Indian Journal of Public Health Research & Development

Abstract

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.

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Abstract

Background: Anti-cyclic citrullinated peptide antibodies (ACPA) and rheumatoid factor (RF) are two important investigations that help in confirming the diagnosis and may help deciding strategies for the treatment. This study’s aim is to investigate the effect of infliximab, a tumor necrosis factor inhibitor on ACPA and RF in patients with rheumatoid arthritis.

Patients and Method:Thirty five Iraqi patients with established RA, enrolled in this study during September 2013-May 2014. They received 3 mg/kg infliximab intravenously at weeks 0, 2, 6, and every 8 weeks thereafter in combination with methotrexate (15-20) mg. At baseline, week 24, CRP and ESR were determined and the disease activity score (DAS28) was calculated. Serum samples collected at the same time points were used to measure ACPA, and IgM-RF (ELISA).

Results:RF mean at the first visit was (106.1±25.2) IU/ml and at the second visit it reduced to (60.1±14.6) IU/ml and the difference was statistically significant, (P=0.038). ACPA mean was (466.5±61.4) U/ml at the first visit reduced significantly to reach (241.9±36.6) U/ml at the second visit (P<0.001). A dramatic and significant change had been found in the disease activity; (P<0.001) mean DAS 28 was (5.7±1.1) at the first visit with a range of (2.7– 8.6), at the second visit the mean was (4.5±1) and the range was (2.04–6.4).

Conclusions:Anti-TNF a treatment in RA cause decrease in serum titers of RF and ACPA in patients with clinical improvement.

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