Hand bone loss in early rheumatoid arthritis during a methotrexate-based treat-to-target strategy with or without adalimumab: a substudy of the optimized treatment algorithm in early RA (OPERA) trial

L M Ørnbjerg, M Østergaard, T Jensen, K Hørslev-Petersen, K Stengaard-Pedersen, P Junker, T Ellingsen, P Ahlquist, H Lindegaard, A Linauskas, A Schlemmer, M Y Dam, I Hansen, Tine Lottenburger, C G Ammitzbøll, A Jørgensen, S B Krintel, J Raun, M L Hetland, OPERA Study GroupOle Slot, Lars Kjær Nielsen, Henrik Skjødt, Ole Majgaard, Tove Lorenzen, Hans Christian Horn, Marcin Kowalski, Inger Lauge Johansen, Peter Mosborg Pedersen, Natalia Manilo, Henning Bliddal

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

This study aims to investigate 1-year hand bone loss (HBL 1-year) in early rheumatoid arthritis (RA) patients treated with a methotrexate (MTX) and intra-articular triamcinolone treat-to-target strategy +/− adalimumab and to determine if HBL 6months is associated with radiographic progression after 2 years. In a clinical trial (OPERA) of 180 treatment-naive early RA patients, bone mineral density (BMD) was estimated from hand radiographs with digital X-ray radiogrammetry (DXR) at baseline, after 6 (n = 90) and 12 months (n = 70) of follow-up. Baseline and 2-year radiographs were scored according to the Sharp/van der Heijde method. Baseline characteristics and HBL 6months (0–6 months changes in DXR-BMD) were investigated as predictors of structural damage by univariate linear (∆ total Sharp/van der Heijde score (TSS) as dependent variable) and logistic (+/−radiographic progression (∆TSS >0) as dependent variable) regression analyses. Variables with p < 0.10 were included in multivariable models. In 70 patients with available HBL 1-year data, HBL 1-year was median (interquartile range (IQR)) −1.9 (−3.3; −0.26 mg/cm 2) in the MTX + placebo group and −1.8 (−3.6; 0.06) mg/cm 2 in the MTX + adalimumab group, p = 0.98, Wilcoxon signed-rank. Increased HBL (compared to general population reference values) was found in 26/37 and 23/33 patients in the MTX + placebo and MTX + adalimumab groups, chi-squared = 0.99. In 90 patients with HBL 6months data and 2-year radiographic data, HBL 6months was independently associated with ∆TSS after 2 years (β = −0.086 (95% confidence interval = −0.15; −0.025) TSS unit/mg/cm 2 increase, p = 0.006) but not with presence of radiographic progression (∆TSS >0) (OR 0.96 (0.92–1.0), p = 0.10). In early RA patients treated with a methotrexate-based treat-to-target strategy, the majority of patients had increased HBL 1-year, irrespective of adalimumab; HBL 6months was independently associated with ∆TSS after 2 years.

Original languageEnglish
JournalClinical Rheumatology
Volume36
Issue number4
Pages (from-to)781–789
ISSN0770-3198
DOIs
Publication statusPublished - 1. Apr 2017

Keywords

  • Adalimumab
  • Digital X-ray radiogrammetry
  • Hand bone loss
  • Rheumatoid arthritis

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