Dear Sujith

This article mey be useful for you:

The effect of newer anti-rheumatic drugs on osteogenic cell proliferation: an in-vitro study

Ajay Malviya1*, Jan Herman Kuiper2, Nilesh Makwana3, Patrick Laing3 and Brian Ashton4

* Corresponding author: Ajay Malviya [email protected]

Author Affiliations

1 Wansbeck General Hospital, Woodhorne Lane, Ashington, Northumberland, NE63 9JJ, UK

2 Joint Reconstruction Unit, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK

3 Orthopaedic Department, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK

4 Arthritis Research Centre, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, SY10 7AG, UK

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Journal of Orthopaedic Surgery and Research 2009, 4:17 doi:10.1186/1749-799X-4-17

In Rheumatoid arthritis, the inflammatory cytokines (TNF alpha, IL1, IL17 etc)  inhibit osteoblast proliferation and promote osteoclast differentiation. This causes bone erosions & periarticular osteopenia locally and generalised osteoporosis at distant sites.

The effect of inflammation in negatively affecting bone loss is very high. Almost all DMARDs have a salutatory effect on bone health by reducing this inflammation. Though invitro studies show that there is some deleterious effect on osteoblast proliferation, this effect is very small compared to the deleterious effects of inflammation itself. Thus, in clinical terms, the net effect is positive by stopping the bone loss or at least reducing the rate significantly.

The newer Biologic DMARDs like the TNF inhibitors (Infliximab, etanercept etc) have even shown reversal of bone erosions in a few studies (by MRI imaging) and possibly have a more positive effect on bone health than the non Biologic DMARDs like methotrexate. 

Hope this helps