Major Finding: In the first 3 months, the rate of bone loss among patients with early RA who were treated with intra-articular corticosteroid injections plus methotrexate vs. methotrexate alone was −0.45% vs. −2.69%, respectively, in digit 2; −0.34% vs. −3.32% in digit 3; −0.39% vs. −2.57% in digit 4, and −0.59% vs. −2.70% in digit 5.
Data Source: A study of 40 patients who were treated for 12 months.
Disclosures: The researchers stated that they had no relevant financial disclosures to make.
Patients with early rheumatoid arthritis who were on methotrexate and received intra-articular corticosteroid injections into inflamed metacarpophalangeal joints for 3 months lost less periarticular density than did those who received methotrexate alone, results from a small study demonstrated.
The finding “supports the concept that, in conditions where inflammation dominates such as early RA, treating inflammation is more important than the negative effect of corticosteroids on bone,” reported researchers led by Dr. Glenn Haugeberg.
Dr. Haugeberg, professor of neuroscience at the Norwegian University of Science and Technology, Trondheim, and a member of the department of rheumatology at Sørlandet Hospital in Kristiansand (Norway), and his associates at two clinical centers in the United Kingdom treated 19 early RA patients with methotrexate alone and 21 with methotrexate plus intra-articular corticosteroid injections for 3 months. Over the next 9 months, all 40 patients received methotrexate plus intra-articular corticosteroid injections.
To assess the effect of treatment on bone loss, the researchers used MRI of the metacarpophalangeal joints of the dominant hand (that is, MCP joints 2-5) at baseline and 3 and 12 months, as well as DXA images of both hands at baseline and 3, 6, and 12 months (Ann. Rheum. Dis. 2011;70:184-7). They used linear regression analysis to determine the association between reduction in bone mineral density and demographic and disease variables, adjusting for treatment group.
The mean age of patients was 54 years, and 55% were women. In the first 3 months, patients who received methotrexate plus intra-articular corticosteroid injections experienced significantly less bone loss in MCP joints 2–5 than did their counterparts in the methotrexate-only group. The rate of bone loss was −0.45% vs. −2.69%, respectively, in digit 2; −0.34% vs. −3.32% in digit 3; −0.39% vs. −2.57% in digit 4, and −0.59% vs. −2.70% in digit 5.
Bone loss in the hand overall was less pronounced over the same time period (−1.53% in patients who received methotrexate plus injections, compared with −2.42% in those in the methotrexate-only group).
In months 3-12, when all patients received intra-articular corticosteroid injections, only minor, nonsignificant differences in the rate of bone loss were observed between the two groups.
“Data from the current study suggest that bone loss may be arrested by intra-articular corticosteroid injections more effectively in periarticular regions than in the whole hand,” the researchers wrote. “This may support the view that periarticular osteoporosis results from local production of proinflammatory cytokines which activate osteoclasts to break down bone locally and is not predominantly the result of circulating proinflammatory cytokines.”
They acknowledged certain limitations of the study, including the small sample size and the fact that “the precision of DXA for periarticular regions is poor compared with whole hand measurement. Furthermore, the method is not feasible for clinical use; it has therefore been recommended that assessment of the whole hand be used as a marker for periarticlar bone loss.”