Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis

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Bone loss in patients with early inflammatory back pain suggestive of spondyloarthritis
Key Take-Away: 

Axial spondyloarthritis is a form of chronic, inflammatory rheumatic disease in which the predominant symptom is back pain. But its association with bone loss has not been explored yet and that is what author has tried to assess and were successful in presenting conclusion to this association.

The objectives of the study were to assess the 2 year BMD changes and their determinants in patients with early inflammatory back pain suggestive of axial spondyloarthritis (SpA) (DESIR cohort).

ABSTRACT: 
Background: 

The objectives of the study were to assess the 2 year BMD changes and their determinants in patients with early inflammatory back pain suggestive of axial spondyloarthritis (SpA) (DESIR cohort).

Methods: 

A total of 265 patients (54% male, mean age 34.4 years) had BMD measurements at baseline and at 2 years.

Low BMD was defined as a Z score ≤-2 (at at least one site) and significant bone loss was defined by a decrease in BMD ≥0.03 g/cm2. Clinical, biological and imaging parameters were assessed over 2 years.

Results: 

Thirty-nine patients (14.7%) had low BMD at baseline; 112 patients (42.3%) had a 2 year significant bone loss.

One hundred and eighty-seven (70.6%) used NSAIDs at baseline and 89 (33.6%) received anti-TNF therapy over 2 years. In anti-TNF users, BMD significantly increased at the lumbar spine and did not change at the hip site from baseline. In multivariate analysis, baseline use of NSAIDs [odds ratio (OR) 0.38, P = 0.006] had a protective effect on hip bone loss. In patients without anti-TNF treatments, baseline use of NSAIDs (OR 0.09, P = 0.006) and a 2 year increase in BMI (OR 0.55, P = 0.003) had protective effects on hip bone loss, whereas a 2 year increase in fat mass was associated with hip bone loss (OR 1.18, P = 0.046).

Conclusion: 

Among patients with symptoms suggestive of early axial SpA, 42.3% of patients have significant bone loss over 2 years. Anti-TNF therapy is protective against bone loss and baseline use of NSAIDs has a protective effect on hip bone loss.

 

Rheumatology (Oxford). 2015 Sep 11
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