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, Kimberley Johanna Beek Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Tamara Rusman Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Maria Alida Cornelia van der Weijden Department of Rheumatology Groene hart ziekenhuis Gouda The Netherlands Search for other works by this author on: Oxford Academic Willem Frederik Lems Department of Rheumatology Amsterdam Rheumatology and Immunology Centre, Reade Amsterdam The Netherlands Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Johannes Christiaan van Denderen Department of Rheumatology Amsterdam Rheumatology and Immunology Centre, Reade Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Maria Konsta Department of Rheumatology Veterans Administration Hospital (NIMTS) Athens Greece Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Ingrid Visman Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Michael Twahier Nurmohamed Department of Rheumatology Amsterdam Rheumatology and Immunology Centre, Reade Amsterdam The Netherlands Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Search for other works by this author on: Oxford Academic Irene Eva van der Horst‐Bruinsma Department of Rheumatology Amsterdam Rheumatology and Immunology Centre Amsterdam UMC Amsterdam The Netherlands Address correspondence to: Prof. dr. I. E. van der Horst‐Bruinsma, VU University Medical Center, Room 3A‐64, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E‐mail: ie.vanderhorst@vumc.nl Search for other works by this author on: Oxford Academic
Journal of Bone and Mineral Research, Volume 34, Issue 6, 1 June 2019, Pages 1041–1048, https://doi.org/10.1002/jbmr.3684
Published:
28 January 2019
Article history
Received:
17 May 2018
Revision received:
15 January 2019
Accepted:
19 January 2019
Published:
28 January 2019
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Kimberley Johanna Beek, Tamara Rusman, Maria Alida Cornelia van der Weijden, Willem Frederik Lems, Johannes Christiaan van Denderen, Maria Konsta, Ingrid Visman, Michael Twahier Nurmohamed, Irene Eva van der Horst‐Bruinsma, Long‐Term Treatment With TNF‐Alpha Inhibitors Improves Bone Mineral Density But Not Vertebral Fracture Progression in Ankylosing Spondylitis, Journal of Bone and Mineral Research, Volume 34, Issue 6, 1 June 2019, Pages 1041–1048, https://doi.org/10.1002/jbmr.3684
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ABSTRACT
The aim of this cohort study was to evaluate the long‐term effects of TNF inhibitors (TNFis) on BMD and the incidence of vertebral fractures (VFxs) in patients with ankylosing spondylitis (AS). Consecutive patients with active AS with TNFi treatment duration up to 4 years with available DXA scans and spine X‐rays were included. BMD (classified according to the WHO criteria for osteoporosis) of the hip and lumbar spine, the VFx (classified as a Genant score text-decoration:underline1/text-decoration:underline20% height loss), and radiological progression (modified stoke ankylosing spondylitis spinal score [mSASSS]) scores were obtained at baseline and at 4 years of TNFi treatment. Overall, 135 AS patients were included. At baseline, 40.1% of patients had low BMD of the hip and 40.2% of the lumbar spine. This decreased to 38.1% (p = 0.03) with low hip BMD and 25.3% (p < 0.001) of the lumbar spine BMD after 4 years of TNFi treatment. VFxs were present at baseline in 11.1% of the 131 patients, which increased to 19.6% after 4 years of TNFi treatment. A Genant score ≥2, was found at baseline in 3 out of 14 VFx (21.4%) patients, which increased to 7 out of 27 VFx (25.9%) patients after 4 years. All disease activity parameters—the ankylosing spondylitis disease activity scale, the C‐reactive protein, the erythrocyte sedimentation rate, and the bath ankylosing spondylitis disease activity index—decreased significantly (p < 0.001). The mean radiological progression (n = 80) increased significantly from a median mSASSS of 4.0 (1.5 to 16.0) at baseline to 6.5 (2.1 to 22.9) after 4 years of TNFi treatment (p < 0.001). Despite the improvement in BMD and the decrease in disease activity, we still found new VFxs, an increase in severity in the number and grade of VFxs, and radiographic progression during 4 years of treatment with TNFis in AS patients with long disease duration. © 2019 American Society for Bone and Mineral Research.
ANKYLOSING SPONDYLITIS, BONE MINERAL DENSITY, VERTEBRAL FRACTURES, RADIOLOGICAL DAMAGE, TNF ALPHA INHIBITORS
© 2019 American Society for Bone and Mineral Research
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
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