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MARKERS OF OSTEOPOROSIS (OPG AND RANKL) IN RHEUMATOID ARTHRITIS IN DIFFERENT BIOLOGIC THERAPIES
2nd Annual Conference on ORTHOPEDICS, RHEUMATOLOGY AND OSTEOPOROSIS
April 15-16, 2019 | Milan, Italy
Katarzyna Romanowska-Prochnicka, Agnieszka Paradowska-Gorycka, Malgorzata Manczak,Anna Felis-Giemza, Slawomir Maslinski, Dariusz Szukiewicz and Marzena Olesinska
Department and Polyclinic of Systemic Connective Tissue Diseases, Institute of Rheumatology, Poland Department of Biochemistry and Molecular Biology, Institute of Rheumatology, Poland Department of Epidemiology and Health Promotion, Institute of Rheumatology, Poland Department of General and Experimental Pathology, CEPT laboratory, Medical University of, Poland
Scientific Tracks Abstracts : J ortho Rehab Surg
Abstract:
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 turnover
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-modifying
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 (Leflunomide
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). Furthermore,
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.
Biography:
Katarzyna Romanowska-Próchnicka has completed her specialization in Rheumatology and Internal Medicine from National Institute of Geriatrics, Rheumatology and Rehabilitation, Department of Connective Tissue Disease and awarded the PhD and MD in Medicine at Warsaw Medical University, Poland. Currently, she is an Assistant Professor at Warsaw Medical University in Pathology Department, where she has completed her Young Assistant- Internship at Military Institute of Medicine at Warsaw, Poland.
E-mail: Katarzyna.prochnicka@gmail.com
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