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Open Access Highly Accessed Research article

A rational use of glucocorticoids in patients with early arthritis has a minimal impact on bone mass

Monica Ibañez1, Ana M Ortiz2, Isabel Castrejón2, J Alberto García-Vadillo2, Inmaculada Carvajal3, Santos Castañeda2 and Isidoro González-Álvaro2*

Author Affiliations

1 Rheumatology Department, Hospital Son Llàtzer, Carretera Manacor km. 4, Palma de Mallorca, 07198, Spain

2 Rheumatology Department, Hospital Universitario de La Princesa, Diego de León 62, Madrid, 28006, Spain

3 Rheumatology Unit, Hospital Nuestra Señora del Rosario, Príncipe de Vergara 53, Madrid, 28006, Spain

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Arthritis Research & Therapy 2010, 12:R50  doi:10.1186/ar2961


See related editorial by Desai and Solomon, http://arthritis-research.com/content/12/3/127

Published: 23 March 2010

Abstract

Introduction

Glucocorticoid (GC)-induced osteoporosis is a frequent complication in patients with rheumatoid arthritis. However, little information exists about the consequences of GC use in patients with early arthritis. Here we describe the variables underlying the use of GC in early arthritis, as well as its effect on bone-mineral density.

Methods

Data from 116 patients in our early arthritis register were analyzed (90 women; median age, 52.5 years, interquartile range (IQR, 38.5-66); 6-month median disease duration at entry (IQR, 4-9)). In this register, the clinical and treatment information was recorded systematically, including the cumulative GC dose. Lumbar spine, hip, and forearm bone-mineral density (BMD) measurements were performed at entry and after a 2-year follow-up. A multivariate analysis was performed to establish the variables associated with the use of GCs, as well as those associated with variations in BMD.

Results

Of the patients with early arthritis studied, 67% received GCs during the 2-year follow-up. GCs were more frequently prescribed to elderly patients, those with higher basal disease activity and disability, and patients with positive rheumatoid factor. When adjusted for these variables, GCs were less frequently prescribed to female patients. The use of GCs was associated with an increase of BMD in the ultradistal region of the forearm, although it induced a significant loss of BMD in the medial region of the forearm. No relevant effect of GC was noted on the BMD measured at other locations.

Conclusions

The frequent use of GCs as a "bridge therapy" in patients with early arthritis does not seem to be associated with relevant loss of bone mass. Moreover, cumulative GC administration might be associated with an increase of juxtaarticular BMD.