Link Between DMARD Use and Microstructural Bone Changes in Rheumatoid Arthritis

Early changes in bone mineral density and microstructure may be slow or resistant to recovery.

Changes in periarticular bone density and microstructure that occur early in rheumatoid arthritis (RA) are consistent with those usually observed in aging bone and are resistant or slow to recover despite treatment with first-line nonbiologic disease-modifying antirheumatic drugs (DMARDs) with or without concomitant glucocorticoids to control inflammatory joint symptoms, according to a study published in BMC Musculoskeletal Disorders.1

Researchers conducted a 1-year, prospective observational cohort study in 30 participants with early RA (average 7.7 months since diagnosis) who were age and sex matched with 30 participants without RA.1 The mean age of the participants was 53 years; 80% were female. At baseline, patients with RA had few active joints and minimal self-reported functional limitation.

Treatment included 15 patients who received DMARDs alone, 13 who received DMARDs and glucocorticoids, 1 who received DMARDs and biologics, and 1 who received only glucocorticoids. Despite these treatments, patients with RA had marked differences in periarticular trabecular and cortical bone density and microstructure compared with participants without RA. In addition, the pattern of early microstructural bone changes in those with early RA was consistent with changes more commonly observed in aging bone.

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After 1 year of treatment, the degree of detectable changes did not differ between participants with and without RA. Although bone damage did not worsen in patients with RA compared with those without RA, there was no evidence of improvement, suggesting that the microstructural bone damage identified within the first year of RA diagnosis is resistant to or very slow to recover, despite good clinical control of inflammatory joint symptoms with first-line nonbiologic DMARD therapies, with or without glucocorticoids.    

The authors concluded that “Clinically, our findings support the importance of early and aggressive treatment and proactive monitoring and targeted management of bone health and fracture risk in individuals living with RA.”1,2


  1. Feehan LM, Li LL, McKay HA. Micro-structural bone changes in early rheumatoid arthritis persist over 1-year despite use of disease modifying anti-rheumatic drug therapy [published online December 11, 2017]. BMC Musculoskelet Disord. doi:10.1186/s12891-017-1888-3
  2. Mullen MB, Saag KG. Evaluating and mitigating fracture risk in established rheumatoid arthritis.Best Pract Res Clin Rheumatol. 2015;29(4):614-627.