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van Ouwerkerk L, Verschueren P, Boers M, Emery P, de Jong PHP, Landewé RB, Lems W, Smolen JS, Huizinga TW, Allaart CF, Bergstra SA. Initial glucocorticoid bridging in rheumatoid arthritis: does it affect glucocorticoid use over time? Ann Rheum Dis 2024; 83:65-71. [PMID: 37607810 DOI: 10.1136/ard-2023-224270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES To compare the use of glucocorticoids (GC) over time in patients with rheumatoid arthritis (RA) who were or were not treated initially with GC bridging therapy. METHODS Data from the BeSt, CareRA and COBRA trials were combined in an individual patient data (IPD) meta-analysis. We compared GC use between bridgers and non-bridgers at 12, 18 and 24 months from baseline with mixed-effects regression analysis. Secondary outcomes were mean cumulative GC dose until 24 months after baseline with and without the bridging period, Disease Activity Score based on 28 joints (DAS28) over time and number of disease-modifying antirheumatic drug (DMARD) changes. RESULTS 252/625 patients (40%) were randomised to GC bridging (bridgers). Excluding the period of bridging, later GC use was low in both groups and cumulative doses were similar. Mean DAS28 was similar between the groups, but bridgers improved more rapidly (p<0.001) in the first 6 months and the bridgers required significantly fewer changes in DMARDs (incidence rate ratio 0.59 (95% CI 0.38 to 0.94)). GC use was higher in the bridgers at t=12 months (OR 3.27 (95% CI 1.06 to 10.08)) and the bridging schedules resulted in a difference in cumulative GC dose of 2406 mg (95% CI 1403 to 3408) over 24 months. CONCLUSION In randomised trials comparing GC bridging and no GC bridging, bridgers had a more rapid clinical improvement, fewer DMARD changes and similar late use of GC compared with non-bridgers. GC bridging per protocol resulted, as could be expected, in a higher cumulative GC dose over 2 years.
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Affiliation(s)
| | | | - Maarten Boers
- Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Emery
- Rheumatology, University of Leeds Faculty of Medicine and Health, Leeds, UK
| | | | - Robert Bm Landewé
- Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands
- Rheumatology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Willem Lems
- Rheumatology, Amsterdam UMC, Amsterdam, The Netherlands
- Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Josef S Smolen
- Rheumatology, Medical University of Vienna, Wien, Austria
| | - Tom Wj Huizinga
- Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cornelia F Allaart
- Rheumatology, Leiden Universitair Medisch Centrum, Leiden, The Netherlands
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Kurowska-Stolarska M, Alivernini S. Synovial tissue macrophages in joint homeostasis, rheumatoid arthritis and disease remission. Nat Rev Rheumatol 2022; 18:384-397. [PMID: 35672464 DOI: 10.1038/s41584-022-00790-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 02/07/2023]
Abstract
Synovial tissue macrophages (STMs) were principally recognized as having a pro-inflammatory role in rheumatoid arthritis (RA), serving as the main producers of pathogenic tumour necrosis factor (TNF). Recent advances in single-cell omics have facilitated the discovery of distinct STM populations, providing an atlas of discrete phenotypic clusters in the context of healthy and inflamed joints. Interrogation of the functions of distinct STM populations, via ex vivo and experimental mouse models, has re-defined our understanding of STM biology, opening up new opportunities to better understand the pathology of the arthritic joint. These works have identified STM subpopulations that form a protective lining barrier within the synovial membrane and actively participate in the remission of RA. We discuss how distinct functions of STM clusters shape the synovial tissue environment in health, during inflammation and in disease remission, as well as how an increased understanding of STM heterogeneity might aid the prediction of clinical outcomes and inform novel treatments for RA.
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Affiliation(s)
- Mariola Kurowska-Stolarska
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Glasgow, UK.
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | - Stefano Alivernini
- Research into Inflammatory Arthritis Centre Versus Arthritis (RACE), Glasgow, UK.
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Division of Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Immunology Research Core Facility, Gemelli Science and Technology Park (GSTeP), Rome, Italy.
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Flegar D, Filipović M, Šućur A, Markotić A, Lukač N, Šisl D, Ikić Matijašević M, Jajić Z, Kelava T, Katavić V, Kovačić N, Grčević D. Preventive CCL2/CCR2 Axis Blockade Suppresses Osteoclast Activity in a Mouse Model of Rheumatoid Arthritis by Reducing Homing of CCR2 hi Osteoclast Progenitors to the Affected Bone. Front Immunol 2021; 12:767231. [PMID: 34925336 PMCID: PMC8677701 DOI: 10.3389/fimmu.2021.767231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023] Open
Abstract
Detailed characterization of medullary and extramedullary reservoirs of osteoclast progenitors (OCPs) is required to understand the pathophysiology of increased periarticular and systemic bone resorption in arthritis. In this study, we focused on identifying the OCP population specifically induced by arthritis and the role of circulatory OCPs in inflammatory bone loss. In addition, we determined the relevant chemokine axis responsible for their migration, and targeted the attraction signal to reduce bone resorption in murine collagen-induced arthritis (CIA). OCPs were expanded in periarticular as well as circulatory compartment of arthritic mice, particularly the CCR2hi subset. This subset demonstrated enhanced osteoclastogenic activity in arthritis, whereas its migratory potential was susceptible to CCR2 blockade in vitro. Intravascular compartment of the periarticular area contained increased frequency of OCPs with the ability to home to the arthritic bone, as demonstrated in vivo by intravascular staining and adoptive transfer of splenic LysMcre/Ai9 tdTomato-expressing cells. Simultaneously, CCL2 levels were increased locally and systemically in arthritic mice. Mouse cohorts were treated with the small-molecule inhibitor (SMI) of CCR2 alone or in combination with methotrexate (MTX). Preventive CCR2/CCL2 axis blockade in vivo reduced bone resorption and OCP frequency, whereas combining with MTX treatment also decreased disease clinical score, number of active osteoclasts, and OCP differentiation potential. In conclusion, our study characterized the functional properties of two distinct OCP subsets in CIA, based on their CCR2 expression levels, implying that the CCR2hi circulatory-like subset is specifically induced by arthritis. Signaling through the CCL2/CCR2 axis contributes to OCP homing in the inflamed joints and to their increased osteoclastogenic potential. Therefore, addition of CCL2/CCR2 blockade early in the course of arthritis is a promising approach to reduce bone pathology.
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MESH Headings
- Animals
- Antirheumatic Agents/pharmacology
- Arthritis, Experimental/drug therapy
- Arthritis, Experimental/metabolism
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/metabolism
- Benzoxazines/pharmacology
- Bone and Bones/drug effects
- Bone and Bones/metabolism
- Bone and Bones/pathology
- Cell Differentiation/drug effects
- Cell Differentiation/genetics
- Cell Movement/drug effects
- Cell Movement/genetics
- Cells, Cultured
- Chemokine CCL2/metabolism
- Disease Models, Animal
- Flow Cytometry
- Humans
- Male
- Mesenchymal Stem Cells/cytology
- Mesenchymal Stem Cells/metabolism
- Methotrexate/pharmacology
- Mice, Inbred C57BL
- Mice, Inbred DBA
- Osteoclasts/cytology
- Osteoclasts/metabolism
- RNA Interference
- Receptors, CCR2/antagonists & inhibitors
- Receptors, CCR2/genetics
- Receptors, CCR2/metabolism
- Spiro Compounds/pharmacology
- Mice
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Affiliation(s)
- Darja Flegar
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Maša Filipović
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Alan Šućur
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Antonio Markotić
- Center for Clinical Pharmacology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
- Department of Physiology, School of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Nina Lukač
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Dino Šisl
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Marina Ikić Matijašević
- Department of Clinical Immunology, Rheumatology and Pulmology, Sveti Duh University Hospital, Zagreb, Croatia
| | - Zrinka Jajić
- Department of Rheumatology, Physical Medicine and Rehabilitation, Clinical Hospital Center Sestre Milosrdnice, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tomislav Kelava
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Vedran Katavić
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nataša Kovačić
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
- Department of Anatomy, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Danka Grčević
- Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia
- Laboratory for Molecular Immunology, Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
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Hsu CY, Chen JF, Su YJ, Chen YC, Lai HM, Yu SF, He HR, Cheng TT. Time-averaged disease activity of rheumatoid arthritis associated with long-term bone mineral density changes. Ther Adv Chronic Dis 2020; 11:2040622320981517. [PMID: 33489063 PMCID: PMC7768880 DOI: 10.1177/2040622320981517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is associated with poor bone mineral density (BMD). We designed the current study owing to the lack of long-term prospective studies regarding whether a high disease activity leads to increased bone loss. Methods: We have continually enrolled patients with RA. According to the average disease activity score in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) during follow-up, the patients were classified into remission, low disease activity, and moderate or high disease activity groups. Patients were examined with dual-energy X-ray absorptiometry at baseline and after 3 years of follow-up. BMD changes were compared among the groups. Results: We have studied 477 patients. Overall BMD was significantly reduced from baseline to the 3-year follow-up (p < 0.05). After stratifying according to the time-averaged DAS28-ESR levels and use of anti-osteoporosis treatment (AOT), the BMD values of the femur and spine significantly increased in patients in the remission group with AOT. The BMD changes of different DAS28-ESR patients were further compared using the generalized estimation equation model. For the patients on AOT, the negative change in femoral BMD values of the moderate or high activity group was significant when compared with the remission group with positive BMD changes (regression coefficient, –0.038; 95% confidence interval, –0.055 to –0.021). Conclusion: For RA patients, if remission is achieved, AOT can better improve BMD, especially in the femur. In addition, moderate or high disease activity will lead to significant bone loss; therefore, disease activity must be actively controlled.
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Affiliation(s)
- Chung-Yuan Hsu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yu-Jih Su
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Ying-Chou Chen
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Han-Ming Lai
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Shan-Fu Yu
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Hsiao-Ru He
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Kaohsiung 833
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5
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Raterman HG, Bultink IE, Lems WF. Osteoporosis in patients with rheumatoid arthritis: an update in epidemiology, pathogenesis, and fracture prevention. Expert Opin Pharmacother 2020; 21:1725-1737. [PMID: 32605401 DOI: 10.1080/14656566.2020.1787381] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disabling disease characterized by a symmetrical articular involvement due to ongoing joint inflammation, if left insufficiently treated. Local and generalized bone loss is one of the main extra-articular complications of RA and leads to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy. Therefore, there is an urgent need for good fracture risk management in the vulnerable RA patient. AREAS COVERED The authors review: the epidemiology and pathophysiology (i.e. risk factors) of osteoporosis (OP), fracture, and vertebral fracture risk assessment, the effects of anti-rheumatic drugs on bone loss, pharmacological treatment of OP in RA including both bisphosphonates (BP) and newer drugs including anti-resorptives and osteoanabolic treatment options. EXPERT OPINION Patients with active RA have elevated bone resorption and local bone loss. Moreover, these patients are at increased risk for generalized bone loss, vertebral and non-vertebral fractures. Since general risk factors (such as low BMI, fall risk) and RA-related factors play a role, optimal fracture prevention in RA patients is based on optimal diagnostics based on both of these factors, and on the use of adequate non-medical and medical treatment options.
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Affiliation(s)
- Hennie G Raterman
- Department of Rheumatology, North West Clinics , Alkmaar, The Netherlands
| | - Irene Em Bultink
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Rheumatology and Immunology Center , Amsterdam, The Netherlands
| | - Willem F Lems
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Rheumatology and Immunology Center , Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center , Amsterdam, The Netherlands
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Pharmacological Management of Osteoporosis in Rheumatoid Arthritis Patients: A Review of the Literature and Practical Guide. Drugs Aging 2020; 36:1061-1072. [PMID: 31541358 PMCID: PMC6884430 DOI: 10.1007/s40266-019-00714-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with increased localized and generalized osteoporosis (OP). Previous studies estimated that approximately one-third of the RA population experience bone loss. Moreover, RA patients suffer from a doubled fracture incidence depending on several clinical factors, such as disease severity, age, glucocorticoid (GC) use, and immobility. As OP fractures are related to impaired quality of life and increased mortality rates, OP has an enormous impact on global health status. Therefore, there is an urgent need for a holistic approach in daily clinical practice. In other words, both OP- and RA-related factors should be taken into account in treatment guidelines for OP in RA. First, to determine the actual fracture risk, dual-energy X-ray absorptiometry (DXA), including vertebral fracture assessment (VFA) and calculation of the 10-year fracture risk with FRAX®, should be performed. In case of high fracture risk, calcium and vitamin D should be supplemented alongside anti-osteoporotic treatment. Importantly, RA treatment should be optimal, aiming at low disease activity or remission. Moreover, GC treatment should be at the lowest possible dose. In this way, good fracture risk management will lead to fracture risk reduction in RA patients. This review provides a practical guide for clinicians regarding pharmacological treatment options in RA patients with OP, taking into account both osteoporotic-related factors and factors related to RA.
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7
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An HJ, Zhang J. Diagnostic accuracy of digital X-ray radiogrammetry on hand bone loss for patients with rheumatoid arthritis. Medicine (Baltimore) 2019; 98:e17280. [PMID: 31574843 PMCID: PMC6775331 DOI: 10.1097/md.0000000000017280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study will aim to evaluate the diagnostic accuracy of digital X-ray radiogrammetry (DXR) on hand bone loss (HBL) for rheumatoid arthritis (RA). METHODS In this study, we will search the literature from PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG from the inception to June 1, 2019 without language restrictions. All case-controlled studies on assessing diagnostic accuracy of DXR on HBL for diagnosis of RA will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be used for eligible studies. We will apply RevMan V.5.3 software and Stata V.12.0 software for statistical analysis. RESULTS We will evaluate diagnostic accuracy of DXR on HBL in patients with RA by assessing the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION This study will detect the diagnostic accuracy of DXR evaluation on HBL in patients with RA. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139489.
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Affiliation(s)
- Hong-Jian An
- Department of Computed Tomography, Qishan County Hospital, Qishan, Shaanxi
| | - Jun Zhang
- Department of Imaging, The Fourth People's Hospital of Shaanxi, Xi’an, China
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8
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Aeberli D, Fankhauser N, Zebaze R, Bonel H, Möller B, Villiger PM. Effect of rheumatoid arthritis and age on metacarpal bone shaft geometry and density: A longitudinal pQCT study in postmenopausal women. Semin Arthritis Rheum 2019; 50:220-227. [PMID: 31466837 DOI: 10.1016/j.semarthrit.2019.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/27/2019] [Accepted: 08/05/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to elucidate the effects of changes in the geometry and density of the metacarpal bone of patients with rheumatoid arthritis (RA). METHODS This prospective study included consecutive postmenopausal RA patients who met the American College of Rheumatology Criteria and healthy controls (HC). Peripheral quantitative computed tomography scans at 50% of the total metacarpal shaft (third metacarpal bone) were obtained at baseline and follow-ups. Use of bisphosphonates (BP), glucocorticoids (GC), biologics, and disease-modifying anti-rheumatic drugs (DMARD) was monitored (baseline to follow-up). Total cross-sectional area (CSA), cortical-transitional zone and compact zone CSA, cortical volumetric bone mineral density, and compact cortex porosity were measured. A linear mixed-effects model was used to determine significant differences in the rate of change in the RA and control groups and in RA patient subgroups. RESULTS Thirty-nine RA patients and 42 consecutive postmenopausal HC were followed for 63 months. RA and HC depicted a time-dependent increase of medullary CSA (+0.41 mm2/year, P < 0.0001), while total CSA remained stable (P = 0.2). RA status was associated with a loss of cortical bone mineral density (interaction: -3.08 mg/mm3; P = 0.014). In RA subgroup analysis, GC use ≥5 mg/day was positively correlated with a fourfold increase of medullary CSA (0.67 mm2/year P = 0.009), which resulted in a three- to fourfold loss of cortical density (-6.6 mg/mm3/year; P = 0.002) and cortical CSA (-0.57 mm2/year, P = 0.004). Patients with high disease activity and high GC dose at baseline demonstrated an increase in the total CSA (0.29 mm2/y; P = 0.049) and a loss of cortical BMD (-5.73 mg/mm3/y; P = 0.05) despite good clinical response. CONCLUSION Increase in medullary metacarpal CSA and thinning of the cortical CSA are physiological and time dependent. RA status is associated with loss in cortical density. Even upon biological therapy, low glucocorticoid dose affects metacarpal bone shaft geometry and density over time.
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Affiliation(s)
- D Aeberli
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland.
| | - N Fankhauser
- Clinical Trial Unit (CTU), University of Bern, 3012 Bern, Switzerland
| | - R Zebaze
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia; Department of Medicine, School of Clinical Sciences, Monash Health, Monash University, Melbourne, Australia
| | - H Bonel
- Department of Radiology, University Hospital and University of Bern, Switzerland
| | - B Möller
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland
| | - P M Villiger
- Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, 3010 Bern Switzerland
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Simon D, Kleyer A, Englbrecht M, Stemmler F, Simon C, Berlin A, Kocijan R, Haschka J, Hirschmann S, Atreya R, Neurath MF, Sticherling M, Rech J, Hueber AJ, Engelke K, Schett G. A comparative analysis of articular bone in large cohort of patients with chronic inflammatory diseases of the joints, the gut and the skin. Bone 2018; 116:87-93. [PMID: 30048820 DOI: 10.1016/j.bone.2018.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/12/2018] [Accepted: 07/22/2018] [Indexed: 12/23/2022]
Abstract
Chronic inflammatory diseases are associated with bone loss. While the occurrence of systemic bone loss is well described in chronic inflammatory diseases, the impact of these conditions on articular bone has not been systematically investigated. Recent refinements in high-resolution CT assessment of the joints now allow the accurate measure of articular bone composition. In this study 476 subjects comprising healthy individuals and patients with anticitrullinated protein antibody (ACPA)-positive rheumatoid arthritis (RA), ACPA-negative RA, Crohn's disease (CD), ulcerative colitis (UC), psoriasis (PsO) and psoriatic arthritis (PsA) were subjected to high-resolution quantitative computed tomography (HR-pQCT) of the hand. Metacarpal heads were assessed for total, trabecular and cortical volumetric bone mineral density (vBMD). Only ACPA+RA, but not the remaining inflammatory diseases (ACPA-RA, CD, UC, PsO, PsA) showed significant (p < 0.001) loss of articular bone affecting both the trabecular and the cortical compartments. Age and body mass index were also associated with articular bone changes, the former with lower, the latter with higher articular bone mass. In multivariate models, presence of ACPA+RA was an independent factor for articular bone loss. Among chronic inflammatory diseases ACPA+RA is the most potent precipitator for articular bone loss pointing out the role of autoimmunity in the development of articular bone disease in the context of chronic inflammatory disease.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Fabian Stemmler
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christoph Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Roland Kocijan
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Judith Haschka
- St. Vincent Hospital, Medical Department II, VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Simon Hirschmann
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Raja Atreya
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany.
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10
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Kurowska-Stolarska M, Alivernini S. Synovial tissue macrophages: friend or foe? RMD Open 2017; 3:e000527. [PMID: 29299338 PMCID: PMC5729306 DOI: 10.1136/rmdopen-2017-000527] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 12/20/2022] Open
Abstract
Healthy synovial tissue includes a lining layer of synovial fibroblasts and macrophages. The influx of leucocytes during active rheumatoid arthritis (RA) includes monocytes that differentiate locally into proinflammatory macrophages, and these produce pathogenic tumour necrosis factor. During sustained remission, the synovial tissue macrophage numbers recede to normal. The constitutive presence of tissue macrophages in the lining layer of the synovial membrane in healthy donors and in patients with RA during remission suggests that this macrophage population may have a role in maintaining and reinstating synovial tissue homeostasis respectively. Recent appreciation of the different origins and functions of tissue-resident compared with monocyte-derived macrophages has improved the understanding of their relative involvement in organ homeostasis in mouse models of disease. In this review, informed by mouse models and human data, we describe the presence of different functional subpopulations of human synovial tissue macrophages and discuss their distinct contribution to joint homeostasis and chronic inflammation in RA.
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Affiliation(s)
- Mariola Kurowska-Stolarska
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,Rheumatoid Arthritis Pathogenesis Centre of Excellence (RACE), Universities of Glasgow, Birmingham and Newcastle, Glasgow, Birmingham and Newcastle, UK
| | - Stefano Alivernini
- Institute of Rheumatology, Fondazione Policlinico Universitario A Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Loredo-Pérez AA, Montalvo-Blanco CE, Hernández-González LI, Anaya-Reyes M, Fernández Del Valle-Laisequilla C, Reyes-García JG, Acosta-González RI, Martínez-Martínez A, Villarreal-Salcido JC, Vargas-Muñoz VM, Muñoz-Islas E, Ramírez-Rosas MB, Jiménez-Andrade JM. High-fat diet exacerbates pain-like behaviors and periarticular bone loss in mice with CFA-induced knee arthritis. Obesity (Silver Spring) 2016; 24:1106-15. [PMID: 27030572 DOI: 10.1002/oby.21485] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Our aim was to quantify nociceptive spontaneous behaviors, knee edema, proinflammatory cytokines, bone density, and microarchitecture in high-fat diet (HFD)-fed mice with unilateral knee arthritis. METHODS ICR male mice were fed either standard diet (SD) or HFD starting at 3 weeks old. At 17 weeks, HFD and SD mice received intra-articular injections either with Complete Freund's Adjuvant (CFA) or saline into the right knee joint every 7 days for 4 weeks. Spontaneous pain-like behaviors and knee edema were assessed for 26 days. At day 26 post-first CFA injection, serum levels of IL-1β, IL-6, and RANKL were measured by ELISA, and microcomputed tomography analysis of knee joints was performed. RESULTS HFD-fed mice injected with CFA showed greater spontaneous pain-like behaviors of the affected extremity as well as a decrease in the weight-bearing index compared to SD-fed mice injected with CFA. Knee edema was not significantly different between diets. HFD significantly exacerbated arthritis-induced bone loss at the distal femoral metaphysis but had no effect on femoral diaphyseal cortical bone. HFD did not modify serum levels of proinflammatory cytokines. CONCLUSIONS HFD exacerbates pain-like behaviors and significantly increases the magnitude of periarticular trabecular bone loss in a murine model of unilateral arthritis.
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Affiliation(s)
- Aleyda A Loredo-Pérez
- Unidad Académica Multidisciplinaria Reynosa-Aztlán, UAT, Reynosa, Tamaulipas, México
| | | | | | | | | | - Juan G Reyes-García
- Sección De Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México City, México
| | | | | | | | | | - Enriqueta Muñoz-Islas
- Departamento de Biología Celular, Instituto Nacional de Perinatología, Secretaría de Salud, México City, México
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Szentpetery A, Heffernan E, Haroon M, Kilbane M, Gallagher P, McKenna MJ, FitzGerald O. Striking difference of periarticular bone density change in early psoriatic arthritis and rheumatoid arthritis following anti-rheumatic treatment as measured by digital X-ray radiogrammetry. Rheumatology (Oxford) 2016; 55:891-6. [PMID: 26850991 DOI: 10.1093/rheumatology/kev443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To examine changes in hand BMD as measured by digital X-ray radiogrammetry (DXR-BMD) in early PsA compared with RA patients prior to and 3 and 12 months after introducing an antirheumatic treatment. Further, to identify predictors for hand bone loss at the time of disease presentation. METHODS Recent-onset, active, treatment-naïve patients were recruited. Clinical assessment, hand X-rays and DXR were obtained at 0, 3 and 12 months. Mean DXR-BMD for both hands and changes in DXR-BMD (mg/cm(2)/month) were compared between the two groups. We compared baseline disease characteristics of patients with normal hand DXR-BMD with those with bone loss. Logistic regression analyses were performed to identify predictors of hand BMD loss. RESULTS A total of 64 patients were included. Hand DXR-BMD decreased in RA throughout the study (P = 0.043). Changes in periarticular bone density over 12 months differed between PsA and RA (P = 0.001). Hand bone loss at 3 months was associated with elevated BMI [odds ratio (OR) = 3.59, P = 0.041] and heavier alcohol intake (OR = 1.13, P = 0.035). Diagnosis of RA (OR = 57.48, P = 0.008), heavier alcohol intake (OR = 1.27, P = 0.012) and higher swollen joint count (SJC28) (OR = 1.5, P = 0.036) were independent predictors for hand bone loss in the first year. CONCLUSION Following treatment, we found ongoing hand bone loss in RA and unchanged periarticular bone density in PsA, supporting the hypothesis that different pathomechanisms are involved in hand bone remodelling in PsA. Presence of RA, heavier alcohol intake and higher SJC were identified as independent predictors for hand bone loss over 1 year.
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Affiliation(s)
| | | | | | - Mark Kilbane
- Metabolism Laboratory, St. Vincent's University Hospital, Dublin, Ireland
| | | | - Malachi J McKenna
- Metabolism Laboratory, St. Vincent's University Hospital, Dublin, Ireland
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13
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Acurcio FA, Moura CS, Bernatsky S, Bessette L, Rahme E. Opioid Use and Risk of Nonvertebral Fractures in Adults With Rheumatoid Arthritis: A Nested Case-Control Study Using Administrative Databases. Arthritis Rheumatol 2015; 68:83-91. [DOI: 10.1002/art.39422] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/01/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Francisco A. Acurcio
- McGill University and McGill University Health Centre, Montreal, Quebec, Canada, and Universidade Federal de Minas Gerais; Belo Horizonte Brazil
| | - Cristiano S. Moura
- McGill University and McGill University Health Centre; Montreal Quebec Canada
| | - Sasha Bernatsky
- McGill University and McGill University Health Centre; Montreal Quebec Canada
| | - Louis Bessette
- Centre Hospitalier de l'Universite Laval; Laval Quebec Canada
| | - Elham Rahme
- McGill University and McGill University Health Centre; Montreal Quebec Canada
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14
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Hoes JN, Bultink IEM, Lems WF. Management of osteoporosis in rheumatoid arthritis patients. Expert Opin Pharmacother 2015; 16:559-71. [PMID: 25626121 DOI: 10.1517/14656566.2015.997709] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In rheumatoid arthritis (RA) patients, the risk of both vertebral and non-vertebral fractures is roughly doubled, which is for an important part caused by inflammation-mediated amplification of bone loss and by immobilization. New treatments have become available in the last two decades to treat both RA and osteoporosis. AREAS COVERED Epidemiology and assessment of osteoporosis and fracture risk (including the influence of RA disease activity and bone-influencing medications such as glucocorticoids), the importance of vertebral fracture assessment in addition to bone density measurement in patients with RA, the use of disease-modifying antirheumatic drugs and their effects on generalized bone loss, and current and possible future anti-osteoporotic pharmacotherapeutic options are discussed with special focus on RA. EXPERT OPINION Assessment of osteoporosis in RA patients should include evaluation of the effects of disease activity and bone-influencing medications such as (the dose of) glucocorticoids, above standard risk factors for fractures or osteoporosis as defined by the FRAX instrument. Disease-modifying antirheumatic drugs are now well able to control disease activity using treat to target strategies. This lowering of disease activity by antirheumatic medications such as anti-TNF-α results in hampering of generalized bone loss; however, no fracture data are currently available. When treating osteoporosis in RA patients, additional focus should be on calcium supplementation, particularly in glucocorticoid users, and also on sufficient vitamin D use. Several anti-osteoporotic medications are now on the market; oral bisphosphonates are most commonly used, but in recent years, more agents have entered the market such as the parenteral antiresorptives denosumab (twice yearly) and zoledronic acid (once yearly), and the anabolic agent parathyroid hormone analogues. New agents, such as odanacatib and monoclonal antibodies against sclerostin, are now being tested and will most likely enlarge the possibilities of osteoporosis treatment in RA patients.
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Affiliation(s)
- Jos N Hoes
- VU University Medical Center, Department of Rheumatology , De Boelelaan 1117, 1081 HV, Amsterdam , The Netherlands
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15
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Wevers-de Boer KVC, Heimans L, Visser K, Kälvesten J, Goekoop RJ, van Oosterhout M, Harbers JB, Bijkerk C, Steup-Beekman M, de Buck MPDM, de Sonnaville PBJ, Huizinga TWJ, Allaart CF. Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study. Ann Rheum Dis 2013; 74:341-6. [PMID: 24285491 DOI: 10.1136/annrheumdis-2013-203749] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIM To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment. METHODS Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity score<1.6) steered strategy. With Sharp/van der Heijde progression ≥0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed. RESULTS Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)). CONCLUSIONS In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.
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Affiliation(s)
| | - L Heimans
- Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands
| | - K Visser
- Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands
| | - J Kälvesten
- Sectra, Linköping, Sweden CMIV Linköping University, Linköping, Sweden
| | - R J Goekoop
- Department of Rheumatology, Haga Hospital, The Hague, Zuid-holland, The Netherlands
| | - M van Oosterhout
- Department of Rheumatology, Groene Hart Hospital, Gouda, Zuid-holland, The Netherlands
| | - J B Harbers
- Department of Rheumatology, Franciscus Hospital, Roosendaal, The Netherlands
| | - C Bijkerk
- Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - M P D M de Buck
- Department of Rheumatology, MCH, The Hague, Zuid-holland, The Netherlands
| | | | - T W J Huizinga
- Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands
| | - C F Allaart
- Department of Rheumatology, LUMC, Leiden, Zuid-holland, The Netherlands
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Alioglu K, Dogu B, Sirzai H, Yilmaz F, Kuran B. Hand bone mineral density reference values in a Turkish healthy female population. Int J Rheum Dis 2013; 20:1965-1972. [DOI: 10.1111/1756-185x.12159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Kenan Alioglu
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Beril Dogu
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Hulya Sirzai
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Figen Yilmaz
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
| | - Banu Kuran
- Department of Physical and Rehabilitation Medicine; Sisli Etfal Training and Research Hospital; Istanbul Turkey
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Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporos Int 2013; 24:2541-53. [PMID: 23775419 DOI: 10.1007/s00198-013-2334-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/20/2013] [Indexed: 01/01/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to local joint deformations (bone erosions and joint space narrowing) and to extra-articular phenomena, including generalized osteoporosis. In addition, in patients with RA, the risk of vertebral and nonvertebral fractures is doubled. High disease activity (inflammation), immobility, and glucocorticoid use are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on classical risk factors such as high age, low body mass, and female gender. New insights on the links between the immune system and the bone system, the field of osteoimmunology, have shown that local and generalized bone loss share common pathways. The receptor activator of nuclear factor κB ligand/osteoprotegerin pathway (RANKl/OPG) is one of the most important pathways, as it is (strongly) upregulated by inflammation. In modern treatment of RA with biologics, for example, TNFα-blocking agents and combination therapy of conventional disease-modifying antirheumatic drugs (DMARDs), clinical remission is a realistic treatment goal. As a consequence, in recent studies, it has been documented that both local and generalized bone loss is absent or minimal in those patients who are in clinical remission.
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Affiliation(s)
- M Vis
- Department of Rheumatology, Erasmus MC, Dr. Molewaterplein 50, 3015, GE, Rotterdam, the Netherlands,
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Bone effects of biologic drugs in rheumatoid arthritis. Clin Dev Immunol 2013; 2013:945945. [PMID: 23864880 PMCID: PMC3705836 DOI: 10.1155/2013/945945] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/02/2013] [Indexed: 12/14/2022]
Abstract
Biologic agents used in the treatment of rheumatoid arthritis (RA) are able to reduce both disease activity and radiographic progression of joint disease. These drugs are directed against several proinflammatory cytokines (TNF α , IL-6, and IL-1) which are involved both in the pathogenesis of chronic inflammation and progression of joint structural damage and in systemic and local bone loss typically observed in RA. However, the role of biologic drugs in preventing bone loss in clinical practice has not yet clearly assessed. Many clinical studies showed a trend to a positive effect of biologic agents in preventing systemic bone loss observed in RA. Although the suppression of inflammation is the main goal in the treatment of RA and the anti-inflammatory effects of biologic drugs exert a positive effect on bone metabolism, the exact relationship between the prevention of bone loss and control of inflammation has not been clearly established, and if the available biologic drugs against TNF α , IL-1, and IL-6 can exert their effect on systemic and local bone loss also through a direct mechanism on bone cell metabolism is still to be clearly defined.
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Abstract
PURPOSE OF REVIEW Tumor necrosis factor (TNF) inhibitors are effective for achieving disease control in several inflammatory diseases. Although anti-TNF agents can inhibit bone loss in vitro, their role in the prevention of clinically relevant outcomes such as osteoporosis and fractures has not been clearly established. RECENT FINDINGS There are many studies of the effects of TNF inhibitors on markers of bone turnover; however, few have measured bone mineral density (BMD) or fractures. Most of these studies have small sample sizes and a minority had a placebo control group. Overall these studies suggest that the antiresorptive effects of anti-TNF therapy are related to control of disease activity. SUMMARY The antiresorptive effects of TNF inhibitors are likely related to their anti-inflammatory properties. Studies to date have not demonstrated any advantages of TNF inhibitors over traditional nonbiologic therapies in the prevention of bone loss and fractures.
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Forslind K, Kälvesten J, Hafström I, Svensson B. Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis? Arthritis Res Ther 2012; 14:R219. [PMID: 23068060 PMCID: PMC4060357 DOI: 10.1186/ar4058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 09/25/2012] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage. METHODS In 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss (HBL) was analyzed using the smallest detectable change (HBLsdc) and tertiles (HBLtertiles). Joint damage in hands and feet were scored according to the Sharp van der Heijde (SHS) method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score (DAS28) was calculated and functional disability assessed. Rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed at baseline. RESULTS Sixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year (ChDXR1yr) correlated significantly and inversely with the change in SHS (ChSHS) at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years. CONCLUSIONS This study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.
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Abstract
Rheumatoid arthritis is a chronic inflammatory disease that results in generalized bone loss and increased fracture risk. Characteristic radiologic features of rheumatoid arthritis include periarticular osteopenia and marginal erosions. An emerging literature highlights the importance of osteoclasts as mediators of the erosive process, with an impairment of bone formation by inhibition of the Wnt signaling pathway as a cause of lack of repair of erosions. MRI has demonstrated the importance of inflammation in the bone marrow compartment as a cause of periarticular osteopenia. The term osteoimmunology has evolved to highlight the association between cells and cytokines of the immune system and their relationship to bone metabolism in rheumatoid arthritis and other forms of chronic inflammatory arthritis.
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Affiliation(s)
- Chad Deal
- Center for Osteoporosis and Metabolic Bone Disease, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western, University School of Medicine, OH, 44122, USA.
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Abstract
Inflammatory joint diseases such as rheumatoid arthritis, as well as other rheumatic conditions, such as systemic lupus erythematosus (SLE) and ankylosing spondylitis, comprise a heterogeneous group of joint disorders that are all associated with extra-articular side effects, including bone loss and fractures. The concept of osteoimmunology is based on growing insights into the links between the immune system and bone. The pathogenesis of osteoporosis in these patients is multifactorial. We have, more or less as an example, described this extensively for patients with SLE. High disease activity (inflammation) and immobility are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on, among other factors, age, body mass index, and gender. Although no fracture reduction has been shown in intervention studies in patients with inflammatory rheumatic diseases, we present treatment options that might be useful for clinicians who are treating these patients.
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Affiliation(s)
- Irene E. M. Bultink
- Department of Rheumatology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus Medical Center, Dr. Molewaterplein 50-60, 3015 GE Rotterdam, The Netherlands
| | | | - Willem F. Lems
- Department of Rheumatology, VU University Medical Center and Reade, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
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