.RESULTS: Prevalence of RA patients on biological agent (anti TNF alpha) who had osteoporosis was 1(3%) and 12(40%) were osteopenic, and in patients on non biological (DMARD), Osteoporosis was present in 8(26%) and osteopenia in 13(43%, p= 0.019).Vitamin D level in patient on biological agent (anti TNF alpha) was low in 24(80%) and normal in 6 (20%) patients. While in non biological agent (DMARD) it was low in 13(43.3%) and normal in 17(56.7%) of patients, p=0.003). Patients on biological agent (anti TNF alpha); 15 (50%) patients showed high calcium, 2(6.7%) low phosphorous, and 2(6.7%) high Alkaline phosphatase (ALP) while in patients on non biological agent the results were 10 patients( 33.3%) had high calcium, and 5(16.7%) had high ALP. There was a significant decrease in bone mineral density in RA patients on DMARDS while biological agent (anti TNF alpha) had a role in arrest bone loss in RA patients.CONCLUSIONS: There was a strong association between types of therapy and reduction of bone mineral density.

Highlights

Rheumatoid arthritis is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis (Zerbini et al, 2016) and it is a frequent cause of secondary osteoporosis (Povoroznyuk et al, 2017) and cause systemic bone loss, reaching ~50% prevalence of osteoporosis in postmenopausal women (Sapir-Koren etal, 2017)
Prevalence of rheumatoid arthritis (RA) patients on biological agent who had osteoporosis was 1(3%) and 12(40%) were osteopenic, and in patients on non biological (DMARD), Osteoporosis was present in 8(26%) and osteopenia in 13(43%, p= 0.019).Vitamin D level in patient on biological agent was low in 24(80%) and normal in 6 (20%) patients
While in non biological agent (DMARD) it was low in 13(43.3%) and normal in 17(56.7%) of patients, p=0.003)

Summary

Introduction

Rheumatoid arthritis is a common systemic autoimmune disease of unknown cause, characterized by a chronic, symmetric, and progressive inflammatory polyarthritis (Zerbini et al, 2016) and it is a frequent cause of secondary osteoporosis (Povoroznyuk et al, 2017) and cause systemic bone loss, reaching ~50% prevalence of osteoporosis in postmenopausal women (Sapir-Koren etal, 2017). Osteoporosis (OP) is a common complication of inflammatory arthritis such as RA. Inflammation has a major contributing role in the development as well as the progression of bone loss in these patients as more severe diseases are associated with greater risk of bone loss. TNF can be considered as an important link between chronic inflammation and bone loss (Zhang et al, 2010). Osteoporosis is an extra-articular complication of rheumatoid arthritis that results in increased risk of fractures and associated morbidity, mortality, and healthcare costs

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