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Effects of High Dose Methylprednisolone Pulse Therapy on Bone Mass and Biochemical Markers of Bone Metabolism in Patients with Active Rheumatoid Arthritis: A 12-Month Randomized Prospective Controlled Study
BRUNO FREDIANI, PAOLO FALSETTI, STEFANIA BISOGNO, FABIO BALDI, CATERINA ACCIAI, GEORGIOS FILIPPOU, MARIA ROMANA BACARELLI, PAOLO FILIPPONI, MAURO GALEAZZI, and ROBERTO MARCOLONGO
ABSTRACT.
Methods. Thirty-one women with active RA were given 1000 mg of MP IV for 3 alternate days, with a mean interval of administration of 76 days (± 8.3 SD) for one year (MPPT group). Bone mineral density (BMD) (total body, lumbar spine, and femur neck), plasma levels of sBAP, and urinary concentrations of uDpyr were assessed at the beginning of the treatment and every 3 months until the end of the study. Moreover, erythrocyte sedimentation rate (ESR), Thompson joint score, and early morning stiffness were assessed at study entry and every month. The control group, 31 women with active RA treated with oral MP, was followed in the same way (OMP group). Results. In the MPPT group there was no significant reduction of BMD at any site compared to significant reductions in lumbar BMD at 6 and 12 months and total body BMD and femur neck BMD at 12 months in the OMP group. Also in the OMP group, a significant reduction in the mean sBAP was observed. The mean uDpyr levels were not significantly reduced in either group. Conclusion. Our results show that MPPT, compared to continuous therapy with oral corticosteroids, preserves bone mass without modifying the biochemical markers of bone metabolism. (J Rheumatol 2004;31:1083-7) Key Indexing Terms:
GLUCOCORTICOID PULSE THERAPY
From the Department of Clinical Medicine and Immunological Sciences, Division of Rheumatology, University of Siena, Siena; and the Bone and Mineral Research Unit, University of Perugia, Perugia, Italy. B. Frediani, MD; P. Falsetti, MD; S. Bisogno, MD; F. Baldi, MD; C. Acciai, MD; G. Filippou, MD; M.R. Bacarelli, TchLab; R. Marcolongo, MD, Professor of Rheumatology; M. Galeazzi, MD, Professor of Rheumatology, University of Siena; P. Filipponi, MD, Professor of Bone Metabolism, University of Perugia. Address reprint requests to Dr. B. Frediani, Department of Clinical Medicine and Immunological Sciences, Division of Rheumatology, University of Siena, Policlinico Le Scotte, viale Bracci 53100 Siena, Italy. E-mail: fredianibruno@tiscalinet.it Submitted May 16, 2003; revision accepted December 30, 2003.
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