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Silva FF, Machado GR, Ribeiro ACM, Bonfiglioli KR, Shimabuco AY, Figueiredo CP, Guerra LMT, Caparbo VF, Pereira RMR, Domiciano DS. Damaged bone microarchitecture by Trabecular Bone Score (TBS) and low appendicular muscle mass: main risk factors for vertebral and non-vertebral fractures in women with long-standing rheumatoid arthritis. Osteoporos Int 2024; 35:819-830. [PMID: 38267666 DOI: 10.1007/s00198-024-07026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024]
Abstract
We ascertained the fracture risk factors stratified by vertebral and non-vertebral sites in rheumatoid arthritis (RA) females. Bone/muscle features, but not disease activity, were the main markers for fractures in this long-standing RA population: low trabecular bone score (TBS) for vertebral fracture and decreased appendicular muscle mass for non-vertebral fracture. PURPOSE To assess risk factors for fractures, including clinical, laboratory and dual energy X-ray absorptiometry (DXA) parameters (bone mass, trabecular bone score-TBS, muscle mass) in women with established rheumatoid arthritis (RA). METHODS Three hundred females with RA (ACR, 2010) were studied. Clinical data were obtained by questionnaire and disease activity by composite indices (DAS28, CDAI, SDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Bone mineral density (BMD), TBS, body composition and Vertebral Fracture Assessment (VFA) were performed by DXA. Logistic regression models were constructed to identify factors independently associated with vertebral (VF) and non-vertebral fractures (NVF), separately. RESULTS Through rigorous eligibility criteria, a total of 265 women were yielded for final data analysis (median age, 55 [22-86] years; mean disease duration, 16.2 years). Prevalence of VF and NVF were 30.6% and 17.4%, respectively. In multivariate analyzes, TBS (OR = 1.6, 95%CI = 1.09-2.36, p = 0.017), CRP (OR = 1.54, 95%CI = 1.15-2.08, p = 0.004), and parathormone (OR = 1.24, 95%CI = 1.05-1.45, p = 0.009) were risk factors for VF, whereas low appendicular muscle mass (OR = 2.71; 95%CI = 1.01-7,28; p = 0.048), body mass index (BMI) (OR = 0.90, 95%CI = 0.82-0.99; p = 0.025), ESR (OR = 1.18, 95%CI = 1.01-1,38, p = 0,038) and hip BMD (OR = 1.82, 95%CI = 1.10-3.03, p = 0.02) were associated with NVF. CONCLUSION In women with long-term RA, markers of fractures differed between distinct skeletal sites (vertebral and non-vertebral). The magnitude of association of bone/muscle parameters with fracture (TBS for VF and appendicular muscle mass for NVF) was greater than that of the association between RA activity and fracture. TBS seems to have greater discriminative power than BMD to identify subjects with VF in long-standing RA.
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Affiliation(s)
- Felipe F Silva
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gisela R Machado
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana C M Ribeiro
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Karina R Bonfiglioli
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Y Shimabuco
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Liliam M T Guerra
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Valéria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Diogo S Domiciano
- Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil.
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Feichao S, Rongrong C, Ji S, Liu B, Junfeng Z. Analysis of the Relationship between Rheumatoid Arthritis and Osteoporosis Based on Mendelian Randomization. Curr Rheumatol Rev 2024; 20:284-295. [PMID: 37937573 DOI: 10.2174/0115733971261225231021173529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/20/2023] [Accepted: 09/13/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND As the global population ages, the World Health Organization has found a yearly increase in the incidence of rheumatoid arthritis and osteoporosis. This trend poses a challenge to public health and healthcare and calls for the implementation of more preventive and treatment measures to address these health issues. OBJECTIVE This study aims to investigate the causal relationship between rheumatoid arthritis (RA) and osteoporosis (OP) using the Mendelian randomization (MR) method. METHODS OP diagnosis was based on the gold standard of bone mineral density (BMD). Single nucleotide polymorphisms (SNPs) were identified from the genome-wide association research database formed by RA and BMD, with a parameter setting of P < 5×10-8, chain imbalance r2<0.01, and kb = 10,000. Five complementary MR methods, including inverse variance weighted (IVW), MR-Egger regression, weighted median, simple mode estimation based on mode, and weighted estimation based on mode, were used to evaluate the causal relationship between RA and OP/BMD using odds ratio (OR) values and 95% confidence intervals (CI). Sensitivity analyses were performed using heterogeneity tests, horizontal pleiotropy, and individual rejection tests. RESULTS A total of 78 instrumental variables were identified that were closely related to both RA and BMD in mixed populations, while 14 instrumental variables were identified in the European population and 38 instrumental variables were identified in the Asian population. Using IVW as the main analysis method, the MR analysis results of RA and BMD showed the following: mixed population OR = 0.96, 95%CI: 0.93-1.00; European population OR = 0.55, 95%CI: 0.27-1.12; and Asian population OR = 0.95, 95%CI: 0.90-1.01. Sensitivity analyses showed that the MR results were robust. CONCLUSION The study found insufficient evidence of a causal relationship between RA and OP/BMD, suggesting that RA may not have a direct effect on OP/BMD.
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Affiliation(s)
- Song Feichao
- Graduate School of Shanxi Medical University, Taiyuan, China
| | - Chen Rongrong
- Graduate School of Shanxi University of Traditional Chinese Medicine, Jinzhong, China
| | - Shichang Ji
- Graduate School of Shanxi Medical University, Taiyuan, China
| | - Bingjie Liu
- Graduate School of Shanxi Medical University, Taiyuan, China
| | - Zhang Junfeng
- Graduate School of Shanxi Medical University, Taiyuan, China
- Graduate School of Shanxi University of Traditional Chinese Medicine, Jinzhong, China
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Ebrahimiarjestan M, Yang L, E. E, Wang T, Carey JJ, Whelan B, Silke C, O’Sullivan M, Gsel A, Brennan A, Dempsey M, Yu M. Bone mineral density and fractures in patients with rheumatoid arthritis: the DXA-HIP project. Rheumatol Adv Pract 2023; 7:rkad091. [PMID: 38025094 PMCID: PMC10640397 DOI: 10.1093/rap/rkad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/15/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives RA is a chronic disabling disease affecting 0.5-1% of adults worldwide. People with RA have a greater prevalence of multimorbidity, particularly osteoporosis and associated fractures. Recent studies suggest that fracture risk is related to both non-RA and RA factors, whose importance is heterogeneous across studies. This study seeks to compare baseline demographic and DXA data across three cohorts: healthy controls, RA patients and a non-RA cohort with major risk factors and/or prior major osteoporotic fracture (MOF). Methods This is a cross-sectional study using data collected from three DXA centres in the west of Ireland from January 2000 to November 2018. Results Data were available for 30 503 subjects who met our inclusion criteria: 9539 (31.3%) healthy controls, 1797 (5.9%) with RA and 19 167 (62.8%) others. Although age, BMI and BMD were similar between healthy controls, the RA cohort and the other cohort, 289 (16.1%) RA patients and 5419 (28.3%) of the non-RA cohort had prior MOF. In the RA and non-RA cohorts, patients with previous MOF were significantly older and had significantly lower BMD at the femoral neck, total hip and spine. Conclusion Although age, BMI and BMD were similar between a healthy control cohort and RA patients and others with major fracture risk factors, those with a previous MOF were older and had significantly lower BMD at all three measured skeletal sites. Further studies are needed to address the importance of these and other factors for identifying those RA patients most likely to experience fractures.
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Affiliation(s)
| | - Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, National University of Ireland, Galway, Ireland
| | - Erjiang E.
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheunatology, Galway University Hospitals, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Miriam O’Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Our Lady’s Hospital, Manorhamilton, Ireland
| | - Amina Gsel
- School of Medicine, National University of Ireland, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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O 'Sullivan D, Silke C, Whelan B, McGowan B, O 'Sullivan M, McCabe JP, Heaney F, Armstrong C, Gsel AM, Connaughton B, Carey JJ. Osteoporotic fracture admissions compared to other major medical admissions in Irish public hospitals. Arch Osteoporos 2022; 18:12. [PMID: 36527534 DOI: 10.1007/s11657-022-01199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
Multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis. Hospital care represents the costliest portion of health services. We found public hospital bed days for fragility fractures in Ireland increased by 43% between 2008 and 2017 which exceeded those for other common diseases. INTRODUCTION Recent multinational reports suggest Ireland has one of the greatest illness burdens related to osteoporosis, manifesting clinically as fragility fractures (FF). International reports show that FF incidence, rate of hospital admission and cost are similar or greater than those for breast cancer, myocardial infarction and stroke. Studies addressing the illness burden of osteoporosis in Ireland are few, and none compares fragility fractures to other common chronic diseases. METHODS A retrospective analysis of national administrative data for all public hospital admissions was performed on adults aged 50 years and older from January 2008 to December 2017. RESULTS In 2017, public hospital bed days for FF totalled 249,887 outnumbering Chronic Obstructive Pulmonary Disease (COPD): 131,897; 6 solid cancers (CA): 118,098; myocardial infarction (MI): 83,477; and diabetes mellitus (DM): 31,044. Bed days for FF increased by 43% between 2008 and 2017, in contrast to a 32%, 28% and 31% reduction for CA, MI and DM, respectively, and a 12% increase for COPD. Public hospital bed days for FF in 2016 were greater than MI, stroke, atrial fibrillation and chest pain combined but less than a combination of COPD, pneumonia and lower respiratory tract infection. CONCLUSION Osteoporotic fractures represent a large and rapidly increasing illness burden amongst older Irish adults, with substantial care requirements and the resulting onus on our healthcare system. Urgent action is needed to address this public health issue and the services for those at risk of fracture.
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Affiliation(s)
- D O 'Sullivan
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - C Silke
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B Whelan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - B McGowan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - M O 'Sullivan
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Ireland
| | - J P McCabe
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
| | - F Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - C Armstrong
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - A M Gsel
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - B Connaughton
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - J J Carey
- School of Medicine, National University of Ireland, Galway, H91 V4AY, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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Irisin and Bone in Sickness and in Health: A Narrative Review of the Literature. J Clin Med 2022; 11:jcm11226863. [PMID: 36431340 PMCID: PMC9699623 DOI: 10.3390/jcm11226863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/24/2022] Open
Abstract
Irisin is a hormone-like myokine produced by the skeletal muscle in response to exercise. Upon its release into the circulation, it is involved in the browning process and thermogenesis, but recent evidence indicates that this myokine could also regulate the functions of osteoblasts, osteoclasts, and osteocytes. Most human studies have reported that serum irisin levels decrease with age and in conditions involving bone diseases, including both primary and secondary osteoporosis. However, it should be emphasized that recent findings have called into question the importance of circulating irisin, as well as the validity and reproducibility of current methods of irisin measurement. In this review, we summarize data pertaining to the role of irisin in the bone homeostasis of healthy children and adults, as well as in the context of primary and secondary osteoporosis. Additional research is required to address methodological issues, and functional studies are required to clarify whether muscle and bone damage per se affect circulating levels of irisin or whether the modulation of this myokine is caused by the inherent mechanisms of underlying diseases, such as genetic or inflammatory causes. These investigations would shed further light on the effects of irisin on bone homeostasis and bone disease.
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The prevalence of osteoporosis in rheumatoid arthritis patient: a systematic review and meta-analysis. Sci Rep 2022; 12:15844. [PMID: 36151246 PMCID: PMC9508181 DOI: 10.1038/s41598-022-20016-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022] Open
Abstract
Osteoporosis (OP) is one of the most commonly known extra-articular complications of rheumatoid arthritis (RA). Since the prevalence of OP is diverse in different studies and there is no general consensus about it, in this systematic review, we aimed to investigate the global prevalence of OP among RA patients. In this review, three databases including Medline via PubMed, Scopus, and Web of Science (Clarivate analytics) were searched by various keywords. After screening of retrieved papers, the related data of included papers were extracted and analyzed. To assess the risk of methodological bias of included studies, quality assessment checklist for prevalence studies was used. Because of heterogeneity among studies, random-effect model was used to pooled the results of primary studies. In this review, the results of 57 studies were summarized and the total included sample size was 227,812 cases of RA with 64,290 cases of OP. The summary point prevalence of OP among RA was estimated as 27.6% (95%CI 23.9-31.3%). Despite significant advances in prevention, treatment and diagnostic methods in these patients, it still seems that the prevalence of OP in these patients is high and requires better and more timely interventions.
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Chu YR, Xu SQ, Wang JX, Zong HX, Chen KM, Wang C, Tong WQ, Wang XL. Synergy of sarcopenia and vitamin D deficiency in vertebral osteoporotic fractures in rheumatoid arthritis. Clin Rheumatol 2022; 41:1979-1987. [DOI: 10.1007/s10067-022-06125-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 12/31/2022]
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Ismail ZNE. Evaluation of fracture risk in Egyptian rheumatoid arthritis patients by the Fracture Risk Assessment Tool. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-021-00101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rheumatoid arthritis (RA) patients have a risk of fractures due to secondary osteoporosis. This study aimed to evaluate the probability of fractures in the next 10 years in Egyptian RA patients by the Fracture Risk Assessment Tool (FRAX).
Results
The study was a case–control study. It included a hundred RA patients as well as 51 apparently healthy volunteers. Bone mineral density (BMD) means of lumbar vertebra, femoral neck, and total femur were significantly lower in the RA patient group. Additionally, FRAX of the major osteoporotic and hip fractures means were significantly higher in the RA group than in the control group. It was also found that age, body mass index (BMI), Health Assessment Questionnaire Disability Index (HAQ-DI), and BMD of the femoral neck were significant predictors of FRAX of major osteoporotic and hip fractures (P ≤ 0.05). The cumulative dose of steroids was a significant predictor for FRAX of major osteoporotic fractures; however, the 28 joints disease activity score calculated with erythrocyte sedimentation rate (ESR) (DAS28-ESR) was a significant predictor for FRAX of hip fractures.
Conclusions
RA patients have a high fracture risk probability. Regular annual screening for BMD and FRAX of major osteoporotic and hip fractures is necessary for those patients.
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Gamez-Nava JI, Ramirez-Villafaña M, Cons-Molina F, Gomez-Ramirez EE, Esparza-Guerrero Y, Saldaña-Cruz AM, Sanchez-Rodriguez EN, Jacobo-Cuevas H, Totsuka-Sutto SE, Perez-Guerrero EE, Huerta M, Trujillo X, Vasquez-Jimenez JC, Nava-Zavala AH, Cardona-Muñoz EG, Alcaraz-Lopez MF, Gonzalez-Lopez L. Serum irisin concentrations and osteoporotic vertebral fractures in women with rheumatoid arthritis: A cross-sectional study. Medicine (Baltimore) 2022; 101:e28799. [PMID: 35147113 PMCID: PMC8830829 DOI: 10.1097/md.0000000000028799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 01/15/2022] [Indexed: 12/26/2022] Open
Abstract
Irisin stimulates osteoblast differentiation increasing bone mass a decreasing in irisin levels might contribute to osteoporotic fractures in inflammatory diseases. To date, there is controverted whether irisin levels are associated with osteoporotic fractures in rheumatoid arthritis (RA). Therefore, we evaluate the association of serum irisin with osteoporotic Vertebral Fractures (VFs) in women with RA.A total of 148 women with RA was included in the study.Clinical characteristics and risk factors of VFs was evaluated. For measurement of bone mineral density we included the assessment of lumbar spine (AP L1-L4) and Femoral Neck by dual-energy X-ray absorptiometry (DXA). VFs were evaluated by lateral vertebral assessment (LVA) of the dorsal and lumbar regions using X-ray and digital vertebral morphometry by DXA, using the Genant scale. Serum irisin levels were measured by ELISA. A reference group of 97 women with non-rheumatic diseases were included to compare irisin levels.RA patients had a median age of 59 years and 41% had osteoporosis. Seventy three (49%) had VFs. Lower irisin levels were observed in RA patients compared to controls (94 ± 74 vs 135 ± 103, P < .001). Irisin concentrations were lower in RA + VFs than RA non-VFs (74 ± 42 vs 113 ± 92 ng/mL, P = .001). In the multivariable logistic regression analysis the low 50 percentile irisin levels < 73 ng/mL (OR:3.1, 95% CI:1.55-6.2, P = .001), and disease duration of RA (OR:1.04, 95% CI:1.001-1.08, P = .04) were associated with an increase in the risk of VFs.A decrease of irisin levels is associated to VFs in RA. These results are valuable to consider that RA patients with low levels of irisin are in a potential risk of VFs.
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Affiliation(s)
- Jorge Ivan Gamez-Nava
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
| | - Melissa Ramirez-Villafaña
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
- Programa de Doctorado en Ciencias Médicas, Universidad de Colima, Colima, Colima, México
| | - Fidencio Cons-Molina
- Centro de Investigación en Artritis y Osteoporosis, Mexicali , Baja California, México
| | - Eli Efrain Gomez-Ramirez
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Yussef Esparza-Guerrero
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Ana Miriam Saldaña-Cruz
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Esther Nerida Sanchez-Rodriguez
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Heriberto Jacobo-Cuevas
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Sylvia Elena Totsuka-Sutto
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Edsaul Emilio Perez-Guerrero
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Miguel Huerta
- Centro Universitario de Investigaciones Biomédicas (CUIB), Universidad de Colima, Colima, México
| | - Xochitl Trujillo
- Centro Universitario de Investigaciones Biomédicas (CUIB), Universidad de Colima, Colima, México
| | | | - Arnulfo Hernan Nava-Zavala
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades, Centro Médico Nacional de Occidente (CMNO), Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, México
- Programa Internacional de Medicina, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México
| | - Ernesto German Cardona-Muñoz
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Miriam Fabiola Alcaraz-Lopez
- Departamento de Medicina Interna-Reumatología, Hospital General Regional 46 and Hospital General Regional 110; IMSS, Guadalajara, Jalisco, México
| | - Laura Gonzalez-Lopez
- Departamento de Fisiología, Instituto de Investigación en Ciencias Biomédicas, Programa de Doctorado en Salud Publica, Departamento de Salud Publica, Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
- Departamento de Medicina Interna-Reumatología, Hospital General Regional 46 and Hospital General Regional 110; IMSS, Guadalajara, Jalisco, México
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Yu KH, Chen HH, Cheng TT, Jan YJ, Weng MY, Lin YJ, Chen HA, Cheng JT, Huang KY, Li KJ, Su YJ, Leong PY, Tsai WC, Lan JL, Chen DY. Consensus recommendations on managing the selected comorbidities including cardiovascular disease, osteoporosis, and interstitial lung disease in rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e28501. [PMID: 35029907 PMCID: PMC8735742 DOI: 10.1097/md.0000000000028501] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities. METHODS The consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities. RESULTS Based on experts' consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities. CONCLUSIONS These consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.
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Affiliation(s)
- Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Biomedicine Science, National Chung Hsing University, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeong-Jian Jan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Meng-Yu Weng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital
| | - Yeong-Jang Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-An Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Tseng Cheng
- Division of Allergy, Immunology and Rheumatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Kuang-Yung Huang
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital
- College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology and Immunology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Carey JJ, Yang L, Erjiang E, Wang T, Gorham K, Egan R, Brennan A, Dempsey M, Armstrong C, Heaney F, McCabe E, Yu M. Vertebral Fractures in Ireland: A Sub-analysis of the DXA HIP Project. Calcif Tissue Int 2021; 109:534-543. [PMID: 34085087 PMCID: PMC8484104 DOI: 10.1007/s00223-021-00868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Osteoporosis is an important global health problem resulting in fragility fractures. The vertebrae are the commonest site of fracture resulting in extreme illness burden, and having the highest associated mortality. International studies show that vertebral fractures (VF) increase in prevalence with age, similarly in men and women, but differ across different regions of the world. Ireland has one of the highest rates of hip fracture in the world but data on vertebral fractures are limited. In this study we examined the prevalence of VF and associated major risk factors, using a sample of subjects who underwent vertebral fracture assessment (VFA) performed on 2 dual-energy X-ray absorptiometry (DXA) machines. A total of 1296 subjects aged 40 years and older had a valid VFA report and DXA information available, including 254 men and 1042 women. Subjects had a mean age of 70 years, 805 (62%) had prior fractures, mean spine T-score was - 1.4 and mean total hip T-scores was - 1.2, while mean FRAX scores were 15.4% and 4.8% for major osteoporotic fracture and hip fracture, respectively. Although 95 (7%) had a known VF prior to scanning, 283 (22%) patients had at least 1 VF on their scan: 161 had 1, 61 had 2, and 61 had 3 or more. The prevalence of VF increased with age from 11.5% in those aged 40-49 years to > 33% among those aged ≥ 80 years. Both men and women with VF had significantly lower BMD at each measured site, and significantly higher FRAX scores, P < 0.01. These data suggest VF are common in high risk populations, particularly older men and women with low BMD, previous fractures, and at high risk of fracture. Urgent attention is needed to examine effective ways to identify those at risk and to reduce the burden of VF.
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Affiliation(s)
- John J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
| | - Lan Yang
- School of Engineering, National University of Ireland Galway, Galway, Ireland
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - E Erjiang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland Galway, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Eva McCabe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
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Perez MO, Figueiredo CP, Sales LP, Medeiros-Ribeiro AC, Takayama L, Domiciano DS, Bonfiglioli K, Caparbo VF, Pereira RM. Bone erosions and osteophytes in premenopausal women with long-standing rheumatoid arthritis: association with systemic bone involvement by HR-Pqct. Arthritis Rheumatol 2021; 74:407-417. [PMID: 34463054 DOI: 10.1002/art.41961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate premenopausal women with long-standing RA and to explore the relationship between parameters of systemic and localized bone involvement. METHODS Eighty consecutive RA premenopausal women were evaluated. Volumetric bone mineral density (vBMD), microarchitecture and finite element analysis were performed using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius (DR) and tibia (DT) and compared with parameters from 160 female healthy controls matched by age and body mass index. Localized bone involvement was also analyzed using HR-pQCT in the metacarpophalangeal and proximal interphalangeal joints to identify erosions and osteophytes. RESULTS The mean age of RA patients was 39.4±6.7years and disease duration 9.8±5.3years. RA patients had impaired trabecular, cortical and bone strength parameters, at DR and DT, compared with healthy controls (p<0.05). Bone erosions and osteophytes were found in 75% and 41.3% of patients, respectively. Comparing patients with and without erosions, at DR and DT, a lower cortical vBMD (DR: 980±72 versus 1021±47mgHA/cm3 , p=0.03; DT:979±47 versus 1003±34 mgHA/cm3 , p=0.04) and higher cortical porosity (DR:2.8±2.5 versus 1.8±1.6%, p=0.04; and DT:3.7±1.6 versus 2.7±1.6%, p=0.01) were observed in patients with erosions. At the DR, osteophyte volume was positively correlated with trabecular vBMD (0.392, p=0.02), trabecular number (0.381, p=0.03) and stiffness (0.411, p=0.02), and negatively with trabecular separation (-0.364, p=0.04). CONCLUSION Our findings showed that premenopausal women with long-standing RA had systemic bone fragility at peripheral sites. Moreover, erosions were associated mainly with cortical bone fragility at the DR and DT, and osteophytes correlated with repair of trabecular bone at the radius.
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Affiliation(s)
- Mariana O Perez
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camille P Figueiredo
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas P Sales
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Cristina Medeiros-Ribeiro
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Liliam Takayama
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo S Domiciano
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Karina Bonfiglioli
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valeria F Caparbo
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa Mr Pereira
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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13
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Risk factor analysis of fragility fractures in rheumatoid arthritis: A 3-year longitudinal, real-world, observational, cohort study. PLoS One 2021; 16:e0255542. [PMID: 34347843 PMCID: PMC8336806 DOI: 10.1371/journal.pone.0255542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/17/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives To explore the risk factors for fragility fractures in rheumatoid arthritis (RA) patients using a 3-year longitudinal, observational cohort study. Methods This RA registry study included consecutive RA patients in the outpatient clinic of Chang Gung Memorial Hospital since September 1, 2014. The demographics, clinical characteristics, lifestyle, evidence of previous fracture, risk factors according to the Fracture Risk Assessment Tool (FRAX®), and the FRAX score of each participant were recorded. The participants were categorized into the new incident fracture (group A) and no incident fracture (group B) groups based on evidence or absence of new incident fractures and propensity score matching (age and gender, 1:2). Results Overall, 477 participants completed the 3-year observation period. After matching, 103 and 206 participants were allocated to groups A and B, respectively. The non-adjusted model revealed, presented as hazard ratio (HR) (95% confidence interval [CI]), that the presence of co-morbidity (1.80 [1.17–2.78], p = 0.008), Health Assessment Questionnaire Disability Index (1.35 [1.07–1.69], p = 0.010), lower baseline hip bone mineral density (0.11 [0.02–0.48], p = 0.004), longer disease duration (1.02 [1.00–1.04], p = 0.026), higher FRAX score of major fracture (1.03 [1.02–1.04], p<0.001) or hip fracture (1.03 [1.02–1.04], p<0.001), and previous fracture history (2.65 [1.79–3.94], p<0.001) were associated with new incident fracture. After adjustment, it was disclosed that a previous fracture is an independent risk factor for fragility fractures in RA patients (2.17 [1.20–3.90], p = 0.010). Conclusions In addition to aging and disease-related factors, previous fracture history is the most important risk factor for fragility fractures in RA patients.
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14
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Erwin J, Enki DG, Woolf AD. Younger people with rheumatoid arthritis are at increased risk of fracture even before age 50 years: a population-based cohort study. Osteoporos Int 2021; 32:1651-1659. [PMID: 33569694 DOI: 10.1007/s00198-021-05862-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED Less is known about the risk of fracture in people with rheumatoid arthritis aged under 50 than those in older age groups. The study shows that the risk of fracture before age 50 remains significantly higher in those with rheumatoid arthritis than matched controls. This has implications for fracture risk management. INTRODUCTION To determine the risk of first and subsequent fracture occurring before age 50 in people diagnosed with rheumatoid arthritis (RA) before age 50. METHODS A retrospective observational cohort study of RA cases with matched controls using data from Clinical Practice Research Datalink (CPRD) of adults ≥ 18 years with diagnosis of RA recorded from 1992 to 2016 in the UK. Patients were followed from index date to the first fracture and subsequent fracture. A total of 36,858 cases were each matched to 3 controls. Incidence rates (IR) and incidence rate ratios (IRR) of first and subsequent fractures were calculated. A multivariate Cox's proportional hazards model was used to calculate the risk of first fracture and of subsequent fracture in the presence of different risk factors. RESULTS The IR of first and subsequent fractures at any age is significantly higher in cases than controls for patients with onset of RA at any age. This includes first fractures occurring before age 50 for those diagnosed with RA before this age. In women, the rate of first fracture before age 50 are significantly higher than matched controls (IRR 1.29 CI 1.12-1.49), the IRR for subsequent fracture is higher but not significantly so. For men, the IRRs of first and subsequent fractures below age 50 are also higher but not significantly so. Gender, previous fracture, glucocorticoid prescription, osteoporosis diagnosis, alcohol, smoking, and bisphosphonate prescription have a significant effect on the risk of first fracture at any age for RA patients; all these variables except osteoporosis diagnosis and alcohol have a significant effect on the risk of subsequent fracture and first fractures before age 50. CONCLUSIONS These results indicate an increased risk of first fracture before age 50 in people with RA diagnosed before this age. It is important that patients with RA of all ages are given timely support from the time of diagnosis to protect their bone health.
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Affiliation(s)
- J Erwin
- Research Development & Innovations, Royal Cornwall Hospitals NHS Trust, Truro, UK.
| | - D G Enki
- School of Medicine, University of Nottingham, Nottingham, UK
| | - A D Woolf
- Research Development & Innovations, Royal Cornwall Hospitals NHS Trust, Truro, UK
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15
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Liu YQ, Liu Y, Chen ZY, Li H, Xiao T. Rheumatoid arthritis and osteoporosis: a bi-directional Mendelian randomization study. Aging (Albany NY) 2021; 13:14109-14130. [PMID: 34015765 PMCID: PMC8202858 DOI: 10.18632/aging.203029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Many observation studies have demonstrated a close relationship between rheumatoid arthritis (RA) and osteoporosis (OP). However, the causal genetic correlation between RA and OP remains unclear. In this study, we performed bi-directional Mendelian randomization (MR) analyses to explore causal inference between these two traits. The instrumental variables for RA were selected from a large-scale genome-wide association study (GWAS) (1,523 cases and 461,487 controls). Bone mineral density (BMD) at five different sites (heel (n=265,627), forearm (FA) (n=8,143), femoral neck (FN) (n=32,735), lumbar spine (LS) (n=28,498), and total body (n=28,498)) were used as phenotypes for OP. The inverse variance weighted (IVW) method did not detect any causal effect of BMDs on RA except heel BMD (beta = -7.57 × 10-4, p = 0.02). However, other methods (MR-Egger, weighted median, weighted mode, MR-PRESSO, and MR-RAPS) showed no causal association between heel BMD and RA. Likewise, we did not find a causal effect of RA on BMD at any sites. In conclusion, we found no evidence that RA is causally associated with OP/BMD, or vice versa. We suggested that the associations found in previous observational studies between RA and OP/BMD are possibly related to secondary effects such as antirheumatic treatment and reduced physical activity.
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Affiliation(s)
- Ying-Qi Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Yong Liu
- Center for System Biology, Data Sciences, and Reproductive Health, School of Basic Medical Science, Central South University, Changsha 410011, China
| | - Zhuo-Yuan Chen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Hui Li
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Tao Xiao
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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Chen YF, Zong HX, Xu SQ, Chu YR, Wang JX, Li WJ, Chen KM. Synergistic effect of sarcopenia and poor balance on osteoporotic vertebral fracture in Chinese patients with rheumatoid arthritis. Clin Rheumatol 2021; 40:3627-3637. [PMID: 33774766 DOI: 10.1007/s10067-021-05703-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to investigate the synergistic effect of sarcopenia and poor balance on osteoporotic vertebral fracture (VOPF) in Chinese patients with rheumatoid arthritis (RA). METHODS A total of 238 RA patients and 158 normal subjects were enrolled in the case-control study. Poor balance capability (Berg balance scale (BBS) score < 40) and sarcopenia (skeletal muscle mass index (SMI) <7.0 (male)/5.7 (female)) between RA patients and normal subjects were compared. Associations of poor balance capability or sarcopenia with disease activity, structural damage, and joint function in different groups were also investigated. RESULTS The incidence of sarcopenia in RA was 58.4%, significantly higher than that in controls (P<0.0001). Moreover, the percentages of low balance capacity (BBS<40) in RA were 43.7%, which was higher than that in controls (P<0.0001). The prevalence of VOPF in the case group was 19.3%, which was higher than that in the controls (P<0.0001). In the RA group, compared to RA patients without VOPF, RA patients with VOPF had higher percentages of poor balance and sarcopenia (P<0.05). Compared with RA patients without sarcopenia or good balance, RA patients with sarcopenia or poor balance had a higher incidence of VOPF, higher disease activity, severer structural damage, and worse joint function (P<0.05). The incidence of VOPF in patients combined with good balance and non-sarcopenia (4.8%) was significantly lower than that in patients combined with poor balance and sarcopenia (38.2%) (P<0.0001). Logistic regression indicated that higher SMI and higher BBS scores were protective factors for VOPF in RA patients, while age was a risk factor for VOPF in RA patients (P<0.0001). CONCLUSION Sarcopenia and poor balance are popular in Chinese patients with RA, and they are associated with disease activity and structural damage. There is a synergistic effect of sarcopenia and poor balance on VOPF in RA. Key Points • Sarcopenia and balance capability were popular (about a half) in patients with RA. • Sarcopenia and poor balance had a synergistic effect on VOPF in RA.
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Affiliation(s)
- Yang-Fan Chen
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
| | - He-Xiang Zong
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
| | - Sheng-Qian Xu
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China.
| | - Yi-Ran Chu
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
| | - Jian-Xiong Wang
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
| | - Wan-Jun Li
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
| | - Ke-Ming Chen
- Department of Rheumatology and Immunology, The First Affiliated hospital of Anhui Medical University, NO.218, Ji-xi Road, Hefei, 230022, China
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Do anti-carbamylated protein antibodies in rheumatoid arthritis reflect local and systemic osteoporosis? A study of osteoprotegrin and receptor activator for nuclear factor kappa B ligand and radiological assessment. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
One of the most important and dangerous complications of rheumatoid arthritis (RA) is bone loss, which manifested by erosions and juxta-articular or systemic bone loss. Anti-carbamylated protein (anti-CarP) antibodies which are also called anti-homocitrulline antibodies have recently been found in RA. Increase anti-CarP antibody titres may lead to severe disease and increase the progression of bone loss. Osteoprotegrin and receptor activator for nuclear factor kappa B and its ligand (RANKL) are the main players in the pathogenesis of osteoporosis. Thus, we aimed to investigate and detect the presence and prevalence of anti-CarP in rheumatoid arthritis and their association with disease severity and osteoporosis, as well as with OPG/RANKL in 80 Egyptian RA patients to highlight this relationship which could be useful in managing RA patients with osteoporosis.
Results
Serum anti-CarP levels were significantly increased in the RA group compared with the control group (P< 0.001). We found a negative association between anti-CarP and anti-CCP and disease activity (r=−0.878, −0.534, respectively, P<0.001). We also found a positive correlation between anti-CarP and the Larsen score, DEXA score, RF, HAQ, and RANKL (r=0.646, 0.287, 0.243, 0.892, 0.671, 0.869 [respectively], P<0.001) and there was negative correlation between anti-CarP and OPG (r=−0.553, P<0.001).
Conclusion
Anti-CarP antibodies are associated with disease severity and disability in RA patients. They could play an important and significant role in the pathogenesis of osteoporosis in these patients.
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Majjad A, Ghassem MA, Toufik H, Sadni S, Debbarh Z, Djossou JH, El Ouardi N, Taoubane L, Abouqal R, Achemlal L, El Maghraoui A. Relationship between vertebral fracture prevalence and abdominal aortic calcification in women with rheumatoid arthritis. Bone 2020; 141:115599. [PMID: 32822872 DOI: 10.1016/j.bone.2020.115599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Vertebral fracture assessment (VFA)-detected abdominal aortic calcification (AAC) has been validated as an indicator of increased risk of vertebral fractures (VFs) in other populations but this relationship in rheumatoid arthritis (RA) is unclear. We assess the prevalence of AAC on VFA scans and its potential relationship with prevalent VFs in a cohort of RA women. METHODS We enrolled 250 women with RA. VFA images, and scans of the lumbar spine and proximal femur were obtained using dual-energy x-ray absorptiometry. The presence/severity of VFs and AAC were carried out using validated approaches. RESULTS AAC was detected in 95 of 250 (38%) eligible subjects and 83 (33.2%) had at least one VF. Significantly subjects with VFs had a higher AAC score (3.4 ± 3.8 versus 0.7 ± 1.4; p˂0.001) and higher prevalence of AAC than those without VFs (65% versus 26%; P˂0.001). The group with VFs tended to be older, had more menopausal women, and lower lumbar spine and total hip BMD than those without VF. They also had a long-standing disease and high DAS 28-CRP, a great steroid cumulative dose, and a high prevalence of rheumatoid factor (RF). In multivariate analyses, a significant association was noted between prevalent VFs and age of patients, RA disease activity, presence of densitometric osteoporosis, RF, and VFA-detected AAC, whereas there was no significant association with steroid cumulative dose and disease duration. CONCLUSION VFA is a convenient tool for the diagnosis of VFs and AAC. In this cohort, VFA-detected AAC was independently associated with prevalent VFs.
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Affiliation(s)
- Abderrahim Majjad
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco.
| | - Mohamed A Ghassem
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Hamza Toufik
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Siham Sadni
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Zineb Debbarh
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Julien H Djossou
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Najlae El Ouardi
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Laila Taoubane
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Lahcen Achemlal
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
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Llorente I, García-Castañeda N, Valero C, González-Álvaro I, Castañeda S. Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons. Front Med (Lausanne) 2020; 7:601618. [PMID: 33330566 PMCID: PMC7719815 DOI: 10.3389/fmed.2020.601618] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis has been classically considered a comorbidity of rheumatoid arthritis (RA). However, recent advances in the pathogenesis of osteoporosis in RA have shown a close interplay between cells of the immune system and those involved in bone remodeling, introducing new actors into the classic route in which osteoclast activation is related to the RANK/RANKL/OPG pathway. In fact, the inflammatory state in early stages of RA, mediated by interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α has the ability to activate and differentiate osteoclasts not only through their relationship with RANKL, but also through the Wnt/DKK1/sclerostin pathway, leading to bone loss. The role of synovial fibroblasts and activated T lymphocytes in the expression of the RANKL system and its connection to bone destruction is also depicted. In addition, autoantibodies such as rheumatoid factor and anti-citrullinated protein antibodies are other pathogenic mechanisms for the development of bone erosions and systemic osteoporosis in RA, even before the onset of arthritis. The aim of this review is to unravel the relationship between different factors involved in the development of osteoporosis in RA patients, both the classic factors and the most novel, based on the relationship of autoantibodies with bone remodeling. Furthermore, we propose that bone mineral density measured by different techniques may be helpful as a biomarker of severity in early arthritis patients.
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Affiliation(s)
- Irene Llorente
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | | | - Cristina Valero
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | | | - Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain.,Cátedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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20
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Soto-Subiabre M, Mayoral V, Fiter J, Valencia L, Subirana I, Gómez-Vaquero C. Vertebral fracture: clinical presentation and severity are linked to fracture risk factors. Osteoporos Int 2020; 31:1759-1768. [PMID: 32377807 DOI: 10.1007/s00198-020-05425-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/15/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Soto-Subiabre
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Rheumatology Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain.
| | - V Mayoral
- Pain Clinic, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - J Fiter
- Rheumatology Service, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - L Valencia
- Rheumatology Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - I Subirana
- Rheumatology Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
| | - C Gómez-Vaquero
- Rheumatology Service, Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, Spain
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21
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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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22
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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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23
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McCabe E, Ibrahim A, Singh R, Kelly M, Armstrong C, Heaney F, Bergin D, McCabe JP, Carey JJ. A systematic review of the Irish osteoporotic vertebral fracture literature. Arch Osteoporos 2020; 15:34. [PMID: 32124074 DOI: 10.1007/s11657-020-0704-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/14/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Vertebral fractures (VF) are the most common osteoporotic fracture. They are associated with significant morbidity and mortality and are an important predictor of future fractures. The epidemiology of VF in Ireland is limited and a greater understanding of their scale and impact is needed. Therefore, we conducted a systematic review of publications on osteoporotic VF in Ireland. METHODS Systematic searches were conducted using PubMed, Medline, Embase, Scopus and Cochrane electronic databases to identify eligible publications from Ireland addressing osteoporotic VF. RESULTS Twenty studies met the inclusion criteria out of 1558 citations. All studies were published since 2000. Data was obtained on 182,771 patients with fractures. Nine studies included more than 100 subjects and three included more than 1000. Females accounted for 70% with an overall mean age of 65.2 years (30-94). There was significant heterogeneity in study design, methods and outcome measures including the following: use of administrative claims data on public hospital admissions, surgical and medical interventions, the impact of a fracture liaison service and the osteoporosis economic burden. The prevalence of VF was difficult to ascertain due to definitions used and differences in the study populations. Only two studies systematically reviewed spine imaging using blinded assessors and validated diagnostic criteria to assess the prevalence of fractures in patient cohorts. CONCLUSIONS Several studies show that VF are common when addressed systematically and the prevalence may be rising. However, there is a deficit of large studies systematically addressing the epidemiology and their importance in Ireland.
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Affiliation(s)
- Eva McCabe
- School of Medicine, National University of Ireland, Galway, Ireland. .,Department of Rheumatology, Galway University Hospital, Galway, Ireland.
| | - Ammar Ibrahim
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Rajneet Singh
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Michael Kelly
- Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Catherine Armstrong
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Fiona Heaney
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
| | - Diane Bergin
- Department of Radiology, Galway University Hospital, Galway, Ireland
| | - John P McCabe
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Trauma and Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland.,Department of Rheumatology, Galway University Hospital, Galway, Ireland
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Fauny M, Albuisson E, Bauer E, Perrier-Cornet J, Chary-Valckenaere I, Loeuille D. Study of vertebral fracture and Scanographic Bone Attenuation Coefficient in rheumatoid arthritis and ankylosing spondylitis vs. controls. Sci Rep 2019; 9:13323. [PMID: 31527613 PMCID: PMC6746735 DOI: 10.1038/s41598-019-49712-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 08/16/2019] [Indexed: 01/14/2023] Open
Abstract
The objective of this study is to identify the prevalence of vertebral fractures (VFs) and to measure the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1) based CT-scan, a biomarker of bone fragility in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and in a control group. This monocentric and retrospective study included patients with RA and AS, based on ACR/EULAR or New-York criteria, respectively. A control group was constituted. All of the patients received a CT-scan. VFs were determined via CT-scans according to the Genant classification, and the SBAC-L1 was measured in Hounsfield units (HU). SBAC-L1 ≤145 HU (fracture threshold) defined patients at risk of VFs. 244 patients were included (105 RA, 83 AS, 56 controls). Of the 4.365 vertebrae studied, 66 osteoporotic VFs were found in 36 patients: 18 (17.1%) RA, 13 (15.7%) AS and 5 (8.9%) controls. The mean SBAC-L1 was 142.2 (±48.4) HU for RA, 142.8 (±48.2) for AS, both of which were significantly lower than that of the control group (161.8 (±42.7) HU). Of the 36 patients with VFs and rheumatism, 28% had a T-score ≤-2.5 SD and 71.4% a SBAC-L1 ≤145 HU. A T-score ≤-2.5 SD and a SBAC-L1 ≤145 HU were associated with VF (OR = 3.07 (CI 95%: 1.07; 8.81), and 2.31 (CI 95%: 1.06; 5.06)), respectively. The SBAC-L1 was significantly lower in the RA and AS groups than in the control group. Furthermore, SBAC-L1 ≤145 HU was associated with a higher risk of VFs, with an odds ratio similar to that of a DXA.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, University Hospital, Nancy, France.
| | - Eliane Albuisson
- Pôle S2R, PARC, University Hospital, Vandoeuvre lès Nancy, France.,University of Lorraine, Faculty of Medicine, InSciDens, Vandoeuvre lès Nancy, France.,CNRS, Institute Elie Cartan de Lorraine, UMR 7502, Vandoeuvre-lès-Nancy, F-54506, France
| | - Elodie Bauer
- Department of Rheumatology, University Hospital, Nancy, France
| | | | | | - Damien Loeuille
- Department of Rheumatology, University Hospital, Nancy, France
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25
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Perrier-Cornet J, Omorou AY, Fauny M, Loeuille D, Chary-Valckenaere I. Opportunistic screening for osteoporosis using thoraco-abdomino-pelvic CT-scan assessing the vertebral density in rheumatoid arthritis patients. Osteoporos Int 2019; 30:1215-1222. [PMID: 30868182 DOI: 10.1007/s00198-019-04931-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Screening for osteoporosis is crucial in rheumatoid arthritis (RA) patients. The aim of this study was to assess the value of thoraco-abdomino-pelvic CT-derived bone mineral density (BMD) results in L1, compared to dual energy X-ray absorptiometry (DXA) results for osteoporosis screening in rheumatoid arthritis patients. METHODS Consecutive RA patients who underwent a CT-scan and DXA within a 2-year period were retrospectively included. The CT sagittal images were then evaluated for vertebral fractures from T4 to L5 using the Genant classification. The CT-attenuation values (in Hounsfield units (HU)) of trabecular bone in L1 were measured on axial images and compared to the DXA results. RESULTS This study included 105 patients (mean age 61.1 years (± 9.5), 78.1% women). There were 28 patients (26.7%) with DXA-defined osteoporosis and 32 (30%) with osteoporotic fractures (vertebral and/or non-vertebral). The CT assessment indicated that the mean (SD) vertebral L1 attenuation was 142.2 HU (± 18.5). The diagnostic performance for the vertebral CT-attenuation measurement was acceptable: the AUC was 0.67 for predicting osteoporotic fractures and of 0.69 for predicting vertebral fractures. Among patients with osteoporotic fractures, there were 23 (74%) patients categorized as osteoporotic with a L1 CT-attenuation of 135 HU or less, whereas there were only 13 patients (42%) identified by DXA. CONCLUSION CT offers a combined opportunistic screening for osteoporosis by assessing both vertebral fractures and bone density on routine CT-scans. This approach may be particularly interesting for RA patients with a high osteoporosis risk.
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Affiliation(s)
- J Perrier-Cornet
- Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France.
| | - A Y Omorou
- Inserm, CIC-1433 Clinical Epidemiology, University Hospital of Nancy, Nancy, France
| | - M Fauny
- Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France
| | - D Loeuille
- Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France
| | - I Chary-Valckenaere
- Rheumatology department, University Hospital of Nancy, 5 rue du Morvan, 54500, Vandœuvre-Lès-Nancy, France
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26
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Bone Mineral Loss and Fracture in Sarcoidosis: A Systematic Review and Meta-Analysis. Arch Rheumatol 2018; 34:130-140. [PMID: 31497759 DOI: 10.5606/archrheumatol.2019.6883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/03/2018] [Indexed: 12/31/2022] Open
Abstract
Objectives This meta-analysis aims to investigate the possibility of bone mineral loss and fracture in sarcoidosis. Materials and methods A comprehensive search of the MEDLINE and Embase databases was performed from inception through August 2017. The inclusion criterion was observational studies evaluating the association between sarcoidosis and bone mineral density (BMD) or fracture. The pooled odds ratio (OR) of fracture, standardized mean difference (SMD) of volumetric BMD and areal BMD, and their 95% confidence interval (CI) were calculated using a random-effects meta-analysis to compare risk between sarcoidosis and controls. The between-study heterogeneity of effect-size was quantified using the Q statistic and I2. Results Data were extracted from 10 studies involving a total of 6,448 sarcoidosis patients and 77,857 controls. The pooled result demonstrated no significant increased risk of fracture in sarcoidosis patients compared with controls (OR=1.68; 95% CI: 0.85-3.31, p value=0.14, I2=72%). There were no differences between the patients and controls in areal BMD (SMD= 0.21 g/cm2; 95% CI: -0.12-0.54, p value= 0.22, I2=0%) or volumetric BMD (SMD= 0.04 mg/cm3; 95% CI: -0.51-0.58, p value=0.89, I2=83%). Conclusion Our study has not shown an increased risk of fracture or bone mineral loss in sarcoidosis. However, based on the currently available studies with heterogeneity in between, the conclusion for the osteoporosis screening and fracture risk assessment of patients with sarcoidosis cannot be drawn until more studies are available.
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27
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Phuan-Udom R, Lektrakul N, Katchamart W. The association between 10-year fracture risk by FRAX and osteoporotic fractures with disease activity in patients with rheumatoid arthritis. Clin Rheumatol 2018; 37:2603-2610. [PMID: 30039267 DOI: 10.1007/s10067-018-4218-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/08/2018] [Accepted: 07/13/2018] [Indexed: 11/29/2022]
Abstract
As rheumatoid arthritis (RA) is an independent risk factor for osteoporotic fractures, the severity of disease activity may correlate with fracture risk. Our objectives were to determine the prevalence of major osteoporotic and hip fractures in patients with RA and to identify the factors related to their 10-year probabilities. This study enrolled 232 patients with RA, aged 40-90 years, who participated in the Siriraj RA Cohort in 2016 and 2017. Demographic data, disease activity scores 28 (DAS28), and health assessment questionnaires (HAQ) were collected. All participants were evaluated for asymptomatic vertebral fractures by thoracolumbar spine radiography. The osteoporotic fracture risks were determined using the fracture risk assessment tool (FRAX). Most subjects were postmenopausal women in their sixth decade; the median disease duration was 12.95 years. Forty-six percent of patients had osteoporotic fractures, and most (87%) were vertebral fractures. Eighty-one patients had asymptomatic vertebral compression fractures. Of those, 57%, 25%, and 18% had low, moderate, and high 10-year probabilities of major osteoporotic fractures, respectively, while 51%, 34%, and 15% had low, moderate, and high 10-year probabilities of hip fractures, respectively. Factors significantly associated with the 10-year probabilities of major osteoporotic and hip fractures were disease duration (p 0.017, 0.009), menopause duration (p < 0.001 both), cumulative disease activity (DAS28; p 0.004, 0.029), and cumulative functional disability (HAQ; p < 0.001 both). Moderate to high 10-year probabilities of major osteoporotic and hip fractures are common in RA. Cumulative disease severity is a high risk for osteoporotic fractures.
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Affiliation(s)
- Ratanapha Phuan-Udom
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Asadang Building 8th Floor, Bangkoknoi, Bangkok, 10700, Thailand.,Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Nittaya Lektrakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanruchada Katchamart
- Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Asadang Building 8th Floor, Bangkoknoi, Bangkok, 10700, Thailand.
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28
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Cheng TT, Yu SF, Su FM, Chen YC, Su BYJ, Chiu WC, Hsu CY, Chen JF, Ko CH, Lai HM. Anti-CCP-positive patients with RA have a higher 10-year probability of fracture evaluated by FRAX®: a registry study of RA with osteoporosis/fracture. Arthritis Res Ther 2018; 20:16. [PMID: 29382355 PMCID: PMC5791167 DOI: 10.1186/s13075-018-1515-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/05/2018] [Indexed: 12/22/2022] Open
Abstract
Background Positive anticyclic citrullinated peptide (anti-CCP+) is associated with bone loss in patients with rheumatoid arthritis (RA). However, whether overall positivity or specific levels of anti-CCP are associated with prevalent fracture or a 10-year probability of fracture remains unclear. Methods This interim analysis of an RA registry was conducted at Chang Gung Memorial Hospital in Kaohsiung (CGMHK) for RA-related osteoporosis/fracture. Consecutive patients with RA who had visited the rheumatology clinic at CGMHK since September 1, 2014, and fulfilled the classification criteria of RA were enrolled. The demographics, disease duration, Disease activity in 28 joints based on erythrocyte sedimentation rate (DAS28-ESR), lifestyle, evidence of previous fracture, risk factors of fracture in the Fracture Risk Assessment Tool (FRAX®), and FRAX® score of each participant were collected. Anti-CCP, rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and bone mineral density (BMD) were measured at enrollment. The patients were grouped by positivity or quartiles of anti-CCP level (I–IV). Results Five hundred twenty-one patients with RA were enrolled through May 31, 2016. In total, 359 (68.9%) patients were anti-CCP+. Compared with anti-CCP− patients, anti-CCP+ patients had a significantly higher DAS28-ESR (p = 0.0001) and 10-year probability of major (15.0 [18.9] vs. 12.0 [15.3], p = 0.0461) or hip (5.0 [9.2] vs. 3.6 [8.2], p = 0.0118) fracture, but a significantly lower BMD of the FN (p = 0.0196). The rates of osteoporosis and previous fracture were comparable. There were 130, 127, 132, and 132 patients in groups I–IV, respectively. The DAS28-ESR was significantly different (p = 0.0001) among the groups and correlated to anti-CCP levels. The BMD and 10-year probability of major (p = 0.0067) and hip (p = 0.0013) fracture among the groups were also different. Conclusions Anti-CCP+ RA patients had a higher 10-year probability of major or hip fracture, independent of anti-CCP levels, and a lower BMD of the FN than anti-CCP− patients.
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Affiliation(s)
- Tien-Tsai Cheng
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China. .,Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Shan-Fu Yu
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Mei Su
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China
| | - Yin-Chou Chen
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben Yu-Jih Su
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China.,Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Chan Chiu
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China
| | - Chung-Yuan Hsu
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China
| | - Jia-Feng Chen
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China
| | - Chi-Hua Ko
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China
| | - Han-Ming Lai
- Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niao-Song District, Kaohsiung, Taiwan, Republic of China.
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29
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Chen YM, Chen HH, Huang WN, Liao TL, Chen JP, Chao WC, Lin CT, Hung WT, Hsieh CW, Hsieh TY, Chen YH, Chen DY. Tocilizumab potentially prevents bone loss in patients with anticitrullinated protein antibody-positive rheumatoid arthritis. PLoS One 2017; 12:e0188454. [PMID: 29155868 PMCID: PMC5695761 DOI: 10.1371/journal.pone.0188454] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/07/2017] [Indexed: 12/27/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with a high risk of osteoporosis and fracture. Interleukin (IL)-6 inhibitors may suppress osteoclast activation. Anticitrullinated protein antibody (ACPA) titers are inversely associated with bone mineral density (BMD). However, the differential effect of ACPA on bone turnover marker (BTM) and BMD changes after IL-6 inhibition remains unclear. This prospective study recruited patients with active RA with inadequate response to methotrexate or biologics. BMD was measured before and after 2-year tocilizumab (TCZ) treatment. Serum osteocalcin, N-terminal propeptide of type I collagen (P1NP), and C-terminal cross-linking telopeptide of type I collagen (CTX) levels were assessed at the baseline and after treatment. We enrolled 76 patients with RA (89.5% women, age: 57.2 ± 13.3 years) receiving TCZ. The 28-joint disease activity score was negatively correlated with BMD and T-scores of the lumbar spine and bilateral femoral neck. ACPA-positive patients had lower lumbar spine and femoral neck T-scores. After 2-year TCZ treatment, CTX levels significantly decreased (0.32 ± 0.21 vs. 0.26 ± 0.17, p = 0.038). Femoral neck BMD increased significantly (0.71 ± 0.22 vs. 0.69 ± 0.55, p = 0.008). Decreased CTX levels and improved BMD were observed only in ACPA-positive patients. After treatment, femoral neck BMD significantly increased only in patients receiving a glucocorticoid dose of ≥5 mg/day. Two-year TCZ treatment reduced bone resorption and increased femoral BMD in ACPA-positive patients. The net effects of glucocorticoids and IL-6 inhibition on BMD imply that strict inflammation control might affect bone metabolism.
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Affiliation(s)
- Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Biostatistics Task Force of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Cheng Chao
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Chest Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Tsai Lin
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Ting Hung
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Wei Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Ph.D. Program of Business, Feng Chia University, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
- * E-mail:
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Choi YJ, Chung YS, Suh CH, Jung JY, Kim HA. Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore) 2017; 96:e8661. [PMID: 29137106 PMCID: PMC5690799 DOI: 10.1097/md.0000000000008661] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Rheumatoid arthritis (RA) is a risk factor for bone fragility, and its effect on fracture risk is independent of bone mineral density (BMD). The trabecular bone score (TBS) is a new indirect parameter of bone quality. In this study, BMD and the TBS were compared between female postmenopausal RA patients with and those without vertebral fractures (VFs).This study had a cross-sectional design. Two hundred seventy-nine postmenopausal women with RA aged 50 years or older were included in this study. TBS measurements were performed on the same vertebrae as those for the BMD measurements.Among the 279 subjects, 34 had VFs (12.5%). There was a significant difference in the TBS (P = .005) but not L-spine BMD (P = .142) between the subjects with and those without VFs. The odds ratio (OR) for the TBS per standard deviation decrease was significant, even after adjusting for confounding factors such as age, height, rheumatoid factor positivity, the disease activity score for 28 joints (DAS28), the cumulative dose of glucocorticoids (GCs), the time since menopause and osteoporosis drug use (OR = 2.86; 95% CI, 1.34-6.09), and L-spine BMD (OR = 2.57; 95% CI, 1.19-5.54). The TBS was negatively correlated with the cumulative dose of GCs, but not with the DAS28 or erythrocyte sedimentation rate. However, the correlation was an L-shaped nonlinear relationship.The TBS could be a supplementary tool for discriminating osteoporotic fractures in postmenopausal women with RA, and it may have a nonlinear relationship with the cumulative dose of GCs, but not with RA disease activity.
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Affiliation(s)
| | | | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
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Lems WF, Raterman HG. Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs. Ther Adv Musculoskelet Dis 2017; 9:299-316. [PMID: 29201155 DOI: 10.1177/1759720x17732562] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/29/2017] [Indexed: 12/31/2022] Open
Abstract
Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.
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Affiliation(s)
- Willem F Lems
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, P.O. Box 7057 1007 MB Amsterdam, The Netherlands
| | - Hennie G Raterman
- Amsterdam Rheumatology and Immunology Centre, VU University Medical Centre and Reade, North West Clinics, Alkmaar, The Netherlands
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Tanouchi T, Shimizu T, Ino M, Toda N, Manabe N, Itoh K, Fueki K. Occipitosacral Fusion for Multiple Vertebral Fractures with Kyphotic Deformity in a Patient with Mutilating Rheumatoid Arthritis: A Case Report. Surg J (N Y) 2017; 3:e48-e52. [PMID: 28825020 PMCID: PMC5553497 DOI: 10.1055/s-0037-1601321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/15/2017] [Indexed: 11/03/2022] Open
Abstract
Osteoporotic vertebral fractures are well-known complications of rheumatoid arthritis. The management of multiple vertebral fractures with kyphotic deformity is controversial. We present a case of a patient with mutilating rheumatoid arthritis who had multiple vertebral fractures with kyphotic deformity after occipitothoracic fusion for rheumatoid cervical disorder. Occipitosacral fusion was effective to create stable spine with better sagittal alignment in this case, but careful clinical assessment for early detection and management of postoperative insufficient pelvic fracture were required.
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Affiliation(s)
- Tetsu Tanouchi
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Takachika Shimizu
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Masatake Ino
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Naofumi Toda
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Nodoka Manabe
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Kanako Itoh
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Keisuke Fueki
- Department of Orthopedic Surgery, Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
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Polymorphism rs2073618 of the TNFRSF11B ( OPG) Gene and Bone Mineral Density in Mexican Women with Rheumatoid Arthritis. J Immunol Res 2017; 2017:7680434. [PMID: 28758134 PMCID: PMC5516719 DOI: 10.1155/2017/7680434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/06/2017] [Accepted: 05/18/2017] [Indexed: 01/12/2023] Open
Abstract
Osteoporosis (OP) is highly prevalent in rheumatoid arthritis (RA) and is influenced by genetic factors. Single-nucleotide polymorphism (SNP) rs2073618 in the TNFRSF11B osteoprotegerin (OPG) gene has been related to postmenopausal OP although, to date, no information has been described concerning whether this polymorphism is implied in abnormalities of bone mineral density (BMD) in RA. We evaluated, in a case-control study performed in Mexican-Mestizo women with RA, whether SNP rs2073618 in the TNFRSF11B gene is associated with a decrease in BMD. RA patients were classified as follows: (1) low BMD and (2) normal BMD. All patients were genotyped for the rs2073618 polymorphism by PCR-RFLP. The frequency of low BMD was 74.4%. Higher age was observed in RA with low BMD versus normal BMD (62 and 54 years, resp.; p < 0.001). Worse functioning and lower BMI were observed in RA with low BMD (p = 0.003 and p = 0.002, resp.). We found similar genotype frequencies in RA with low BMD versus RA with normal BMD (GG genotype 71% versus 64.4%, GC 26% versus 33%, and CC 3% versus 2.2%, resp.; p = 0.6). We concluded that in Mexican-Mestizo female patients with RA, the rs2073618 polymorphism of the TNRFS11B gene is not associated with low BMD.
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Bours S, de Vries F, van den Bergh JPW, Lalmohamed A, van Staa TP, Leufkens HGM, Geusens PPP, Drent M, Harvey NC. Risk of vertebral and non-vertebral fractures in patients with sarcoidosis: a population-based cohort. Osteoporos Int 2016; 27:1603-1610. [PMID: 26630976 PMCID: PMC4791462 DOI: 10.1007/s00198-015-3426-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/13/2015] [Indexed: 11/12/2022]
Abstract
UNLABELLED In this retrospective cohort study using the Clinical Practice Research Datalink (CPRD), patients with sarcoidosis have an increased risk of clinical vertebral fractures and when on recent treatment with oral glucocorticoids, also an increased risk of any fractures and osteoporotic fractures. INTRODUCTION Sarcoidosis is a chronic inflammatory disease, in which fragility fractures have been reported despite normal BMD. The aim of this study was to assess whether patients with sarcoidosis have an increased risk of clinical fractures compared to the general population. METHODS A retrospective cohort study was conducted using the CPRD. All patients with a CPRD code for sarcoidosis between January 1987 and September 2012 were included. Cox proportional hazards models were used to derive adjusted relative risks (RRs) of fractures in all sarcoidosis patients compared to matched controls, and within the sarcoidosis group according to use and dose of systemic glucocorticoids. RESULTS Five thousand seven hundred twenty-two sarcoidosis patients (mean age 48.0 years, 51 % females, mean follow-up 6.7 years) were identified. Compared to 28,704 matched controls, the risk of any fracture was not different in patients with sarcoidosis. However, the risk of clinical vertebral fractures was significantly increased (adj RR 1.77; 95 % CI 1.06-2.96) and the risk of non-vertebral fractures was decreased although marginally significant (adj RR 0.87; 95 % CI 0.77-0.99). Compared to sarcoidosis patients not taking glucocorticoids, recent use of systemic glucocorticoids was associated with an increased risk of any fracture (adj RR 1.50; 95 % CI 1.20-1.89) and of an osteoporotic fracture (adj RR 1.47; 95 % CI 1.07-2.02). CONCLUSIONS Patients with sarcoidosis have an increased risk of clinical vertebral fractures, and when using glucocorticoid therapy, an increased risk of any fractures and osteoporotic fractures. In contrast, the risk of non-vertebral fractures maybe decreased. Further investigation is needed to understand the underlying mechanisms of these contrasting effects on fracture risk.
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Affiliation(s)
- S Bours
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - F de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands.
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands.
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - J P W van den Bergh
- Department of Internal Medicine, Viecuri MC Venlo, Venlo, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - A Lalmohamed
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T P van Staa
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands
- Farr Institute, University of Manchester, Manchester, UK
| | - H G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht, The Netherlands
| | - P P P Geusens
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Biomedical Research Institute, Hasselt University, Hasselt, Belgium
| | - M Drent
- ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Pharmacology and Toxicology, FHML, University Maastricht, Maastricht, The Netherlands
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Koyama K, Sakuma M, Ohba T, Suzuki K, Haro H. Fractures lead to worsening of disease activity in rheumatoid arthritis. Mod Rheumatol 2016; 26:873-877. [PMID: 26872549 DOI: 10.3109/14397595.2016.1153566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The cause of rheumatoid arthritis (RA) flares is multifactorial and not well understood. No reports of fractures influencing disease activity in patients with RA have been published. The purpose of this study was to determine whether fractures influence disease activity in patients with RA. METHODS Hospital records of 470 patients with RA between 2011 and 2014 were analyzed. We first examined the incidence of flare using multiple regression analysis. Secondly, we examined the incidence of flare using DAS28-ESR, DAS28-CRP, and drug changes before bone fracture until bone union in the fracture cases. RESULTS Multiple linear regression analysis showed that female sex (p < 0.001), bottom DAS28-ESR (p < 0.001), and fracture (p = 0.041) were independent factor for DAS28-ESR at the last observation period, and sex (p = 0.040), bottom DAS28-CRP (p < 0.001), and fracture (p = 0.019) were independent factor for DAS28-CRP at the last observation period. The average DAS28-ESR value was significantly increased from 3.19 (prefracture) to 3.58 (bone union). The average DAS28-CRP value was also significantly increased from 2.45 (prefracture) to 2.79 (bone union). CONCLUSIONS We have demonstrated that fractures influence disease activity in patients with RA. Larger numbers of fracture cases are required to confirm the present observations; however, the prevention of fracture is clearly required in patients with RA.
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Affiliation(s)
- Kensuke Koyama
- a Department of Orthopedic Surgery , University of Yamanashi , Chuo , Yamanashi , Japan
| | - Michitomo Sakuma
- b Department of Orthopedic Surgery , Yamanashi Prefectural Central Hospital , Kofu , Yamanashi , Japan , and
| | - Tetsuro Ohba
- a Department of Orthopedic Surgery , University of Yamanashi , Chuo , Yamanashi , Japan
| | - Kohta Suzuki
- c Department of Health Sciences, Basic Science for Clinical Medicine, Division of Medicine, Graduate School of Interdisciplinary Research , University of Yamanashi , Chuo , Yamanashi , Japan
| | - Hirotaka Haro
- a Department of Orthopedic Surgery , University of Yamanashi , Chuo , Yamanashi , Japan
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Abstract
Vertebral fractures are one of the most common fractures associated with skeletal fragility and can cause as much morbidity as hip fractures. However, the epidemiology of vertebral fractures differs from that of osteoporotic fractures at other skeletal sites in important ways, largely because only one quarter to one-third of vertebral fractures are recognized clinically at the time of their occurrence and otherwise require lateral spine imaging to be recognized. This article first reviews the prevalence and incidence of clinical and radiographic vertebral fractures in populations across the globe and secular trends in the incidence of vertebral fracture over time. Next, associations of vertebral fractures with measures of bone mineral density and bone microarchitecture are reviewed followed by associations of vertebral fracture with various textural measures of trabecular bone, including trabecular bone score. Finally, the article reviews clinical risk factors for vertebral fracture and the association of vertebral fractures with morbidity, mortality, and other subsequent adverse health outcomes.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MD, USA.
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Abstract
Patients with rheumatoid arthritis are predisposed to systemic bone loss, and they are at an increased risk of fractures. Although there are similarities in the patient demographics between rheumatoid arthritis patients and the general population of osteoporosis patients, there are factors, particularly the use of glucocorticoids, which are specific to rheumatoid arthritis. These factors can lead to an increased risk of bone loss and fracture. Given that fractures are often very debilitating, especially in elderly patients, it is of paramount importance for the practicing rheumatologist to be aware of ways to reduce the risk of fracture in patients with rheumatoid arthritis. This review discusses currently available modalities for fracture risk assessment as well as pharmacologic and lifestyle interventions available to treat and prevent bone loss in rheumatoid arthritis patients.
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38
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Drampalos E, Nikolopoulos K, Baltas C, Balanika A, Galanos A, Papaioannou N, Pneumaticos S. Vertebral fracture assessment: Current research status and application in patients with kyphoplasty. World J Orthop 2015; 6:680-687. [PMID: 26495245 PMCID: PMC4610910 DOI: 10.5312/wjo.v6.i9.680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023] Open
Abstract
Imaging of the spine is of paramount importance for the recognition of osteoporotic vertebral fractures (VFs), and standard radiography (SR) of the spine is the suggested diagnostic method but is not routinely used because of the cost and radiation exposure considerations. VF assessment (VFA) is an efficient, low radiation method for identifying VFs at the time of bone mineral density (BMD) measurement. Prediction models used to indicate the need for VFA may have little predictive power in subspecialty referral populations such as rheumatologic patients or patients who underwent kyphoplasty. Rheumatologic patients are frequently at increased risk for VFs, and VFA should be performed on an individual basis, also taking in account the guidelines for the general population. Kyphoplasty is a new minimal invasive procedure for the treatment of VFs and is being performed with increasing frequency. Following kyphoplasty, there may be a risk of new VFs in adjacent vertebrae. The assessment and follow-up of patients who underwent kyphoplasty requires repetitive X-ray imaging with the known limitations of SR. Thus, VFA may facilitate the evaluation of VFs in these patients because most of the kyphoplasty patients would fulfill the criteria. In a pilot study, we measured the BMD and performed VFA in 28 patients treated with kyphoplasty. Ratios of anterior to posterior (A/P) and middle to posterior (M/P) height were measured, and Genant’s method was used to classify vertebrae accordingly. Intraobserver and interobserver reliability for A/P, M/P and the Genant’s method were determined. Only 1 patient did not meet the criteria for VFA. Of the 364 available vertebrae, 295 could be analyzed. Most missing data (concerning 69 vertebrae) occurred in the upper thoracic region. Three of the 69 non-eligible vertebrae were lumbar vertebrae with cement leakage from the kyphoplasty procedure. In our hands, VFA was highly reproducible, demonstrating very good agreement in terms of intraobserver and interobserver reliability. Agreement was very good on the vertebral level, “vertebrae with kyphoplasty” level and “2 above and 1 below the kyphoplasty vertebrae” level. The application of Genant’s method to these patients also resulted in perfect agreement. We believe that the potential value of VFA in patients treated with kyphoplasty requires further evaluation, particularly comparing VFA with SR and performing a longitudinal follow-up. More research will help to adopt care processes that determine which patients require VFA and how often VFA should be performed, while also considering the impact of this technique on the cost of healthcare organizations.
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Wen L, Kang JH, Yim YR, Lee JW, Lee KE, Park DJ, Kim TJ, Park YW, Lee SS. Risk factors for treatment failure in osteoporotic patients with rheumatoid arthritis. Mod Rheumatol 2015; 26:194-9. [PMID: 26140470 DOI: 10.3109/14397595.2015.1069444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Lihui Wen
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Ji-Hyoun Kang
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yi-Rang Yim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Jeong-Won Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Kyung-Eun Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
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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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Mallory GW, Halasz SR, Clarke MJ. Advances in the treatment of cervical rheumatoid: Less surgery and less morbidity. World J Orthop 2014; 5:292-303. [PMID: 25035832 PMCID: PMC4095022 DOI: 10.5312/wjo.v5.i3.292] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 03/08/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine. While it was initially thought that cervical involvement was innocuous, natural history studies have substantiated the progressive nature of untreated disease. Over the past 50 years, there has been further elucidation in the pathophysiology of the disease, as well as significant advancements in medical and surgical therapy. The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery. Advancement in instrumentation techniques has improved patient outcomes and fusion rates. The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity. In this review, we give a brief overview of the pertinent positives of the disease. A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided. With improved medical therapies and less invasive approaches, we will likely continue to see less advanced cases of disease and less surgical morbidity. Nonetheless, a thorough understanding of the disease is crucial, as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.
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Brance ML, Brun LR, Lioi S, Sánchez A, Abdala M, Oliveri B. Vitamin D levels and bone mass in rheumatoid arthritis. Rheumatol Int 2014; 35:499-505. [DOI: 10.1007/s00296-014-3071-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
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43
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Cho SK, Lee JH, Han M, Lee S, Kim JY, Ryu JA, Choi YY, Bae SC, Sung YK. The influence of vertebral fracture on the functional disability of patients with rheumatoid arthritis. J Korean Med Sci 2014; 29:859-63. [PMID: 24932090 PMCID: PMC4055822 DOI: 10.3346/jkms.2014.29.6.859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/07/2014] [Indexed: 11/20/2022] Open
Abstract
The aim of the present study was to identify the influence of vertebral fracture (VF) on the functional disability in patients with rheumatoid arthritis (RA). This study consecutively enrolled 100 female patients aged 50 yr or older with RA. All participants underwent lateral imaging of the thoracolumbar spine by simple radiography to identify any VFs. They also completed questionnaires via interview regarding demographics, medical history, and disease outcomes including functional disability. We used univariate analysis to evaluate associations between functional disability and VF, and made multivariate logistic regression models to test independent effect of the presence of VF, the number of VFs, and the severity of VF on functional disability. Among the 100 RA patients, 47 had at least one VF, but 34 of them were asymptomatic that they had experienced a fracture. The multiple VFs ≥ 3 (OR, 8.95; 95% CI, 1.77-44.15, P = 0.01) and moderate or severe VF (OR, 3.38; 95% CI, 1.26-9.04, P = 0.02) were related to disability in univariate analysis. The multiple VFs ≥ 3 (OR, 6.13; 95% CI, 1.02-36.94, P = 0.048) was associated with functional disability of RA patients after adjusting various confounders and it was mainly in walking and arising. The VF might be an important factor which affects functional disability in RA patients.
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Affiliation(s)
- Soo-Kyung Cho
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Joo-Hyun Lee
- Department of Rheumatology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Minkyung Han
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Seunghun Lee
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Ah Ryu
- Department of Radiology, Hanyang University College of Medicine, Seoul, Korea
| | - Yun Young Choi
- Department of Nuclear Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
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Bultink IEM, Lems WF. Performance of vertebral fracture assessment in addition to dual energy X-ray absorptiometry in patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53:775-6. [PMID: 24435409 DOI: 10.1093/rheumatology/ket448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irene E M Bultink
- Department of Rheumatology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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