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Kim JW, Jung JY, Kim HA, Suh CH. Anti-Inflammatory Effects of Low-Dose Glucocorticoids Compensate for Their Detrimental Effects on Bone Mineral Density in Patients with Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10132944. [PMID: 34209074 PMCID: PMC8268831 DOI: 10.3390/jcm10132944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/26/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives: This study aimed to provide reliable information on the impact of low-dose glucocorticoids (GCs) on the bone mineral density (BMD) of patients with rheumatoid arthritis (RA). Methods: This retrospective study enrolled 933 patients with RA who continued the consumption of GCs (GC group) and 100 patients who had discontinued consumption for >1 year (no-GC group). The BMD values were measured at baseline and follow-up, and the annual rate of change in BMD between the groups was compared using dual-energy X-ray absorptiometry. We used multiple linear regression analysis to identify the factors associated with changes in BMD. Results: The demographic characteristics and use of medical treatments affecting bone metabolism were similar between the two groups. Furthermore, there were no significant differences in the annual rate of changes in BMD and incidence of newly developed osteoporosis and incidental fractures between the two groups. Multiple linear regression analysis revealed that the disease activity score for 28 joints with erythrocyte sedimentation rate was the only factor affecting the annual rate of changes in BMD, and it was inversely proportional to changes in BMD. Conclusion: The benefits of GC therapy in attenuating inflammation compensate for the risk of osteoporosis if adequate measures to prevent bone loss are implemented in patients with RA.
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Affiliation(s)
- Ji-Won Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Korea; (J.-W.K.); (J.-Y.J.); (H.-A.K.)
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Korea; (J.-W.K.); (J.-Y.J.); (H.-A.K.)
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Korea; (J.-W.K.); (J.-Y.J.); (H.-A.K.)
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon 16499, Korea; (J.-W.K.); (J.-Y.J.); (H.-A.K.)
- Department of Molecular Science and Technology, Ajou University, Suwon 16499, Korea
- Correspondence: ; Tel.: +82-31-219-5118; Fax: +82-31-219-5157
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Shlobin NA, Dahdaleh NS. Cervical spine manifestations of rheumatoid arthritis: a review. Neurosurg Rev 2020; 44:1957-1965. [PMID: 33037539 DOI: 10.1007/s10143-020-01412-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/20/2020] [Accepted: 10/05/2020] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) is a progressive autoimmune inflammatory disease affecting 1% of the population with three times as many women as men. As many as 86% of patients suffering from RA have cervical spine involvement. Synovial inflammation in the cervical spine causes instability and injuries including atlantoaxial subluxation, retroodontoid pannus formation, cranial settling, and subaxial subluxation. While many patients with cervical spine involvement are asymptomatic, symptomatic patients often present with nonspecific symptoms resulting from inflammation and additional secondary symptoms that are due to compression of the brainstem, cranial nerves, vertebral artery, and spinal cord. Radiographs are the imaging modality used most often, while MRI and CT are used for assessment of neural element involvement and surgical planning. Multiple classification systems exist. Early diagnosis and treatment of cervical spine involvement is critical. Surgical management is indicated when patients experience symptoms from cervical involvement that result in biomechanical instability and, or a neurological deficit. Atlantoaxial instability managed with atlantoaxial fusion, retroodontoid pannus with neural element compression is managed with posterior decompression and atlantoaxial fusion or occipitocervical fusion. Cranial settling is managed can be managed with anterior decompression and posterior fusion or with dorsal only approaches. Subaxial subluxation is managed with circumferential fusion or posterior only decompression and fusion. Patients with atlantoaxial instability have better functional and neurologic outcomes. RA patients have higher complication rates and more frequent need for revision surgery than the general population of spine surgery patients.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA.
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
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Vamorolone, a dissociative steroidal compound, reduces collagen antibody-induced joint damage and inflammation when administered after disease onset. Inflamm Res 2019; 68:969-980. [PMID: 31446438 DOI: 10.1007/s00011-019-01279-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/02/2019] [Accepted: 08/19/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE AND DESIGN The objective of this study was to assess the effect of vamorolone, a first-in-class dissociative steroidal compound, to inhibit inflammation when administered after disease onset in the murine collagen antibody-induced arthritis model of arthritis. ANIMALS 84 DBA1/J mice were used in this study (n = 12 per treatment group). TREATMENT Vamorolone or prednisolone was administered orally after disease onset for a duration of 7 days. METHODS Disease score and bone erosion were assessed using previously described scoring systems. Cytokines were measured in joints via immunoassay, and joint cathepsin B activity (marker of inflammation) was assessed using optical imaging of joints on live mice. RESULTS We found that vamorolone treatment led to a reduction of several disease parameters including disease score, joint inflammation, and the presence of pro-inflammatory mediators to a degree similar of that observed with prednisolone treatment. More importantly, histopathological analysis of affected joints showed that vamorolone treatment significantly reduced the degree of bone erosion while this bone-sparing property was not observed with prednisolone treatment at any of the tested doses. CONCLUSIONS While many intervention regimens in other studies are administered prior to disease onset in animal models, the current study involves delivery of the potential therapeutic after disease onset. Based on the findings, vamorolone may offer an efficacious, yet safer alternative to conventional steroidal compounds in the treatment of rheumatoid arthritis and other inflammatory diseases.
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Sanmartí R, Tornero J, Narváez J, Muñoz A, Garmendia E, Ortiz AM, Abad MA, Moya P, Mateo ML, Reina D, Salvatierra-Ossorio J, Rodriguez S, Palmou-Fontana N, Ruibal-Escribano A, Calvo-Alén J. Efficacy and safety of glucocorticoids in rheumatoid arthritis: Systematic literature review. ACTA ACUST UNITED AC 2018; 16:222-228. [PMID: 30057295 DOI: 10.1016/j.reuma.2018.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES 1) To systematically and critically review the evidence on the characteristics, efficacy and safety of glucocorticoids (CS) in rheumatoid arthritis (RA); 2) to generate practical recommendations. METHODS A systematic literature review was performed through a sensitive bibliographic search strategy in Medline, Embase and the Cochrane Library. We selected randomized clinical trials that analyzed the efficacy and/or safety of CS in patients with RA. Two reviewers performed the first selection by title and abstract. Then 10 reviewers selected the studies after a detailed review of the articles and data collection. The quality of the studies was evaluated with the Jadad scale. In a nominal group meeting, based on the results of the systematic literature review, related recommendations were reached by consensus. RESULTS A total of 47 articles were finally included. CS in combination with disease-modifying antirheumatic drugs help control disease activity and inhibit radiographic progression, especially in the short-to-medium term and in early RA. CS can also improve function and relieve pain. Different types and routes of administration are effective, but there is no standardized scheme (initial dose, tapering and duration of treatment) that is superior to others. Adverse events when using CS are very frequent and are dose-dependent and variable severity, although most are mild. Seven recommendations were generated on the use and risk management of CS. CONCLUSIONS These recommendations aim to resolve some common clinical questions and aid in decision-making for CS use in RA.
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Affiliation(s)
- Raimon Sanmartí
- Servicio de Reumatología, Hospital Clínic, Barcelona, España.
| | - Jesús Tornero
- Servicio de Reumatología, Departamento de Medicina y Especialidades Médicas, Hospital Universitario de Guadalajara, Universidad de Alcalá, Guadalajara, España
| | - Javier Narváez
- Servicio de Reumatología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Alejandro Muñoz
- Servicio de Reumatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Elena Garmendia
- Servicio de Reumatología, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
| | - Ana M Ortiz
- Servicio de Reumatología, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria La Princesa (IIS-IP), Madrid, España
| | - Miguel Angel Abad
- Servicio de Reumatología, Hospital Virgen del Puerto, Plasencia, Cáceres, España
| | - Patricia Moya
- Sección de Reumatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - María Lourdes Mateo
- Servicio de Reumatología, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - Delia Reina
- Servicio de Reumatología, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | | | - Sergio Rodriguez
- Servicio de Reumatología, Hospital Universitario Virgen de Valme, Sevilla, España
| | - Natalia Palmou-Fontana
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Cantabria, España
| | | | - Jaime Calvo-Alén
- Servicio de Reumatología, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, España
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Su YJ, Chen CT, Tsai NW, Huang CC, Wang HC, Kung CT, Lin WC, Cheng BC, Su CM, Hsiao SY, Lu CH. The Role of Monocyte Percentage in Osteoporosis in Male Rheumatic Diseases. Am J Mens Health 2017; 11:1772-1780. [PMID: 28901203 PMCID: PMC5675259 DOI: 10.1177/1557988317721642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis is easily overlooked in male patients, especially in the field of rheumatic diseases mostly prevalent with female patients, and its link to pathogenesis is still lacking. Attenuated monocyte apoptosis from a transcriptome-wide expression study illustrates the role of monocytes in osteoporosis. This study tested the hypothesis that the monocyte percentage among leukocytes could be a biomarker of osteoporosis in rheumatic diseases. Eighty-seven males with rheumatic diseases were evaluated in rheumatology outpatient clinics for bone mineral density (BMD) and surrogate markers, such as routine peripheral blood parameters and autoantibodies. From the total number of 87 patients included in this study, only 15 met the criteria for diagnosis of osteoporosis. Both age and monocyte percentage remained independently associated with the presence of osteoporosis. Steroid dose (equivalent prednisolone dose) was negatively associated with BMD of the hip area and platelet counts were negatively associated with BMD and T score of the spine area. Besides age, monocyte percentage meets the major requirements for osteoporosis in male rheumatic diseases. A higher monocyte percentage in male rheumatic disease patients, aged over 50 years in this study, and BMD study should be considered in order to reduce the risk of osteoporosis-related fractures.
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Affiliation(s)
- Yu-Jih Su
- 1 Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao Tung Chen
- 2 Department of Family Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- 3 Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Huang
- 3 Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- 4 Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- 5 Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- 6 Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- 1 Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,7 Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Min Su
- 5 Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Yuan Hsiao
- 5 Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,7 Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- 3 Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,7 Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.,8 Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, China
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Muto M, Giurazza F, Frauenfelder G, Marcia S, Masala S, Guarnieri G. Interventions and Therapy in Rheumatology. Radiol Clin North Am 2017; 55:1103-1110. [DOI: 10.1016/j.rcl.2017.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Di Fede O, Bedogni A, Giancola F, Saia G, Bettini G, Toia F, D'Alessandro N, Firenze A, Matranga D, Fedele S, Campisi G. BRONJ in patients with rheumatoid arthritis: a multicenter case series. Oral Dis 2016; 22:543-8. [PMID: 27062502 DOI: 10.1111/odi.12490] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/15/2016] [Accepted: 04/02/2016] [Indexed: 12/30/2022]
Affiliation(s)
- O Di Fede
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - A Bedogni
- Department of Neurosciences; University of Padua; Padua Italy
| | - F Giancola
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - G Saia
- Department of Neurosciences; University of Padua; Padua Italy
| | - G Bettini
- Department of Maxillofacial Surgery; University Hospital of Padua; Padua Italy
| | - F Toia
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
| | - N D'Alessandro
- Clinical Pharmacology Unit; Azienda Ospedaliera Universitaria Policlinico ‘P. Giaccone’; Palermo Italy
| | - A Firenze
- Department of Sciences for Health Promotion and Mother and Child Care ‘G. D'Alessandro’; University of Palermo; Palermo Italy
| | - D Matranga
- Department of Sciences for Health Promotion and Mother and Child Care ‘G. D'Alessandro’; University of Palermo; Palermo Italy
| | - S Fedele
- UCL Eastman Dental Institute; University College London; London UK
- NIHR University College London Hospitals Biomedical Research Centre; London UK
| | - G Campisi
- Department of Surgical, Oncological and Oral Sciences; University of Palermo; Palermo Italy
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Rheumatoid Arthritis and the Cervical Spine: A Review on the Role of Surgery. Int J Rheumatol 2015; 2015:252456. [PMID: 26351458 PMCID: PMC4553335 DOI: 10.1155/2015/252456] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting a significant percentage of the population. The cervical spine is often affected in this disease and can present in the form of atlantoaxial instability (AAI), cranial settling (CS), or subaxial subluxation (SAS). Patients may present with symptoms and disability secondary to these entities but may also be neurologically intact. Cervical spine involvement in RA can pose a challenge to the clinician and the appropriate role of surgical intervention is controversial. The aim of this paper is to describe the pathology, pathophysiology, clinical manifestations, and diagnostic evaluation of rheumatoid arthritis in the cervical spine in order to provide a better understanding of the indications and options for surgery. Both the medical and surgical treatment options for RA have improved, so has the prognosis of the cervical spine disease. With the advent of disease modifying antirheumatic drugs (DMARDs), fewer patients are presenting with cervical spine manifestations of RA; however, those that do, now have improved surgical techniques available to them. We hope that, by reading this paper, the clinician is able to better evaluate patients with RA in the cervical spine and determine in which patients surgery is indicated.
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