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 in the January 2011 issue of Annals of the Rheumatic Diseases.
[Digital X-Ray Radiogrammetry Shows Minute Bone Loss in RA]
Dr. Haugeberg, professor of neuroscience at the Norwegian University of Science and Technology, Trondheim, and a member of the department of rheumatology at S?rlandet 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 (dual-energy x-ray absorptiometry) 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 of the study, patients in the group who received methotrexate plus intra-articular-corticosteroid injections experienced significantly lower rates of 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% among patients who received methotrexate plus intra-articular corticosteroid injections, compared with –2.42% among 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."
In discussing their findings, the investigators wrote that the "results from the hand bone density studies also suggest that prednisolone is equivalent to [anti–tumor necrosis factor] treatment in reducing the rate of hand bone loss. From a practical point of view, local administration of corticosteroids may be better than systemic administration as the drug is administered at the target site of the inflammatory process and is not disseminated throughout the body."
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 periarticular bone loss."
The researchers stated that they had no relevant financial disclosures to make.