EFFECTS OF ANTI-INFLAMMATORY THERAPY ON BONE MINERAL DENSITY IN PATIENTS WITH ANKYLOSING SPONDYLITIS: RESULTS OF PROSPECTIVE STUDY

Aim: To evaluate bone mineral density (BMD) in patients with ankylosing spondylitis (AS) and distinct therapeutic regimens within 3 years of follow-up. Materials and Methods: We recruited 72 male patients with AS and divided them into two groups depending on the therapeutic regimen: 29 patients received infliximab and non-steroidal anti-inflammatory drugs (NSAIDs) while 43 patients received NSAIDs only. BMD was measured annually using dual energy X-ray absorptiometry. Results: Both therapeutic regimens led to an increase in BMD at the lumbar spine (LI-LIV) compared to baseline after 3 years of follow-up; however, only the combination of infliximab with NSAIDs led to an increase in BMD at the femoral neck compared to baseline. Patients who received infliximab and NSAIDs had significantly higher BMD at the femoral neck compared to those who received only NSAIDs after 3 years of follow-up. Conclusions: In patients with AS, the combination of infliximab and NSAIDs has a therapeutic advantage over NSAIDs only.

анкилозирующий спондилит, мужчины, минеральная плотность кости, инфликсимаб, ankylosing spondylitis, bone mineral density, infliximab, NSAIDs

1. Dydykina IS, Alekseeva LI. Osteoporosis in rheumatoid arthritis: diagnosis, risk factors, fractures, treatment. Rheumatology scienсe-practice. 2011; (5): 13-17. Russian (Дыдыкина И.С., Алексеева Л.И. Остеопороз при ревматоидном артрите: диагностика, факторы риска, переломы, лечение // Научно-практическая ревматология. 2011. №5. С.13-17).

2. Kang KY, Ju JH, Park SH, Kim HY. The paradoxical effects of TNF inhibitors on bone mineral density and radiographic progression in patients with ankylosing spondylitis. Rheumatology. 2013; 52(4):718-726.

3. Nasonov EL, Skripnicova IA, Nasonova VA. Osteoporosis: a rheumatology perspective. Therapeutic archive. 1997; (5): 5-9. Russian (Насонов Е.Л., Скрипникова И.А., Насонова В.А. Остеопороз: ревматологические перспективы // Терапевтический архив. 1997. №5. С. 5-9).

4. Benevalenskaya LI, Lesnyak OM. Osteoporosis. Diagnosis, prevention and treatment. Clinical guidelines. Moskow: GEOTAR- Media, 2011. 14 p. Russian (Беневоленская Л.И., Лесняк О.М. Остеопороз. Диагностика, профилактика и лечение. Клинические ре- комендации. М.: ГЭОТАР-Медиа, 2011. С.14).

5. Rumyanceva OA, Bochkova AG, Kuzikyanc KH et al. The experience of long-term therapy with infliximab in patients with ankylosing spondylitis. Rheumatology scienсe-practice. 2010;(6):16-22. Russian (Румянцева О.А., Бочкова А.Г., Кузикянц К.Х. и др. Опыт длительной терапии инфликсимабом у больных анкилозирующим спондилитом. // Научно-практическая ревматология. 2010. №6. С. 16-22).

6. Badokin VV. Drug therapy of ankylosing spondylitis. Russian medical journal. 2004; 12(20):1128-1136. Russian (Бадокин В.В. Медикаментозная терапия анкилозирующего спондилоартрита. // Русский медицинский журнал. 2004. Т. 12. № 20. С.1128-1136).

7. Wanders A, D. van Heijde, Landewe R, Béhier JM, Calin A, Olivieri I et al. Nonsteroidal antiinflammatory drugs reduce radiographic progression in patients with ankylosing spondylitis: A randomized clinical trial. Arthritis Rheum. 2005; 52(6):1756-1765.

8. Nemes D, Vermesan H, Vermesan D. The quality of live in patients with secondary osteoporosis due to seronegative spondyloarthropathies. Osteoporosis Int. 2011; 22(1):184-185.

9. Borcan M, Matei D, Popescu R. Management of osteoporosis in ankylosing spondylitis. Osteoporosis Int. 2011; 22(1):309-310.

10. Instructions for use of infliximab company. Centocor Inc. от 17 may 2006 y. Available at: http://www.fda.gov (accessed 05.03.2013). Russian (Инструкция по применению инфликсимаба компании. Centocor Inc. от 17 мая 2006 г. Доступ: http://www.fda. gov (дата обращения 05.03.2013).

11. Braun J, Van den Berg R, Baraliakos X., Boehm H, Burgos-Vargas R, Collantes-Estevez E et al. Update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann. Rheum. Dis. 2011; 70(6): 896-904.

12. Arends S, Spoorenberg A, Brouwer E et al. Clinical studies on bone-related outcome and the effect of TNF-α blocking therapy in ankylosing spondylitis. Curr. Opin. Rheumatol. 2014; 26(3): 259-268.

13. Sriganthan J, Ghanim N, Inman RD et al. Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: a systematic review and meta-analysis. Semin. Arthritis. Rheum. 2014; 44(2): 155-161.

14. Osta B, Benedetti G, Miossec P. Classical and Paradoxical Effects of TNF-α on Bone Homeostasis. Front. Immunol. 2014; (5): 48.

15. Borcan M, Matei D, Popescu R. Management of osteoporosis in ankylosing spondylitis. Osteoporosis Int. 2011; 22(1): 309-310.

16. Van der Linden S, Valkenburg H, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthr. Rheum. 1984; 27(4): 361-368.

17. Muntean L, Rojas-Vargas M, Font P. et al. Relative value of the lumbar spine and hip bone mineral density and bone turnover markers in men with ankylosing spondylitis. Clin. Rheumatol. 2011; 30(5): 691-695.