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Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T. Response to Early-onset Pamidronate Treatment in Chronic Nonbacterial Osteomyelitis: A Retrospective Single-center Study. J Rheumatol 2019; 46:1515-1523. [PMID: 30988129 DOI: 10.3899/jrheum.181254] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Chronic nonbacterial osteomyelitis (CNO) is a sterile inflammatory bone disorder with an unpredictable disease course. The objective was to assess clinical and radiological disease activity in children with CNO including response to early-onset pamidronate treatment. METHODS A single-center retrospective study was conducted of children fulfilling the Bristol Criteria for CNO. At the time of diagnosis, whole-body magnetic resonance imaging (WB-MRI) or local MRI was performed to assess radiological disease activity. Children with multifocal or spinal bone inflammation and clinical disease activity not responding to nonsteroidal antiinflammatory drugs were categorized as having extended CNO. Clinical disease activity was assessed annually. RESULTS Fifty-one children were included. Median followup time was 4 years (interquartile range 3-7). Children categorized with extended CNO (n = 32) were treated in an early-onset 2-year pamidronate regimen. In extended CNO, WB-MRI was performed at time of diagnosis, and at years 1 and 2 in 88%, 84%, and 91% of cases, respectively. During the first year, the total number of radiologically active lesions and number of spinal lesions per patient declined (p = 0.01). Clinically inactive disease was recorded in 12/32 children (38%). However, 8/12 children (67%) experienced clinical relapse. In limited CNO (n = 19), 10/19 children (53%) presented with clinically inactive disease after 1 year and did not experience clinical relapse. CONCLUSION Pamidronate might contribute to improvement in clinical and radiological disease activity in extended CNO, especially after 1 year of treatment. However, children with continuously active disease after 2 years of pamidronate treatment were seen.
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Affiliation(s)
- Caroline Marie Andreasen
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. .,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital.
| | - Anne Grethe Jurik
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Mia B Glerup
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Christian Høst
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Birgitte T Mahler
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Ellen-Margrethe Hauge
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
| | - Troels Herlin
- From the Department of Rheumatology, the Department of Radiology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; the Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,C.M. Andreasen, MD, PhD, Department of Rheumatology, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; A.G. Jurik, MD, DMSc, Department of Radiology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; M.B. Glerup, MD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; C. Høst, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; B.T. Mahler, MD, PhD, Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital; E.M. Hauge, MD, PhD, Department of Rheumatology, Aarhus University Hospital, and the Department of Clinical Medicine, Aarhus University; T. Herlin, MD, DMSc, Department of Clinical Medicine, Aarhus University, and the Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital
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Kittaka M, Mayahara K, Mukai T, Yoshimoto T, Yoshitaka T, Gorski JP, Ueki Y. Cherubism Mice Also Deficient in c-Fos Exhibit Inflammatory Bone Destruction Executed by Macrophages That Express MMP14 Despite the Absence of TRAP+ Osteoclasts. J Bone Miner Res 2018; 33:167-181. [PMID: 28914985 PMCID: PMC5771992 DOI: 10.1002/jbmr.3295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/28/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022]
Abstract
Currently, it is believed that osteoclasts positive for tartrate-resistant acid phosphatase (TRAP+) are the exclusive bone-resorbing cells responsible for focal bone destruction in inflammatory arthritis. Recently, a mouse model of cherubism (Sh3bp2KI/KI ) with a homozygous gain-of-function mutation in the SH3-domain binding protein 2 (SH3BP2) was shown to develop auto-inflammatory joint destruction. Here, we demonstrate that Sh3bp2KI/KI mice also deficient in the FBJ osteosarcoma oncogene (c-Fos) still exhibit noticeable bone erosion at the distal tibia even in the absence of osteoclasts at 12 weeks old. Levels of serum collagen I C-terminal telopeptide (ICTP), a marker of bone resorption generated by matrix metalloproteinases (MMPs), were elevated, whereas levels of serum cross-linked C-telopeptide (CTX), another resorption marker produced by cathepsin K, were not increased. Collagenolytic MMP levels were increased in the inflamed joints of the Sh3bp2KI/KI mice deficient in c-Fos. Resorption pits contained a large number of F4/80+ macrophages and genetic depletion of macrophages rescued these erosive changes. Importantly, administration of NSC405020, an MMP14 inhibitor targeted to the hemopexin (PEX) domain, suppressed bone erosion in c-Fos-deficient Sh3bp2KI/KI mice. After activation of the NF-κB pathway, macrophage colony-stimulating factor (M-CSF)-dependent macrophages from c-Fos-deficient Sh3bp2KI/KI mice expressed increased amounts of MMP14 compared with wild-type macrophages. Interestingly, receptor activator of NF-κB ligand (RANKL)-deficient Sh3bp2KI/KI mice failed to show notable bone erosion, whereas c-Fos deletion did restore bone erosion to the RANKL-deficient Sh3bp2KI/KI mice, suggesting that osteolytic transformation of macrophages requires both loss-of-function of c-Fos and gain-of-function of SH3BP2 in this model. These data provide the first genetic evidence that cells other than osteoclasts can cause focal bone destruction in inflammatory bone disease and suggest that MMP14 is a key mediator conferring pathological bone-resorbing capacity on c-Fos-deficient Sh3bp2KI/KI macrophages. In summary, the paradigm that osteoclasts are the exclusive cells executing inflammatory bone destruction may need to be reevaluated based on our findings with c-Fos-deficient cherubism mice lacking osteoclasts. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Mizuho Kittaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kotoe Mayahara
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,Department of Orthodontics, Nihon University, School of Dentistry, Tokyo, Japan
| | - Tomoyuki Mukai
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tetsuya Yoshimoto
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Teruhito Yoshitaka
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jeffrey P Gorski
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City (UMKC) Center of Excellence in the Study of Dental and Musculoskeletal Tissues (CEMT), Kansas City, MO, USA
| | - Yasuyoshi Ueki
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Kansas City, MO, USA.,University of Missouri-Kansas City (UMKC) Center of Excellence in the Study of Dental and Musculoskeletal Tissues (CEMT), Kansas City, MO, USA
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Pappagallo M, Breuer B, Lin HM, Moberly JB, Tai J, Noto C, Sanchez A, Manfredi PL. A pilot trial of intravenous pamidronate for chronic low back pain. Pain 2013; 155:108-117. [PMID: 24060707 DOI: 10.1016/j.pain.2013.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 08/27/2013] [Accepted: 09/11/2013] [Indexed: 01/08/2023]
Abstract
Intravenous (i.v.) bisphosphonates relieve pain in conditions such as Paget's disease of bone, metastatic bone disease, and multiple myeloma. Based on positive findings from a prior case series, we conducted a randomized placebo-controlled study to assess the analgesic effect of i.v. pamidronate in subjects with chronic low back pain (CLBP) and evidence of degenerative disease of the spine. Four groups of 11 subjects (7 active, 4 placebo) were enrolled at escalating dose levels of 30, 60, 90, and 180 mg pamidronate (the latter administered as two 90 mg infusions). Primary outcomes were safety and change from baseline in average daily pain scores, recorded at 1, 2, 3, and 6 months postinfusion using electronic diaries. Secondary outcomes included responder rate, daily worst pain, and pain-related interference with daily function. There were no pamidronate-related serious adverse events or other significant safety findings. A statistically significant overall treatment difference in pain scores was observed, with clinically meaningful effects persisting for 6 months in the 180 mg pamidronate group. Least squares mean changes in daily average pain score were -1.39 (SE=0.43) for placebo, and -1.53 (0.71), -1.26 (0.81), -1.42 (0.65), and -4.13 (0.65) for pamidronate 30, 60, 90, and 180 mg, respectively (P=0.012 for pamidronate 180 mg vs placebo). The proportion of responders, changes in worst pain, and pain interference with daily function were also significantly improved for pamidronate 180 mg compared with placebo. In conclusion, i.v. pamidronate, administered as two 90 mg infusions, decreased pain intensity for 6 months in subjects with CLBP.
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Affiliation(s)
- Marco Pappagallo
- Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA Department of Health Evidence and Policy, Mount Sinai Medical Center, New York, NY, USA Department of Anesthesiology, Mount Sinai Medical Center, New York, NY, USA Grünenthal USA, Bedminster, NJ, USA The Feinstein Institute for Medical Research at North Shore-LIJ Health System, Long Island, NY, USA Patrician Medical, West Chester, PA, USA
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Le Goff B, Heymann D. Pharmacodynamics of bisphosphonates in arthritis. Expert Rev Clin Pharmacol 2012; 4:633-41. [PMID: 22220307 DOI: 10.1586/ecp.11.40] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inflammatory arthritis is a group of autoimmune diseases characterized by chronic inflammation of the joints. Rheumatoid arthritis, the most common form of arthritis, is associated with local joint destruction and systemic bone loss. Osteoclasts, the only cells of the body able to resorbe bone, are key players in these two types of bone loss. Bisphosphonates are analogs of pyrophosphate that inhibit osteoclast action and bone resorption. They are indicated in pathology associated with excess resorption. Besides their effect on bone they also exhibit extra-osseous properties, acting on tumor cells, inflammation and angiogenesis. As a result, they have been trialed in the context of arthritis. It is now clear that they do not have any significant direct effect on disease activity or pain. If their indication in the prevention of glucocorticoid-induced osteoporosis is clear, any beneficial effects on bone erosions are still controversial but interesting preliminary results warrant further investigations.
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Affiliation(s)
- Benoit Le Goff
- INSERM UMR-S957, Physiopathologie de la Résorption Osseuse et Thérapie des Tumeurs Osseuses Primitives, Faculté de Médecine, 1 rue Gaston Veil, 44035 Nantes cedex 1, France.
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5
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Abstract
Several inflammatory diseases such as rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, celiac disease, cystic fibrosis and chronic obstructive pulmonary disease have been associated to bone resorption. The link between osteoclast, macrophage colony stimulating factor and pro-inflammatory cytokines, especially tumor necrosis factor-alpha and interleukin-1 explain the association between inflammation and osteoporosis. These diseases are related to osteoporosis and high fracture risk independent of other risk factors common to inflammatory diseases such as reduced physical activity, poor nutritional status, hypovitaminosis D, decrease in calcium intake and glucocorticoid treatment. Erythrocyte sedimentation rate and C-reactive protein should always be performed, but the indication about when to perform the densitometry test should be analyzed for each disease. Bisphosphonates are nowadays the best choice of therapy but new medications such as denosumab, IL-1 receptor antagonist, and TNF-alpha antibody have risen as new potential treatments for osteoporosis secondary to inflammation.
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Le Goff B, Soltner E, Charrier C, Maugars Y, Rédini F, Heymann D, Berthelot JM. A combination of methotrexate and zoledronic acid prevents bone erosions and systemic bone mass loss in collagen induced arthritis. Arthritis Res Ther 2009; 11:R185. [PMID: 20003278 PMCID: PMC3003529 DOI: 10.1186/ar2877] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 12/03/2009] [Accepted: 12/10/2009] [Indexed: 11/10/2022] Open
Abstract
Introduction Osteoclasts play a key role in the pathogenesis of bone erosion and systemic bone mass loss during rheumatoid arthritis (RA). In this study, we aimed to determine the effect of methotrexate (MTX) and zoledronic acid (ZA), used alone or in combination, on osteoclast-mediated bone erosions and systemic bone mass loss in a rat model of collagen induced arthritis (CIA). We hypothesized that MTX and ZA could have an additive effect to prevent both bone erosion and systemic bone loss. Methods Arthritis was induced in 64 female Sprague-Dawley rats. After the clinical onset of CIA, rats were assigned to treatment with MTX (1 mg/kg/week), ZA (100 μg/kg twice weekly), both treatments at the same regimens, or vehicle. Arthritis score and paw thickness were recorded twice weekly. The rats were sacrificed on D28 and hind paws were removed for radiographic, histological and immunohistochemical analysis. The effects of treatments on osteoclastogenesis were determined by Tartrate resistant acid phosphatase (TRAP) staining. Micro-CT of the tibia was carried out for histomorphometric analysis. Bone mass density was evaluated by densitometry. Results MTX significantly decreased the severity of CIA, whereas ZA slightly exacerbated it. When these two drugs were used in combination, MTX prevented the pro-inflammatory effect of ZA. The combination of ZA with MTX was more effective than MTX alone for reducing structural joint damage with a dramatic decrease of osteoclasts' number in the eroded joints. However, MTX alone also significantly reduced the number of osteoclasts and the number of CD68+ mononuclear cells. ZA alone, or ZA with MTX, significantly increased the systemic bone mass density measured by densitometry and bone volume on histomorphometric analysis. Conclusions A combination of MTX and ZA prevented both bone erosion and systemic bone loss in a rat model of arthritis. Both treatments independently decreased the number of osteoclasts in the eroded joint. However, while MTX probably acts mainly through a decrease of inflammation, ZA has a direct effect on osteoclasts, allowing a dramatic down-regulation of these cells in inflamed joints. These two different mechanisms of action provide support for the use of a combination of these two drugs to improve the prevention of structural joint damage in RA.
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Affiliation(s)
- Benoit Le Goff
- INSERM UMR-S 957, 1 rue Gaston Veil, 44035, Nantes Cedex 1, France.
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Tsutsumi R, Hock C, Bechtold CD, Proulx ST, Bukata SV, Ito H, Awad H, Nakamura T, O'Keefe RJ, Schwarz EM. Differential effects of biologic versus bisphosphonate inhibition of wear debris-induced osteolysis assessed by longitudinal micro-CT. J Orthop Res 2008; 26:1340-6. [PMID: 18404739 PMCID: PMC2742224 DOI: 10.1002/jor.20620] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aseptic loosening of total joint replacements is caused by wear debris-induced osteoclastic bone resorption, for which bisphosphonates (BPs) and RANK antagonists have been developed. Although BPs are effective in preventing metabolic bone loss, they are less effective for inflammatory bone loss. Because this difference has been attributed to the antiapoptotic inflammatory signals that protect osteoclasts from BP-induced apoptosis, but not RANK antagonists, we tested the hypothesis that osteoprotegerin (OPG) is more effective in preventing wear debris-induced osteolysis than zoledronic acid (ZA) or alendronate (Aln) in the murine calvaria model using in vivo micro-CT and traditional histology. Although micro-CT proved to be incompatible with titanium (Ti) particles, we were able to demonstrate a 3.2-fold increase in osteolytic volume over 10 days induced by polyethylene (PE) particles versus sham controls (0.49 +/- 0.23 mm(3) versus 0.15 +/- 0.067 mm(3); p < 0.01). Although OPG and high-dose ZA completely inhibited this PE-induced osteolysis (p < 0.001), pharmacological doses of ZA and Aln were less effective but still reached statistical significance (p < 0.05). Traditional histomorphometry of the sagital suture area of calvaria from both Ti and PE-treated mice confirmed the remarkable suppression of resorption by OPG (p < 0.001) versus the lack of effect by physiological BPs. The differences in drug effects on osteolysis were largely explained by the significant difference in osteoclast numbers observed between OPG versus BPs in both Ti- and PE-treated calvaria; and linear regression analyses that demonstrated a highly significant correlation between osteolysis volume and sagittal suture area versus osteoclast numbers (p < 0.001).
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Affiliation(s)
- Ryosuke Tsutsumi
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York,Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Colleen Hock
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - C. Dustin Bechtold
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Steven T. Proulx
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Susan V. Bukata
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Hani Awad
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Takashi Nakamura
- Department of Orthopaedic Surgery, Kyoto University Medical School, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto 606−8507, Japan
| | - Regis J. O'Keefe
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York
| | - Edward M. Schwarz
- The Center for Musculoskeletal Research, University of Rochester, Rochester, New York,To whom correspondence should be addressed: Dr. Edward M. Schwarz The Center for Musculoskeletal Research University of Rochester Medical Center 601 Elmwood Avenue, Box 665, Rochester, NY 14642 Phone 585−275−3063, FAX 585−756−4727 E-mail:
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Herman S, Krönke G, Schett G. Molecular mechanisms of inflammatory bone damage: emerging targets for therapy. Trends Mol Med 2008; 14:245-53. [PMID: 18468489 DOI: 10.1016/j.molmed.2008.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 03/31/2008] [Accepted: 04/04/2008] [Indexed: 01/01/2023]
Abstract
Chronic inflammatory bone diseases, such as rheumatoid arthritis (RA), ankylosing spondylitis and periodontal disease, demonstrate the major impact of chronic inflammation on both bone metabolism and bone architecture. During the past decade, scientists have gained increasing insight into the link between inflammation and bone. As a result of new discoveries about the molecular mechanisms of inflammatory bone loss, several molecules have been identified that are attractive and novel targets for the treatment of inflammatory bone loss. These novel therapeutic approaches include anti-tumor necrosis factor (TNF)-alpha blocking agents, neutralizing antibodies against certain pro-inflammatory cytokines, such as interleukin (IL)-6 and IL-17, and a set of other promising targets that still require extensive research, such as the Wnt signaling network.
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Affiliation(s)
- Sonja Herman
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany
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Abstract
The receptor activator of nuclear factor-κB ligand (RANKL), its cognate receptor RANK, and its natural decoy receptor osteoprotegerin have been identified as the final effector molecules of osteoclastic bone resorption. This has provided an ideal target for therapeutic interventions in metabolic bone disease. As described in previous reviews in this supplement, RANKL signaling is required for osteoclast differentiation, activation, and survival. Furthermore, in vivo inhibition of RANKL leads to immediate osteoclast apoptosis, and there are no in vivo models of bone resorption that are refractory to RANKL inhibition. Thus, the only step remaining in the development of a clinical intervention is the generation of a safe, effective, and specific drug that can inhibit RANKL in humans. Here we review the clinical development of denosumab (formerly known as AMG 162), which is a fully human mAb directed against RANKL. This discussion includes the breadth of 21 human studies that have led to the current phase 3 clinical trials seeking approval for use of this agent to treat postmenopausal women with low bone mineral density (osteoporosis) and patients with metastatic lytic bone lesions (multiple myeloma, and prostate and breast cancer).
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Affiliation(s)
- Edward M Schwarz
- The Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Breuil V, Euller-Ziegler L. Bisphosphonate therapy in rheumatoid arthritis. Joint Bone Spine 2006; 73:349-54. [PMID: 16616575 DOI: 10.1016/j.jbspin.2005.10.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Accepted: 10/04/2005] [Indexed: 10/24/2022]
Abstract
Focal bone damage and generalized bone loss are features of rheumatoid arthritis (RA). The introduction of TNFalpha antagonists has radically improved the management of RA by providing a means of slowing or preventing the occurrence of focal bone damage. However, some patients with severe RA have contraindications to TNFalpha antagonist therapy and others either fail to respond or fail to tolerate TNFalpha antagonists. In addition, whether TNFalpha antagonists effectively combat generalized bone loss remains unknown. Bisphosphonates can prevent generalized bone loss. Their main target is the osteoclast, which has been identified as the culprit in focal bone damage caused by inflammatory diseases. As a result, the potential effects of bisphosphonates on focal bone damage related to RA are generating strong interest. Although results from the few studies in humans have been disappointing, new insights into the mechanisms of action of amino-bisphosphonates and recent data obtained in animals, most notably with new-generation bisphosphonates, have rekindled the hope that bisphosphonates may be beneficial in RA. We review herein the main studies of the effects of bisphosphonate therapy on focal bone damage and generalized bone loss in patients with RA.
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Affiliation(s)
- Véronique Breuil
- Rheumatology Department, Hôpital L'Archet 1, 151, route Saint-Antoine-de-Ginestière, 06202 Nice cedex 3, France.
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Abstract
PURPOSE OF REVIEW Inflammation-induced osteolysis is a problem in both inflammatory arthritis and total joint arthroplasty. New drug therapies have been shown to slow, halt, or even reverse the osteolysis associated with inflammatory arthritis. Unfortunately, similar advances in the medical treatment of periprosthetic osteolysis have not occurred. This review will update the state of periprosthetic osteolysis. RECENT FINDINGS Preliminary results with phase I and II clinical trials with AMG-162, a human IgG2 that binds receptor activator of nuclear factor kappaB (RANK) ligand, have been reported. Based on these results AMG-162 appears to be safe and to have a potent effect on osteoclast function. Based on animal studies, it is expected that regents such as AMG-162 that block RANK-ligand/RANK interaction will have activity in inflammation-induced osteolysis. Volumetric three-dimensional and magnetic resonance imaging scans for detecting and quantifying periprosthetic osteolysis have been validated in cadaver studies. Lymphocytic infiltrates and positive skin tests to cobalt have been found in patients with periprosthetic osteolysis after second generation metal-on-metal prostheses. These findings again raise the question of whether metal allergy may contribute to implant failure in these patients. A new subset of T helper cells that are neither Th1 nor Th2, but secrete a unique pattern of cytokines including IL-17, has recently been discovered. The importance of these cells in modifying particle-induced osteolysis remains to be determined. SUMMARY There have been significant advances in our understanding of periprosthetic osteolysis, imaging technology to quantify osteolysis, and drug development. The time now seems ripe to translate these advances in clinical trials.
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Affiliation(s)
- R John Looney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, NY 1442, USA.
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Romas E. Bone loss in inflammatory arthritis: mechanisms and therapeutic approaches with bisphosphonates. Best Pract Res Clin Rheumatol 2006; 19:1065-79. [PMID: 16301197 DOI: 10.1016/j.berh.2005.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The inflammatory process in rheumatoid arthritis provokes intense bone resorption, evidenced as bone erosions, juxta-articular osteopenia and generalized osteoporosis. These types of bone loss share a common pathogenesis, and the role of osteoclasts in focal bone erosion was verified in elegant animal studies. The tumour necrosis factor (TNF) family of cytokines and receptors--specifically TNF-alpha, RANKL, RANK and OPG--are dominant regulators of osteoclastic bone resorption in rheumatoid arthritis. The confirmation of the osteoclast mechanism provides new insight into the structural joint protection afforded by disease-modifying drugs and suggests innovative approaches to limit bone destruction. Emerging treatment strategies for bone disease in rheumatoid arthritis are the use of monoclonal antibodies to neutralize RANKL, and powerful bisphosphonates that target pathogenic osteoclasts.
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Affiliation(s)
- Evan Romas
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia.
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Zhao H, Liu S, Huang D, Xu Q, Shuto T, Iwamoto Y. The protective effects of incadronate on inflammation and joint destruction in established rat adjuvant arthritis. Rheumatol Int 2005; 26:732-40. [PMID: 16237529 DOI: 10.1007/s00296-005-0061-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2005] [Accepted: 08/21/2005] [Indexed: 11/26/2022]
Abstract
The effects of a new generation bisphosphonate, incadronate, in established adjuvant arthritis rats were evaluated according to the arthritis index, hind paw volume, and radiological and histopathological examinations. Incadronate suppressed the radiological and histopathological changes of hind paws, as well as the joint swelling in a dose-dependent manner. In contrast, the arthritis control rats showed drastic joint inflammation, marked destruction of bone and articular cartilage. The remains of articular cartilage lost Safranin O staining, and were attached with numerous TRAP-positive multinuclear cells. Some of resorption lacunas could be seen at the cartilage matrix nearby the TRAP-positive multinuclear cells. As regards the chondroprotective effects of bisphosphonates, we speculate that it is probably concerned with the inhibition of the chondroclasts. These data indicate that bisphosphonates may be a class of effective agent that can be considered for treatment of various arthritic conditions, including human rheumatoid arthritis.
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Affiliation(s)
- Hongpu Zhao
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510120, China.
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Roldán EJ, Pérez-Llore A, Ferretti JL. Olpadronate: a new amino-bisphosphonate for the treatment of medical osteopathies. Expert Opin Investig Drugs 2005; 7:1521-38. [PMID: 15992050 DOI: 10.1517/13543784.7.9.1521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Olpadronate is a nitrogenated bisphosphonate. Although it shares the therapeutic and pharmacological properties of pamidronate and alendronate, it has a greater dosage amplitude, more predictable effects and a greater digestive tolerability than other bisphosphates. Therefore, it may be more appropriate in the treatment of medical osteopathies, by both oral and parenteral routes of administration. According to various experimental and human models, the pharmacological potency of olpadronate is 5- to 10-times higher than that of pamidronate and close to that of alendronate. The two methyl groups bound to the nitrogen atom give the compound a high water solubility, which is about 8-times higher than that of the two other bisphosphonates. The lack of a terminal amino group in the side-chain of the molecule and the absence of crystallised forms of the compound in the digestive tract (due to its high water solubility) may avoid the potential for inducing oesophageal and gastrointestinal side-effects. These features may explain the high tolerability reported after the administration of doses of olpadronate (by the oral route) up to 5- to 10-times higher than the maximum tolerated dose of alendronate in Paget's bone disease and bone metastases, thus widening the possibilities for its clinical usage. In addition, initial pharmacokinetic studies suggest that olpadronate's oral bioavailability would fit into a confidence range of 2-4%, which contrasts with the erratic absorption shown by other highly potent bisphosphonates. The clinical efficacy demonstrated in preliminary studies in Paget's bone disease (including ultra-short treatments), and also in single-dose iv. therapy of hypercalcaemia of malignancies, renders olpadronate among the most promising bisphosphonate compounds, with potential use in the treatment of a variety of bone-involving diseases, such as osteoporosis, malignancies and rheumatoid arthritis.
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Affiliation(s)
- E J Roldán
- Department of Clinical Pharmacology, Gador SA, Buenos Aires, Argentina
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Akiyama T, Mori S, Mashiba T, Miyamoto K, Komatsubara S, Cao Y, Manabe T, Norimatsu H, Dobashi H, Tokuda M. Incadronate disodium inhibits joint destruction and periarticular bone loss only in the early phase of rat adjuvant-induced arthritis. J Bone Miner Metab 2005; 23:295-301. [PMID: 15981025 DOI: 10.1007/s00774-004-0602-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Accepted: 12/22/2004] [Indexed: 10/25/2022]
Abstract
Destruction of articular cartilage and subchondral bone loss in the affected joints of rat adjuvant arthritis have never been quantified histologically. This study aimed to evaluate the effect of incadronate disodium on joint destruction and periarticular bone loss, using histomorphometric measurements. Seven-week-old female Lewis rats were injected with 0.1 mg of heat-killed Mycobacterium butyricum into the tail base. Immediately after sensitization, vehicle, or incadronate at 10 or 100 microg/kg per day, was administered subcutaneously, three times per week. Hind-paw volume was measured weekly and the animals were killed at 2, 4, 6, and 10 weeks after sensitization. After taking X-rays, decalcified sagittal sections of the ankle joint were prepared and stained with toluidine blue and tartarate-resistant acid phosphatase. Articular cartilage destruction and subchondral bone loss were evaluated histomorphometrically. At 2 weeks after sensitization, no radiographic or histologic changes were observed. However, at 4 weeks, severe articular cartilage destruction and subchondral bone loss were found in the arthritic control group, while these changes were inhibited dose-dependently by incadronate treatment. At 6 and 10 weeks, both the destructive changes and the bone loss had further progressed, and they were not inhibited by incadronate treatment. Incadronate dose-dependently inhibited articular cartilage destruction and subchondral bone loss at 4 weeks after sensitization in this adjuvant arthritis model. However, the suppressive effects of incadronate did not continue until 6 and 10 weeks.
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Affiliation(s)
- Tomoyuki Akiyama
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kagawa 761-0793, Japan
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Sims NA, Green JR, Glatt M, Schlict S, Martin TJ, Gillespie MT, Romas E. Targeting osteoclasts with zoledronic acid prevents bone destruction in collagen-induced arthritis. ACTA ACUST UNITED AC 2004; 50:2338-46. [PMID: 15248235 DOI: 10.1002/art.20382] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the effect of zoledronic acid (ZA) on synovial inflammation, structural joint damage, and bone metabolism in rats during the effector phase of collagen-induced arthritis (CIA). METHODS CIA was induced in female dark agouti rats. At the clinical onset of CIA, rats were assigned to treatment with vehicle or single subcutaneous doses of ZA (1.0, 10, 50, or 100 microg/kg). Clinical signs in all 4 paws were scored on a daily basis. After 2 weeks, the joints in the hind paws were assessed using plain radiographs, microfocal computed tomography (micro-CT), histologic scoring, and histomorphometry, and the serum levels of type I collagen crosslinks were measured by enzyme-linked immunosorbent assay. RESULTS Although ZA mildly exacerbated synovitis, it effectively suppressed structural joint damage. At doses of >/=10 microg/kg, ZA significantly reduced radiographic bone erosions, Larsen scores, and juxtaarticular trabecular bone loss as quantified by micro-CT. ZA prevented increased type I collagen (bone) breakdown in CIA and diminished histologic scores of focal bone erosion by up to 80%. Increases in the percentage of eroded surface, osteoclast surface, and osteoclast numbers associated with CIA were prevented by ZA, even though synovitis scores were unchanged. CONCLUSION Single doses (>/=10 microg/kg) of ZA strikingly reduced focal bone erosions and juxtaarticular trabecular bone loss, although synovitis was mildly exacerbated. Targeting osteoclasts with ZA may therefore be an effective strategy for preventing structural joint damage in rheumatoid arthritis.
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Affiliation(s)
- Natalie A Sims
- St. Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Goldring SR, Gravallese EM. Bisphosphonates: Environmental protection for the joint? ACTA ACUST UNITED AC 2004; 50:2044-7. [PMID: 15248201 DOI: 10.1002/art.20383] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pappagallo M, Breuer B, Schneider A, Sperber K. Treatment of chronic mechanical spinal pain with intravenous pamidronate: a review of medical records. J Pain Symptom Manage 2003; 26:678-83. [PMID: 12850650 DOI: 10.1016/s0885-3924(03)00201-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We explored the effect of intravenous infusions of a bisphosphonate, pamidronate, in the management of chronic mechanical spinal pain, a worldwide public health problem in terms of lost workdays, medical treatment costs, and suffering. Bisphosphonates have an anti-nociceptive effect in animals. In humans, intravenous pamidronate relieves numerous painful conditions, including metastatic bone pain, ankylosing spondylitis, rheumatoid arthritis, and complex regional pain syndrome. We reviewed the charts of 25 patients who had experienced disabling spinal pain for several years, and whom we treated with intravenous pamidronate. None had a history of osteoporotic vertebral fractures or metastatic disease. Pain rating scores decreased in 91% of patients: on a 0-10 numeric rating scale, the mean pain change was -3.6 points and mean percentage change was -41% (P<0.0001). There was no increase in opioid or nonopioid analgesic medications associated with pain relief. The apparent analgesic effect of pamidronate for chronic mechanical spinal pain needs to be confirmed with placebo-controlled trials.
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Affiliation(s)
- Marco Pappagallo
- Comprehensive Pain Treatment Center, Hospital for Joint Diseases, Orthopaedic Institute, and Department of Neurology, New York University School of Medicine, New York, New York 10003, USA
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20
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Yamane I, Hagino H, Okano T, Enokida M, Yamasaki D, Teshima R. Effect of minodronic acid (ONO-5920) on bone mineral density and arthritis in adult rats with collagen-induced arthritis. ARTHRITIS AND RHEUMATISM 2003; 48:1732-41. [PMID: 12794842 DOI: 10.1002/art.10987] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study the effect of minodronic acid (ONO-5920) on bone loss and arthritis in rats with collagen-induced arthritis (CIA) treated according to 2 different schedules. METHODS Four groups of female Sprague-Dawley rats (7 months old) were studied: rats without CIA treated with vehicle (controls), CIA rats treated with vehicle (CIA-V), CIA rats treated therapeutically with minodronic acid (CIA-T), and CIA rats treated prophylactically with minodronic acid (CIA-P). Minodronic acid was administered orally at 0.2 mg/kg 3 times a week, beginning 2 weeks after initial sensitization in the CIA-T rats and beginning the day after initial sensitization in the CIA-P rats. Bone mineral density (BMD) was measured by peripheral quantitative computed tomography in the proximal metaphysis and diaphysis of the tibia every 2 weeks until week 8, when the rats were killed. The BMD and bone microstructure of the excised femur were evaluated by dual x-ray absorptiometry and microfocal computed tomography, respectively. Histomorphometry of the proximal tibia was also performed. RESULTS In CIA-P rats, the incidence of arthritis and the severity of posterior limb swelling were reduced early after sensitization, and the decrease in BMD was prevented throughout the observation period. Bone and joint destruction evaluated by radiography of the foot was reduced in CIA-P rats. The eroded surface was reduced and the microstructure was maintained in CIA-P rats compared with CIA-V rats. The mineral apposition and bone formation rates were not reduced in the CIA-P rats. In CIA-T rats, however, the inflammation was not suppressed and the inhibitory effect on bone loss was smaller than that in CIA-P rats. CONCLUSION Minodronic acid suppressed the decrease in BMD and the deterioration of the bone microstructure caused by arthritis. Prophylactic administration of minodronic acid had a preventive effect on arthritis at the early stage, although not throughout the observation period.
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Affiliation(s)
- Itsuro Yamane
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, Yonago, Japan
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Abstract
Spondyloarthropathies (SpA) are a group of inflammatory arthritides classified according to common features of peripheral and spinal arthritis. The conventional anti-inflammatory and disease-modifying or slow-acting anti-rheumatic drugs do appear to be efficacious in treatment of the peripheral arthritis in a comparable fashion to seropositive rheumatoid arthritis, however, their efficacy in axial disease is unproven. This review examines new pharmacological developments in the treatment of SpA including the specific features of sacroiliitis, enthesitis and spondylitis in addition to the peripheral manifestations. The main points that are discussed are new cyclo-oxygenase (COX)-2 specific anti-inflammatories, biological therapies, such as anti-TNF compounds, and novel uses of well-known agents.
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Affiliation(s)
- Ruth Z Lee
- Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin, Ireland
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22
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Redlich K, Hayer S, Maier A, Dunstan CR, Tohidast-Akrad M, Lang S, Türk B, Pietschmann P, Woloszczuk W, Haralambous S, Kollias G, Steiner G, Smolen JS, Schett G. Tumor necrosis factor alpha-mediated joint destruction is inhibited by targeting osteoclasts with osteoprotegerin. ARTHRITIS AND RHEUMATISM 2002; 46:785-92. [PMID: 11920416 DOI: 10.1002/art.10097] [Citation(s) in RCA: 235] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study the effects of osteoclast-targeted therapies, such as osteoprotegerin (OPG) and pamidronate, on joint inflammation and bone destruction using a tumor necrosis factor alpha (TNF alpha)-transgenic mouse model. METHODS Mice were placed into 5 groups that received either OPG, pamidronate, a combination of both agents, infliximab as a positive control, or phosphate buffered saline as a negative control. Treatment was initiated at the onset of arthritis, continued over 6 weeks, and thereafter, the clinical, radiologic, and histologic outcomes were assessed. RESULTS A significant improvement in clinical symptoms, as assessed by the reduction of paw swelling, was only found in the infliximab group, whereas all other treatment groups failed to show significant improvement. However, when assessing structural damage with radiographic analysis, a significant retardation of joint damage was evident in animals treated with OPG (55% reduction of erosions), pamidronate (50% reduction of erosions) the combination therapy of OPG and pamidronate (64% reduction of erosions), and with infliximab (66% reduction of erosions). Confirming these data, quantitative histologic analysis revealed a significant reduction in the size of bone erosions in all treatment groups (OPG 56%, pamidronate 53%, OPG and pamidronate 81%, and infliximab 46%) compared with the control group. Furthermore, a significant reduction of osteoclast numbers was seen in animals treated with OPG alone or in combination with pamidronate as well as in animals treated with infliximab. CONCLUSION These data suggest that OPG alone or in combination with bisphosphonates is an effective therapeutic tool for the prevention of TNF alpha-mediated destruction of bone by reducing the number of bone-resorbing cells in the inflammatory tissue.
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Moran EL, Fornasier TL, Bogoch TR. Pamidronate prevents bone loss associated with carrageenan arthritis by reducing resorptive activity but not recruitment of osteoclasts. J Orthop Res 2000; 18:873-81. [PMID: 11192246 DOI: 10.1002/jor.1100180605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Carrageenan arthritis is associated with high-turnover bone loss. We sought to determine whether the bisphosphonate pamidronate can modify this effect of inflammatory arthritis. Sixty mature, New Zealand White rabbits were randomly assigned to five groups: normal; normal with a therapeutic dose of pamidronate (300 microg/kg/day, administered subcutaneously); arthritis (induced in the right tibiofemoral joint with 10 intraarticular carrageenan injections); arthritis with a therapeutic dose of pamidronate (300 microg/kg/day, subcutaneous); and arthritis with a low dose of pamidronate (7.5 microg/kg/day, subcutaneous). All animals received the fluorochrome calcein green (0.5 g/l/day) in drinking water ad libitum from days 21 to 49. Undecalcified, transverse sections of the distal femur were photographed or imaged to determine bone volume; new bone volume; resting, eroded, osteoid, and osteoblast perimeters; and osteoclast number. Results were evaluated with analysis of variance and pairwise Bonferroni's tests. In trabecular bone adjacent to the joint affected by carrageenan arthritis, resting perimeter was substantially reduced compared with normal joints, and primary indices of osteoblast and osteoclast activity were abnormally high (p < 0.001). Daily treatment with a therapeutic dose of pamidronate (300 microg/kg/day, subcutaneous) during the induction of arthritis significantly decreased new bone volume, osteoid perimeter, and osteoblast perimeter compared with the untreated arthritis group (p < 0.001). Osteoclast number and eroded perimeter remained abnormally high despite treatment with pamidronate. The concomitant increase of bone volume and these osteoclast indices show that pamidronate prevents bone loss in this model of experimental inflammatory arthritis by inhibiting the resorptive activity, but not the formation or recruitment, of osteoclasts. These findings are relevant to the use of bisphosphonates in the treatment of rheumatoid arthritis.
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Affiliation(s)
- E L Moran
- Orthopaedic Research Laboratory, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Schwarz EM, Looney RJ, O'Keefe RJ. Anti-TNF-alpha therapy as a clinical intervention for periprosthetic osteolysis. ARTHRITIS RESEARCH 2000; 2:165-8. [PMID: 11094423 PMCID: PMC129996 DOI: 10.1186/ar81] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/1999] [Revised: 01/25/2000] [Accepted: 02/18/2000] [Indexed: 12/12/2022]
Abstract
Aseptic loosening of total joint arthroplastics due to periprosthetic osteolysis is a frequent cause of implant failure. The absence of clinical interventions to arrest or prevent this complication limits the use of total joint replacement especially in younger patients. Here we review recent studies implicating tumor necrosis factor (TNF)-alpha in periprosthetic osteolysis and the rationale for clinical studies of anti-TNF therapy and other interventions for periprosthetic loosening.
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Affiliation(s)
- E M Schwarz
- Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Nakamura M, Ando T, Abe M, Kumagai K, Endo Y. Contrast between effects of aminobisphosphonates and non-aminobisphosphonates on collagen-induced arthritis in mice. Br J Pharmacol 1996; 119:205-12. [PMID: 8886399 PMCID: PMC1915878 DOI: 10.1111/j.1476-5381.1996.tb15972.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
1. Bisphosphonates (BPs) are inhibitors of bone resorption, and many derivatives have been developed for the treatment of enhanced bone resorption. Aminobisphosphonates (aminoBPs) are particularly potent in this respect. We have shown previously that aminoBPs, such as 4-amino-1-hydroxybutylidene-1,1-bisphosphonic acid (AHBuBP), induce histidine decarboxylase, the enzyme forming histamine, and increase macrophages, granulocytes and osteoclast numbers. Non-aminoBPs do not show this activity. 2. In the present study, an additional aminoBP, cycloheptyl-aminomethylene bisphosphonate (CHAMBP), was shown to have similar properties to AHBuBP suggesting that these actions are common among aminoBPs. 3. In experiments carried out to determine if aminoBPs affect immune responses, we found that CHAMBP and AHBuBP each exacerbated the arthritis induced in mice by the co-injection of type II collagen and an adjuvant, a model for rheumatoid arthritis. In contrast, dichloromethylene bisphosphonate (C12MBP), a typical non-aminoBP, did suppress the arthritis. 4. On the basis of these results, and those obtained previously, we propose that the exacerbating effects of CHAMBP and AHBuBP may be related to their ability to stimulate the synthesis of histamine and to increase macrophages and granulocytes. Conversely, we propose that the suppressive effect of C12MBP on arthritis is related to its cytotoxic action on macrophages or granulocytes.
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Affiliation(s)
- M Nakamura
- Department of Anatomy, School of Medicine, Tohoku University, Sendai, Japan
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Eggelmeijer F, Papapoulos SE, van Paassen HC, Dijkmans BA, Valkema R, Westedt ML, Landman JO, Pauwels EK, Breedveld FC. Increased bone mass with pamidronate treatment in rheumatoid arthritis. Results of a three-year randomized, double-blind trial. ARTHRITIS AND RHEUMATISM 1996; 39:396-402. [PMID: 8607888 DOI: 10.1002/art.1780390307] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Osteoporosis is a frequent complication of rheumatoid arthritis (RA). We therefore investigated the effect of oral pamidronate therapy as a specific bone-sparing agent in RA. METHODS The study design was a 3-year randomized, double-blind trial of 300 mg oral pamidronate/day compared with placebo in 105 RA patients. Bone mineral density (BMD) measured at 12-month intervals was the primary efficacy parameter. RESULTS In 3 years, lumbar spine and forearm BMD increased significantly in the pamidronate-treated group (by 8.4 +/- 6.9% [mean =/- SEMI] [P < 0.00011 and 5.2 =/- 6.5% [P < 0.005], respectively), compared with nonsignificant changes in the placebo-treated patients (increase of 0.6 =/- 5.2% and decrease of 1.2 =/- 5.8%, respectively). Femoral neck BMD increased in the pamidronate-treated group (by 2.6 =/- 8.6%) and decreased significantly in the placebo-treated group (by 4.0=/- 1.3% [P < 0.005]). The changes in BMD with time at all 3 measurement sites were significantly different between the treatment groups (P < 0.0001). Changes in radiographic signs of joint damage and in disease activity were similar in the 2 groups. CONCLUSION The present study provides the first evidence that long-term treatment with an orally administered bisphosphonate overcomes bone loss and increases bone mass when compared with placebo. This finding may have significance with regard to the treatment of patients with RA.
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