Effect of disease-modifying anti-rheumatic drugs on bone structure and strength in psoriatic arthritis patients

Abstract

Objectives To address whether the use of methotrexate (MTX) and biological disease-modifying anti-rheumatic drugs (bDMARDs) impacts bone structure and biomechanical properties in patients with psoriatic arthritis (PsA). Methods This is a cross-sectional study in PsA patients receiving no DMARDs, MTX, or bDMARDs. Volumetric bone mineral densities (vBMDs), microstructural parameters, and biomechanical properties (stiffness/failure load) were determined by high-resolution peripheral quantitative CT and micro-finite element analysis in the respective groups. Bone parameters were compared between PsA patients with no DMARDs and those receiving any DMARDs, MTX, or bDMARDs, respectively. Results One hundred sixty-five PsA patients were analyzed, 79 received no DMARDs, 86 received DMARDs, of them 52 bDMARDs (TNF, IL-17- or IL-12/23 inhibitors) and 34 MTX. Groups were balanced for age, sex, comorbidities, functional index, and bone-active therapy, while disease duration was longest in the bDMARD group (7.8 ± 7.4 years), followed by the MTX group (4.6 ± 7.4) and the no-DMARD group (2.9 ± 5.2). No difference in bone parameters was found between the no-DMARD group and the MTX group. In contrast, the bDMARD group revealed significantly higher total ( p = 0.001) and trabecular vBMD ( p = 0.005) as well as failure load ( p = 0.012) and stiffness ( p = 0.012). In regression models, age and bDMARDs influenced total vBMD, while age, sex, and bDMARDs influenced failure load and stiffness. Conclusion Despite longer disease duration, bDMARD-treated PsA patients benefit from higher bone mass and better bone strength than PsA patients receiving MTX or no DMARDs. These data support the concept of better control of PsA-related bone disease by bDMARDs. Electronic supplementary material The online version of this article (10.1186/s13075-019-1938-3) contains supplementary material, which is available to authorized users.

High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease

“…Compared to treatment naïve PsA patients, patients with a history of biological disease-modifying anti-rheumatic drugs (DMARD) treatment had significantly higher vBMD, BV/TV as well as greater trabecular number and thickness. No significant differences in bone density or microarchitecture outcomes were observed in patients previously treated with MTX compared to treatment naïve PsA patients ( 68 ).…”

Inflammatory Skin-Derived Cytokines Accelerate Osteoporosis in Mice with Persistent Skin Inflammation

“…On the other hand, when human peripheral blood CD14 + monocytes are stimulated and cultured with monocyte colony stimulating factor and IL-17, osteoclasts differentiate in a concentration-dependent manner [23]. Recent studies have shown that the use of cytokine inhibitor improves BMD in PsA patients [24]. In our model, a large amount of inflammatory cytokines are produced from the skin lesions (manuscript in preparation); therefore, we tried to prevent osteoporosis using antibodies against inflammatory cytokines, such as TNF-α, IL-1α/β, and IL-17A/F, but BMD did not change in any of the groups (data not shown).…”

Osteoporosis in Inflammatory Arthritides: New Perspective on Pathogenesis and Treatment

“…As concerning PsA, a recent study compared the effects of methotrexate (MTX) with bDMARDs on bone structure and biomechanical properties ( 125 ). It was found that bDMARD-treated patients had higher bone mass and better bone strength than patients receiving MTX or no DMARDs (despite longer disease duration in bDMARDs-treated group) ( 125 ).…”