The Impact of Low-Dose Disease-modifying Anti-rheumatics Drugs (DMARDs) on Bone Mineral Density of Premenopausal Women in Early Rheumatoid Arthritis

Introduction.Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by symmetrical polyarthritis and multisystemic involvement.Objective.The aim of this study was to assess the impact of low dose of methotrexate on bone mineral density (BMD) in patients with early rheumatoid arthritis (RA).Materials and methods.This paper follows a retrospective study, which involves 60 female patients with early onset RA diagnosed according to the American Rheumatism Association Criteria (ACR/EULAR 2010).The patients were divided into two groups: group I was composed of thirty patients treated with dose of 7.5 mg/weekly methotrexate (MTX), while group II included thirty patients treated with dose of 2 g/daily sulfasalazine (SSZ).The Disease Activity was measured by a combination of Erythrocyte Sedimentation Rate (ESR) and Disease Activity Score (DAS-28).Bone mineral density of the lumbar spine (L2-4), and femoral neck, was measured by dual energy X-ray absorptiometry (DEXA) (Stratos 800).Laboratory findings included: serum calcium, phosphorus and alkaline phosphatase.Results.In this study, we found no negative effect on BMD in RA patients treated with low dose MTX in comparison to patients treated with SSZ.There was not observed significant difference in BMD of the lumbar spine, femur neck or trochanter, of MTX and SSZ patients in the pretreatment phase, nor after 12 months of treatment.No significant change in the biochemical parameters of the both groups. Conclusion.Based on the results of our study, low dose of methotrexate has no negative effect on BMD in premenopausal RA patients.We believe that these results might provide new insights and that further longitudinal studies with larger groups of premenopausal RA patients are required.