Background: Osteoporosis (OP) can affect patients with Rheumatoid Arthritis (RA). This can be due to long-time use of glucocorticoids (GCS) or to the activation of proinflammatory pattern, via TNFα signalling, that leads to osteoclast (OC) activation with bone resorption.

Objectives: Aim of this study is to assess how therapy with GCS, methotrexate (MTX) and bDMARDs may change bone density parameters.

Methods: 66 RA patients were enrolled in this study. Bone Mineral Density (BMD), T-score of spine and femur, Trabecular Bone Score (TBS) and TBS T-score were evaluated at baseline and after 18 months of treatment with GCS, MTX, bDMARDs. Comparison among different patient groups were evaluated by ANOVA. P-value < 0.05 was considered significative.

Results: At baseline, 66% of patients were female and 44% male, mean age was 62.2 (± 8.4) years, mean disease duration was 17.8 (± 11.2) years, 76% of patients were Rheumatoid Factor (RF) positive and 24% were RF negative, 71% were ACPA positive and 29% were ACPA negative, mean DAS-28 was 3.67 (± 1.34), mean L1-L4 BMD was 0.930 (± 0.175) g/cm ³ , mean neck’s femur BMD was 0.705 (± 0.102) g/cm ³ , mean L1-L4 T-score was -1.11 (± 1.54), mean neck’s femur T-Score was -1.17 (± 1.02), mean TBS was 1.239 (± 0.132) and mean TBS T-score was -2.36 (± 1.42). Among the entire population in study, 24.4% were affected by OP, 74.6% were in therapy with GCS, 57.8% with MTX and 16.6% were under OP treatment with bisphosphonate or teriparatide or denosumab. At baseline, 51.6% of patients started an TNFi treatment, 3.1% started an anti IL-6 treatment, 9.3% started an anti-CTLA4 treatment and 23.4% started a JAKi treatment. By ANOVA analysis, patients at baseline in therapy with MTX had mean L1-L4 BMD and L1-L4 T-score higher than those not in therapy with MTX, respectively 0.985 (± 0.184) g/cm ³ vs 0.866 (± 0.144) g/cm ³ (p < 0.05) and -0.73 (± 1.70) vs – 1.62 (± 1.13) (p < 0.05). At 18 months patients treated with MTX had higher L1-L4 T-score than those not in therapy with MTX, respectively -0.48 (± 1.68) vs – 1.68 (± 1.18) (p < 0.05). Percentage variations in BMD, T-score, TBS and TBS T-score between baseline and 18-month endpoint were not significative; nevertheless, we observed a positive trend in lumbar and femur BMD percentage variations in patients treated with JAKi (2.89%), and in TBS percentage variations in patients in TNFi treatment (2.98%).

Conclusion: In this study we confirmed the high prevalence of OP in RA-patients. Therapy with MTX seems to prevent bone resorption, but it does not improve bone density parameters. Moreover, we observed a positive trend in JAKi-patients BMD and TNFi-patients TBS percentage variations, even though these data are not statistically significative due to the small sample.

Disclosure of Interests: None declared