Acute effects on bone metabolism markers and inflammatory mediators after TNF blocker treatment in RA patients.

초록

Background: TNF blocking agents are known to be effective in suppressing inflammatory activity and inhibiting bone destruction in patients with rheumatoid arthritis (RA). Objectives: We investigated how bone metabolism markers and inflammatory mediators were acutely affected after administration of TNF blocking agents in RA patients. Methods: Twenty-seven patients (23 women and 4 men; age 47.6 ± 13.3 years) with RA were included. It was required to be active RA, thus they should have either ESR ≥ 28mm/hr or CRP ≥ 2.0 mg/dL and morning stiffness ≥ 45 minutes. Venous blood was drawn before therapy and at week between 14-16. Bone metabolism was assessed using osteoprotegerin (OPG), sclerostin and serum c-telopeptide (CTX). The serum level of inflammatory mediators including ESR, CRP and IL-6 were also determined. Results: Bone metabolism markers did not show significant change after administration of TNF blockers as shown in Table 1. Serum OPG slightly decreased whereas sclerostin was increasing. A bone resorbing marker, serum CTX also increased at week 14-16 but it was not significant either. However inflammatory mediators improved significantly. Both ESR and CRP decreased markedly and serum IL-6 was also significantly reduced. Conclusions: Inflammatory mediators rapidly responded to the TNF blockers. But the effect on bone turnover markers was much slower and it could be assumed that bone erosion was still in progress even after administration of TNF blocker. Therefore we conclude that TNF blocking agents do not affect bone metabolism in RA patients within 4 months of treatment while it effectively controls systemic inflammation.