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Page 25
April 15-16, 2019 | Milan, Italy
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
Ortho Congress 2019 Journal of Orthopedic Surgery and Rehabilitation | ISSN: 2630-4473 | Volume 3
ORTHOPEDICS, RHEUMATOLOGY
AND OSTEOPOROSIS
2nd Annual Conference on
MARKERS OF OSTEOPOROSIS (OPG AND RANKL) IN RHEUMATOID ARTHRITIS IN
DIFFERENT BIOLOGIC THERAPIES
Katarzyna Romanowska-Próchnicka 1,4, Agnieszka Paradowska-Gorycka2, Małgorzata Mańczak3,
Anna Felis-Giemza1, Sławomir Maśliński4, Dariusz Szukiewicz4 and Marzena Olesińska1
1 Department and Polyclinic of Systemic Connective Tissue Diseases, Institute of Rheumatology, Poland
2 Department of Biochemistry and Molecular Biology, Institute of Rheumatology, Poland
3 Department of Epidemiology and Health Promotion, Institute of Rheumatology, Poland
4 Department of General and Experimental Pathology, CEPT laboratory, Medical University of, Poland
Introduction: Osteoprotegerin (OPG) is a soluble decoy receptor which blocks osteoclast differentiation and
activation by neutralizing the receptor activator of NF-κB ligand (RANKL). The balance between RANKL, which
stimulates osteoclast genesis and osteoplastic activation, and its physiological antagonist OPG plays a critical
role in the regulation of bone resorption in rheumatoid arthritis (RA).
Objectives: The aim of the study was to examine the impact of various drug therapies in RA on the bone turn-
over activity markers, i.e. sRANKL and OPG.
Material: A group of 125 patients (pts) with RA and a control group of 42 healthy people have been qualified to
the study. All patients fulfilled the American College of Rheumatology (ACR 2010) criteria for RA. RA group was
divided into several subgroups. First group included 39 RA pts on Leflunomide. Second group included 49 RA
pts on Methotrexate (MTX) and Etanercept (First line biologic therapy). Third group included 16 RA pts on MTX
and Adalibumab, Golibumab, Infliksimab (Second line biologic therapy). Fourth group included 16 RA pts on
MTX and antiCD20 or anti IL6 (Third line biologic therapy). Fifth group included 44 RA pts on Disease-modify-
ing Antirheumatic drugs (DMARD’s), 39 of them were included into Leflunomide therapy, also with intolerable
toxicity to MTX. Estimate research period was 12 months. Average age of participants was 54 (22-79 years).
All pts have been examined based on DAS28 before and after 90 days of therapy. The blood samples for bone
markers RANKL and OPG levels were measured by ELISA after 90 days therapy. Bone erosions in hands and feet
were evaluated by Larsen methods. Dexa scan of femoral neck was performed.
Results: All subgroups of RA pts were compared in respect of markers of osteoporosis. The individual groups
of pts do not differ from each other in the following parameters: The radiological destructions of the disease,
organ damage, presence of anti-CCP and RF, the average use of GKS, and co-occurrence with osteoporosis and
osteopenia. The above-mentioned groups of pts were relatively homogeneous. In all groups of RA pts treated
with various therapies decreased level of sRANKL/OPG has been observed compared to DMARD therapy (Le-
flunomide to DMARD’s-p- 0, 06, first line biologic therapy to DMARD’s- p-0,05, second line biologic therapy to
DMARD’s- p-0,04, third line biologic therapy to DMARD’s p- 0, 001. Additionally in the RA group treated with
anti CD20 and anti IL6 therapy serum OPG level was significantly higher than in other group (p-0,003). Further-
more, serum sRANKL level was reduced in the third-line therapy compared to DMARD’s (p- 0,003) (Figure 1).
Conclusions: In conclusion our findings indicate that both OPG as well as sRANKL help with evaluation of
treatment effectiveness in RA and are useful parameters in daily clinical practice.
Katarzyna Romanowska-Próchnicka et al., J ortho Rehab Surg. 2019, Volume 3 | DOI: 10.4066/2630-4473-C1-002