Effect of Infliximab and Methotrexate on Bone Mineral Density in Rheumatoid Arthritis Patients

Background:Osteoporosis is an extra-articular complication of rheuma toid arthritis that results in increased risk of fractures and associated mor bidity, mortality, and healthcare costs. The study aims at evaluation of changes in bone mineral density in a Rheumatoid arthritis patients on inflixmab and methotrexate.

Patients and Method:A cross sectional study enrolled 60 RA patients diagnosed according to the ACR 1987/2010 revised criteria for the classification of RA. Thirty patient were on infliximab and other (30 patient) on methotrexate. Dermatographic and clinical data were collected (disease duration, disease activity score index of 28 joints (DAS 28) and (CDI), functional class, body mass index and treatment history. Patients with histories of chronic disease and smokers were excluded. Complete blood count, erythrocyte sedimentation rate serum calcium, phosphorous, alkaline phosphatate, vitamin D level were measured in both groups. Bone mineral density was measured by dual energy x-ray absorptiometry of hip and lumber spines for patients. Tor Z–score equal or less than (-2.5 standard deviation) of healthy young adults was taken as osteoporotic, and scores between (-1 to -2.5 standard deviation) was taken as osteopenic. Informed consent was obtained from individuals.

Results:The analysis of Dual energy x-ray absorptiometry of hips and lumber spines revealed that the number of RA patients on Inflixmab having osteoporosis was 1 (3%) and 12 (40%) were osteopenic, compared to patients on MTX osteoporosis was present in 8 (26%) and osteopenia in 13 (43%), which is a significant difference, p-value (0.019). Vitamin D level in patient on Inflixmab was low in 24 (80%) and normal in 6 (20%) patients. While in MTX it was low in 13 (43.3%) and normal in 17 (56.7%) of patients, p-value (0.003).

Conclusions: There was significant decrease in bone mineral density in RA patients on MTX while inflixmab had a role in arrest in bone loss.