CHANGES OF BONE MINERAL DENSITY DURING FOUR-YEAR RITUXIMAB AND METHOTREXATE THERAPY IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS
https://doi.org/10.14412/1995-4484-2016-530-534
Abstract
Objective: to estimate the changes of bone mineral density (BMD) at the femoral neck and lumbar spine during fouryear combination therapy with rituximab (RTM) and methotrexate (MT) in postmenopausal women with rheumatoid arthritis (RA).
Subjects and methods. 79 postmenopausal women with a documented diagnosis of RA were followed up. They were divided into two groups according to the basic treatment: 1) 44 patients received combination therapy with RTM and MT; 2) 36 patients had MT monotherapy. BMD was assessed by dual-energy X-ray absorptiometry using an Excell XR-46 stationary dual-energy X-ray bone densitometer (Norland, USA) once per year (over 48 months).
Results and discussion. The group of patients receiving RTM and MT achieved a statistically significant increase in femoral neck BMD after 36 months of therapy. Statistically significant changes in femoral neck BMD were not revealed in the patients who had MT monotherapy. Lumbar spine BMD was decreased during MT monotherapy, but it remained stable in the RTM + MT group throughout the 48-month follow-up.
Conclusion. Thirty-six-month combination treatment with RTM and MT provides positive changes in femoral neck BMD, which persists within 48 months after treatment initiation. Lumbar spine BMD remained stable in the patients receiving RTM and MT.
About the Authors
T. A. Raskina
Kemerovo State Medical University
Russian Federation
22a, Voroshilov St., Kemerovo 650000
Russian Federation
22a, Voroshilov St., Kemerovo 650000
M. V. Koroleva
Kemerovo State Medical University
Russian Federation
Russian Federation
Marina Koroleva.
22a, Voroshilov St., Kemerovo 650000
O. S. Malyshenko
Kemerovo State Medical University
Russian Federation
22a, Voroshilov St., Kemerovo 650000
Russian Federation
22a, Voroshilov St., Kemerovo 650000
References
1. Дыдыкина И.С, Алексеева Л.И. Остеопороз при ревматоидном артрите: диагностика, факторы риска, переломы, лечение. Научно-практическая ревматология. 2011;49(5):13-7 [Dydykina IS, Alekseeva LI. Osteoporosis in rheumatoid arthritis: diagnosis, risk factors, fractures, treatment. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2011;49(5):13-7 (In Russ.)]. doi: 10.14412/1995-4484-2011-1454
2. Каратеев ДЕ, Раденска-Лоповок СГ, Насонова ВА. Синовиальная оболочка на ранней стадии ревматоидного артрита: клинико-морфологические сопоставления. Терапевтический архив. 2003;(5):12-20 [Karateev DE, Radenska-Lopovok SG, Nasonova VA. The synovium in the early stages of rheumatoid arthritis: clinical and morphological comparisons. Terapevticheskii Arkhiv. 2003;(5):12-20 (In Russ.)].
3. Раскина ТА, Летаева МВ. Минеральная плотность костной ткани у мужчин при различных клинических вариантах ревматоидного артрита. Научно-практическая ревматология. 2011;49(2):21-4 [Raskina TA, Letaeva MV. Bone mineral density with men at various clinical variants of rheumatoid arthritis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2011;49(2):21-4 (In Russ.)]. doi: 10.14412/1995-4484-2011-598
4. Лесняк ОМ, Беневоленская ЛИ. Остеопороз. Диагностика, профилактика и лечение. Клинические рекомендации. Москва; 2011. 270 с. [Lesnyak OM, Benevolenskaya LI. Osteoporoz. Diagnostika, profilaktika i lechenie. Klinicheskie rekomendatsii [Osteoporosis. Diagnosis, prevention and treatment. Clinical guidelines]. Moscow; 2011. P. 270].
5. Goldring SR. The effects of inflammatory arthritis on bone remodeling. Arthritis Res Ther. 2005;7(1):12. doi: 10.1186/ar1518
6. Wada T, Nakashima T, Hiroshi N, et al, RANKL-RANK signaling in osteoclastogenesis and bone disease. Trends Mol Med. 2006;12(1):17-25. doi: 10.1016/j.molmed.2005.11.007
7. Насонов ЕЛ. Новые направления терапии ревматоидного артрита: перспективы применения моноклональных антител к В-лимфоцитам (ритуксимаб). Русский медицинский журнал. 2006;25:1778-82 [Nasonov EL. New directions for rheumatoid arthritis therapy: perspectives of monoclonal antibodies against B-lymphocytes (rituximab). Russkiy Meditsinskiy Zhurnal. 2006;25:1778-82 (In Russ.)].
8. Насонов ЕЛ. Анти-В-клеточная терапия в ревматологии: фокус на ритуксимаб. Москва; 2012. 344 с. [Nasonov EL. AntiB-kletochnaya terapiya v revmatologii: fokus na rituksimab [The anti-B-cell therapy in rheumatology: the focus on rituximab]. Moscow; 2012. 344 p.].
9. Kanis JA, Johanson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2000;19):893-9.
10. Григорьева НВ. Метотрексат и костная ткань. Новости медицины и фармации. 2009;19:293 [Grigoreva NV. Methotrexate and bone tissue. Novosti Mediciny i Farmacii. 2009;19:293 (In Russ.)].
11. Ziolkowska M, Kurowska M, Radzikowska A, et al. High levels of osteoprotegerin and soluble receptor activator of nuclear factor κB ligand in serum of rheumatoid arthritis and their normalization after antitumor necrosis factor a treatment. Arthritis Rheum. 2002;46:1744-53.
12. Cohen SB, Emery P, Greenwald MW, et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebocontrolled, phase III trial evaluating primary effectiveness and safety at twenty-four weeks. Arthritis Rheum. 2006;54(9):2793-806. doi: 10.1002/art.22025
13. Tak PP, Rigby WF, Rubbert-Roth A, et al. Inhibition of joint damage and improved clinical outcоmes with rituximab plus methotrexate in early active rheumatoid arthritis: the IMAGE trial. Ann Rheum Dis. 2011;70:39-46. doi: 10.1136/ard.2010.137703
14. Boumans MJ, Thurlings RM, Yeo L, et al. Rituximab abrogates joint destruction in rheumatoid arthritis by inhibiting osteoclastogenesis. Ann Rheum Dis. 2012;71(1):108-13. doi: 10.1136/annrheumdis-2011-200198
15. Wheater G, Hogan VE, Teng YKO, et al. Suppression of bone turnover by B-cell depletion in patients with rheumatoid arthritis. Osteoporos Int. 2011;22:3067-72. doi: 10.1007/s00198-011-1607-0
Review
For citations:
Raskina T.A., Koroleva M.V., Malyshenko O.S. CHANGES OF BONE MINERAL DENSITY DURING FOUR-YEAR RITUXIMAB AND METHOTREXATE THERAPY IN POSTMENOPAUSAL WOMEN WITH RHEUMATOID ARTHRITIS. Rheumatology Science and Practice. 2016;54(5):530-534. (In Russ.) https://doi.org/10.14412/1995-4484-2016-530-534
Views:
660
Email this article 