Disease-modifying antirheumatic drugs and bone mass in rheumatoid arthritis

O. Di Munno¹, A. Delle Sedie¹, M. Rossini², S. Adami²

¹Department of Internal Medicine.U.O. Reumatologia, University of Pisa, Pisa, Italy; ²Riabilitazione Reumatologica, University of Verona, Verona, Italy.

ABSTRACT
This article reviews the effects of DMARDs (including biologic agents) on bone metabolism in rheumatoid arthritis (RA). At present there is no evidence that methotrexate, at least at dosages ranging from 5 to 20 mg/week, negatively affects bone mass as measured by DXA (BMD) as documented in both cross-sectional and longitudinal studies. Most studies of cyclosporine (CyA) use reporting a reduction in erosions and joint damage with no adverse effects on bone, did not measure BMD; CyA treatment is associated with a dose-dependent increase of bone turnover as well as a decrease in both animal and human studies; however, its use in RA setting at a dose &Mac178; 5 mg/Kg/ day has so far not been associated with clinical relevant adverse effects on bone metabolism. Anti-TNF-a agents, infliximab reduced markers of bone turnover in two longitudinal studies. Data on BMD are not available in RA; nevertheless, an increase in BMD has been documented in spondyloarthropathies with infliximab and etanercept. No clinical data concerning BMD are available on leflunomide as well as on the newer biologic agents (adalimumab, rituximab, anakinra).

Key words
DMARDs, bone metabolism, bone mineral density, rheumatoid arthritis, spondyloarthropathies, methotrexate, cyclosporine, leflunomide, biologic agents.

Please address correspondence and reprint requests to: Ombretta Di Munno, MD, Dipartimento di Medicina Interna, U.O. Reumatologia, Università di Pisa, Via Roma, 67, 56126 Pisa, Italy.
E-mail: odimunno@int.med.unipi.it

Clin Exp Rheumatol 2005; 23: 137-144.
© CLINICAL AND EXPERIMENTAL RHEUMATOLOGY 2005.