Bone minderal density and biochemical markers of bone metabolism in late onset rheumatoid arthritis and polymyalgia rheumatica - a prospective study on the influence of glucocorticoid therapy

Journal/Book: Z Rheumatol 1999; 58: 312. 1999;

Abstract: U. Lange; Kerckhoff Klinik Rheumatologie Stiftung W.G. Kerckhoff Herz- und Rheumazentrum Bad Nauheim Objectives: Late onset rheumatoid arthritis (LORA) and polymyalgia rheumatica (PMR) affect patients aged 60 or above. The hall mark in both rheumatic diseases is an inflammatory process with raised erythrocyte sedimentation rate and C-reactive protein. In recent studies it was proposed that bone metabolism is increased in inflammatory rheumatic diseases. Methods: In the present investigation bone metabolism was examined in 51 patients at the time of diagnosis and 6-7 months later: 29 patients had definitive diagnosis of LORA and 22 patients had PMR. At the time of diagnosis the patients did not receive any medication during the 6-7 months of follow up they were treated with corticosteroids and nonsteroidal-antirheumatic drugs (NSAID). Serum levels of osteocalcin alkaline phosphatase and ostase as markers for bone formation were tested. Bone density was examined by dual x-ray absorption (DEXA) of the lumbar spine and the leftward triangle. Results: At the time of diagnosis no signs of bone alteration were seen. After 6-7 months abnormal values of the serum parameters and bone mineral density were found in 16/51 patients (31%): 10/29 patients with LORA and 6/22 patients with PMR. Conclusions: Thus our findings suggest that an alteration of bone metabolism could be observed in a minority of patients during the first months of glucocorticoid medication but in a majority of patients an osteoprotective effect seems to be worth of discussing. The results suggest from a prophylactic and therapeutic point of view that an additional disease-modifying antirheumatic medication should be considered in the early stages of therapy to reduce the osteoporotic risk of a long term corticoid therapy. ... le

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