Abstract
ObjectiveTo determine the prevalence of vertebral fractures (VFs) after 5 years of disease activity score (DAS)-steered treatment in patients with early rheumatoid arthritis (RA) and to investigate the association of VFs with disease activity, functional ability and bone mineral density (BMD) over time.MethodsFive-year radiographs of the spine of 275 patients in the BeSt study, a randomized trial comparing four treatment strategies, were used. Treatment was DAS-steered (DAS ≤ 2.4). A height reduction >20% in one vertebra was defined a vertebral fracture. With linear mixed models, DAS and Health Assessment Questionnaire (HAQ) scores over 5 years were compared for patients with and without VFs. With generalized estimating equations the association between BMD and VFs was determined.ResultsVFs were observed in 41/275 patients (15%). No difference in prevalence was found when stratified for gender, prednisone use and menopausal status. Disease activity over time was higher in patients with VFs, mean difference 0.20 (95% CI: 0.05-0.36), and also HAQ scores were higher, independent of disease activity, with a mean difference of 0.12 (95% CI: 0.02-0.2). Age was associated with VFs (OR 1.06, 95% CI: 1.02-1.09), mean BMD in spine and hip over time were not (OR 95% CI, 0.99: 0.78-1.25 and 0.94: 0.65-1.36, respectively).ConclusionAfter 5 years of DAS-steered treatment, 15% of these RA patients had VFs. Higher age was associated with the presence of VFs, mean BMD in hip and spine were not. Patients with VFs have greater functional disability over time and a higher disease activity, suggesting that VFs may be prevented by optimal disease activity suppression.
Highlights
Vertebral fractures are more common in patients with rheumatoid arthritis (RA) compared to the general population [1,2,3,4,5]
It is suggested that an appropriate control of disease may be protective of the quality and density of bone and prevent the development of vertebral fractures [11]. Such control of disease is generally more effectively achieved with disease activity score (DAS) steered treatment strategies [12,13] and more early with initial combination therapy with a synthetic disease-modifying antirheumatic drugs (DMARDs) and prednisone or anti tumor necrosis factor [14,15,16,17]. To investigate if such a treatment strategy results in less vertebral fractures, we conducted a cross-sectional analysis to determine the prevalence of vertebral fractures after 5 years of DAS-steered treatment in patients with early active RA, treated according to four different treatment strategies
Rheumatoid arthritis at baseline was active with a mean DAS of 4.4 and a mean Health Assessment Questionnaire (HAQ) score of 1.3
Summary
Vertebral fractures are more common in patients with RA compared to the general population [1,2,3,4,5]. Patients with fractures have a decreased functional ability and a higher mortality compared to patients without fractures [3,6,7,8,9]. In patients with RA, in addition to established risk factors such as lower body mass index (BMI), increased age, lower bone mineral density (BMD) and. To investigate if such a treatment strategy results in less vertebral fractures, we conducted a cross-sectional analysis to determine the prevalence of vertebral fractures after 5 years of DAS-steered treatment in patients with early active RA, treated according to four different treatment strategies. We investigated the association of vertebral fractures with disease activity, functional ability and mean bone mineral density over time. The mean BMD is calculated for each individual patient from measurements performed using the same device
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
