In fact, there is an increase in BMD during the first year of treatment regardless of the use of GCs. Our findings of a minimal impact of GCs on bone and the absence of significant differences between GC and placebo group are in line with results of several earlier studies on BMD in early RA [3, 6, 16, 17, 34]. There were small increases in lumbar sBMD in both the GC and placebo groups, possibly reflecting the effective dampening of the inflammatory process in early RA, especially of pro-inflammatory cytokines such as IL-1 and TNF. These have Selleck Adriamycin direct effects

on osteoclast formation and stimulate osteoblasts and T lymphocytes to produce receptor activator of nuclear factor kappa B (RANK) ligand, leading to differentiation and activation of osteoclasts [35–37]. To this increase in lumbar sBMD, the bone protective medication prescribed in all our patients probably will also have contributed. The changes in BMD in our study are comparable to changes encountered in other studies on the effectiveness of alendronate in GC-induced osteoporosis in patients with RA and other inflammatory rheumatic diseases who also received calcium tablets [38, 39]. Again, effects were strongest on BMD of the lumbar spine [38]. In recent guidelines, the use of bisphosphonates is recommended with chronic prednisone use in dosages above 7.5 mg daily

in postmenopausal women and in men with age above 70 years [40, 41]. In premenopausal women and men with age below 70 years, it is advised that additional BMD measurements be performed to assess the need for bisphosphonates [40, 41]. This implicates that in our study some patients might PU-H71 cell line have not needed the osteoporosis preventive medication. Nevertheless, with ongoing inflammation and decrease in

physical activity, patients with RA are at a higher risk for developing osteoporosis, and early intervention including bisphosphonates can be advocated. This study revealed an influence of inflammation on BMD. In the mixed model analyses, the DAS28 measurements during the acetylcholine trial had a negative impact on BMD of both lumbar spine and hip. This indicates that in active early RA the benefits of GC therapy on the dampening of inflammation outweigh the risk of developing osteoporosis if preventive measures for osteoporosis have been taken. It is unclear whether the positive effects on BMD also lead to a reduction of the fracture risk since an increased risk of fracture has been observed with the same BMD level in GC users compared to non-GC users [42]. This suggests that bone structure negatively influenced by GCs might also play a role. A subgroup of patients with active disease who this website responded insufficiently to treatment with methotrexate and prednisone or placebo started anti-TNF alpha treatment with adalimumab added to medication. The number of subcutaneous adalimumab injections was positively associated with lumbar sBMD and negatively with hip sBMD in our study.