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Bone status in adults with early-onset juvenile idiopathic arthritis following 1-year anti-TNFα therapy and discontinuation of glucocorticoids

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Abstract

Juvenile idiopathic arthritis (JIA) is an inflammatory disease associated with bone loss and low bone mineral density (BMD). The treatment involves disease-modifying antirheumatic drugs, glucocorticoids (GCs) and biological agents. The aim of this study was to evaluate effects of 12-month therapy with the anti-tumor necrosis factor alpha (anti-TNFα) preparations on bone mineral density (BMD) and biochemical turnover markers (BTM) in adult patients with JIA who were previously either treated or not treated with glucocorticoids (GC) and to assess effects of the discontinuation of GCs on their bone status. Nineteen adult patients (12 women, 7 men) aged 18–33 years with active JIA were prospectively enrolled to receive the anti-TNFα therapy (infliximab, etanercept or adalimumab). BMD and BTMs were determined at baseline and 1-year follow-up. The anti-TNFα therapy resulted in a significant reduction in disease activity score 28 (DAS28) and C-reactive protein (CRP) and a significant increase in BMD at the lumbar spine and total body and in serum N-terminal propeptide of type I procollagen (PINP, marker of bone formation). No significant changes in serum beta C-terminal telopeptide of type I collagen (βCTX, marker of osteoclastic bone resorption) and osteocalcin (marker of bone remodeling) were found. A significant negative correlation was observed between the change in the DAS28, CRP and serum PINP. The change in serum PINP concentrations positively correlated with the change in lumbar spine BMD. A significant increase in serum PINP was observed only in patients discontinuing GCs during the anti-TNFα treatment. After the initiation of the anti-TNFα therapy in young adults with JIA, the increase in new bone formation can be explained by discontinuation of GCs administration as the patients with the largest reduction in DAS28 and CRP probably are the ones most likely to stop GC.

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Acknowledgments

We would like to acknowledge the professional cooperation by Mrs. Ludmila Hauptvoglova, Blanka Runstukova, Vladislava Trojanova, Pavlina Bobrova, Katerina Vondrickova, Jirina Friedova, Marie Cerna, Slavka Ferdanova and Hana Janochova. The study fully supported by the Grant Agency of Charles University in Prague, GAUK 84208/2008 and by the Ministry of Health Research Grant MZd CR 000 2372.

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The authors stated that there is no conflict of interest regarding the publication of this article.

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Authors and Affiliations

  1. Institute of Rheumatology, Na Slupi 4, 128 50, Prague 2, Czech Republic

    Kristyna Brabnikova Maresova, Katerina Jarosova, Karel Pavelka & Jan J. Stepan

  2. First Faculty of Medicine, Charles University, Prague, Czech Republic

    Kristyna Brabnikova Maresova, Katerina Jarosova, Karel Pavelka & Jan J. Stepan

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  1. Kristyna Brabnikova Maresova
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Correspondence to Kristyna Brabnikova Maresova.

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Brabnikova Maresova, K., Jarosova, K., Pavelka, K. et al. Bone status in adults with early-onset juvenile idiopathic arthritis following 1-year anti-TNFα therapy and discontinuation of glucocorticoids. Rheumatol Int 33, 2001–2007 (2013). https://doi.org/10.1007/s00296-013-2678-3

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