Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis

Katalin Gulyás, Ágnes Horváth, Edit Végh, Anita Pusztai, Ágnes Szentpétery, Zsófia Pethö, Andrea Váncsa, Nóra Bodnár, Péter Csomor, Attila Hamar, Levente Bodoki, Harjit Pal Bhattoa, Balázs Juhász, Zoltán Nagy, Katalin Hodosi, Tamás Karosi, Oliver FitzGerald, Gabriella Szücs, Zoltán Szekanecz, Szilvia SzamosiSándor Szántó

Research output: Contribution to journalArticle

Abstract

Objectives: Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) have been associated with generalized and localized bone loss. We conducted a comprehensive study using imaging (dual-energy X-ray absorptiometry, DXA) and laboratory biomarkers in order to determine bone health and to study the effects of anti-tumor necrosis factor (TNF) biologics in RA and AS. Patients and methods: Thirty-six RA and 17 AS patients undergoing 1-year etanercept (ETN) or certolizumab-pegol (CZP) therapy were studied. Bone density was assessed by DXA at baseline and after 12 months. Serum C-reactive protein (CRP), calcium, phosphate, parathyroid hormone (PTH), vitamin D3, osteocalcin, procollagen type I N-propeptide (P1NP), C-terminal telopeptide (βCTX), osteoprotegerin, sclerostin (SOST), Dickkopf-1 (DKK-1), soluble receptor activator nuclear kappa B ligand (sRANKL), and cathepsin K (cathK) levels were determined at baseline and after 6 and 12 months. Results: TNF-α inhibition was clinically effective. Anti-TNF-α halted further bone loss over 1 year. In general, anti-TNF therapy significantly increased P1NP, SOST levels, and the P1NP/βCTX ratios, while decreased DKK-1 and CathK production at different time points in most patient subsets. In the full cohort and in RA, baseline and/or 12-month bone mineral density (BMD) at multiple sites exerted inverse relationships with CRP and βCTX, and positive correlation with SOST. In AS, L2-4 BMD after 1-year biologic therapy inversely correlated with baseline βCTX, while femoral neck BMD rather showed inverse correlations with CRP. Conclusions: Anti-TNF therapy slowed down generalized bone loss, in association with clinical improvements, in both diseases. TNF blockade may enhance bone formation and suppress joint destruction. Anti-TNF therapy may act inversely on DKK-1 and SOST. Independent predictors of BMD were SOST and βCTX in RA, whilst CRP in AS.Key Points• One-year anti-TNF therapy halted generalized bone loss in association with clinical improvement in arthritides.• Anti-TNF therapy may inversely act on DKK-1 and SOST.• Independent predictors of BMD were SOST and βCTX in RA, while CRP in AS.

Original languageEnglish
Pages (from-to)167-175
Number of pages9
JournalClinical rheumatology
Volume39
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

Keywords

  • Biologics
  • Bone loss
  • DKK-1
  • Erosion
  • JAK inhibitors
  • Osteoporosis
  • Osteoprotegerin
  • RANKL
  • Rheumatoid arthritis
  • Sclerostin
  • Spondyloarthritis
  • Syndesmophyte

ASJC Scopus subject areas

  • Rheumatology

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    Gulyás, K., Horváth, Á., Végh, E., Pusztai, A., Szentpétery, Á., Pethö, Z., Váncsa, A., Bodnár, N., Csomor, P., Hamar, A., Bodoki, L., Bhattoa, H. P., Juhász, B., Nagy, Z., Hodosi, K., Karosi, T., FitzGerald, O., Szücs, G., Szekanecz, Z., ... Szántó, S. (2020). Effects of 1-year anti-TNF-α therapies on bone mineral density and bone biomarkers in rheumatoid arthritis and ankylosing spondylitis. Clinical rheumatology, 39(1), 167-175. https://doi.org/10.1007/s10067-019-04771-3