Patients with psoriatic arthritis who received biological DMARDs demonstrate better bone mass and strength than those treated with methotrexate or no DMARDs at all, according to data published in Arthritis Research & Therapy.
“In contrast to RA, little is known about the effect of [DMARDs] on bone structure in PsA,” Georg Schett, MD, of Friedrich–Alexander University Erlangen–Nürnberg, Germany, and colleagues wrote. “In rheumatoid arthritis, biological DMARDs have shown to inhibit bone loss and thus may prevent pathological fractures. To date, no such studies have been done in PsA; however, it can be assumed that effective control of inflammation may also impact secondary bone loss and bone biomechanics in PsA patients.”
To analyze whether treatment with methotrexate and biological DMARDs affect bone structure and biomechanical characteristics among patients with PsA, Simon and colleagues conducted a cross-sectional study of participants in the Erlangen Imaging Cohort. According to the researchers, participants in this cohort were consecutively recruited during routine diagnostic assessments for inflammatory arthritis at the department of internal medicine 3 of the Friedrich–Alexander University Erlangen–Nürnberg.
Patients with PsA who received biological DMARDs demonstrate better bone mass and strength than those treated with methotrexate or no DMARDs at all, according to data.
Simon and colleagues analyzed 165 patients with PsA, of whom 86 were treated with DMARDs. Among the patients treated with DMARDs, 34 received methotrexate and 52 received biological DMARDs — such as TNF inhibitors, secukinumab (Cosentyx, Novartis) or ustekinumab (Stelara, Janssen) — for at least 6 months. The researchers used high-resolution peripheral quantitative CT and micro-finite element analysis to determine volumetric bone mineral densities and biomechanical properties. Data were compared between patients who received no DMARDs and those treated with any DMARDs, methotrexate or biological DMARDs.
According to the researchers, disease duration was longest among patients who received biological DMARDs, at 7.8±7.4years, compared with 4.6±7.4 for methotrexate and 2.9±5.2 for no DMARD treatment. In addition, there were no differences in bone parameters between patients in the no-DMARD and methotrexate groups. However, patients who received biological DMARDs demonstrated significantly higher total (P = .001) and trabecular volumetric bone mineral density (P = .005), compared with those in the methotrexate and no-DMARD groups.
Participants treated with biological DMARDs also revealed higher failure load (P = .012) and stiffness (P = .012). Regression models demonstrated that age and biological DMARDs impacted total volumetric bone mineral density. Age, sex and biological DMARDs affected failure load and stiffness.
“This study shows that biological agents used for the treatment of psoriatic arthritis are associated with a better outcome in bone health, which is an important finding for patients and doctors” Schett told Healio Rheumatology. “The results are even more relevant when considering that patients with psoriatic arthritis receiving treatment with biological agents have more severe and resistant disease. Despite this situation, such patients enjoy a better bone health, suggesting that biological agents allow a better and more sustained control of inflammation in this disease.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.