Increased frequency of osteoporosis and BMD below the expected range for age among South Korean women with rheumatoid arthritis
Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea. International Journal of Rheumatic Diseases
(Impact Factor: 1.47).
06/2012; 15(3):289-96. DOI: 10.1111/j.1756-185X.2012.01729.x
To compare the frequency of osteoporosis and bone mineral density (BMD) below the expected range for age between female patients with rheumatoid arthritis (RA) and healthy subjects and to determine risk factors for bone loss in female patients with RA.
Two hundred and ninety-nine patients with RA and 246 age-matched healthy subjects were included in this study. BMD in the lumbar spine, femoral neck and total hip were measured with dual-energy X-ray absorptiometry. A T-score of -2.5 or lower in postmenopausal women was defined as osteoporosis, and a Z-score -2.0 or lower in females prior to menopause was defined as below the expected range for age.
The frequency of osteoporosis in the RA patients (22.1%) was significantly higher than in healthy subjects (11.4%) at either the spine or hip (P = 0.014). The occurrence of BMD below the expected range for age in RA patients (7.8%) was also significantly higher than in healthy subjects (1.0%, P = 0.015). In 299 female patients with RA, higher age, lower body mass index and postmenopausal status were significantly associated with the lumbar spine and hip BMD reduction. Of disease-related variables, glucocorticoid use was independently associated with reduction of hip BMD.
The prevalence of osteoporosis in the RA patients was 1.9 times higher than in healthy subjects. Glucocorticoid use was a risk factor for generalized bone loss in female RA patients.
Available from: Zihui TANG
- "Despite of the reported association between OP and RA, there have been a number of controversial opinions in the literature. Kim et al. investigated the effects of disease modifying anti-rheumatic drug (DM- ARD) use on fracture risk in RA patients and their study suggests that medication of RA does not consequently decrease fracture risk in OP . Moreover, the relationship between the use of corticosteroids in RA and OP remains debated and unclear  . "
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The main purpose of this study was to estimate the associations between rheumatoid arthritics (RA) and osteoporosis (OP) in general Chinese men.
We conducted a large-scale, community-based, cross-sectional study to investigate the associations by using self-report questionnaire to access medical history. A total of 1041 men were recruited sis in this study. Multiple regression models controlling for confounding factors to include RA were performed to investigate the relationships for OP.
Univariate analysis indicated there was no significant association between RA and T-score (P = 0.103), however, significant association between RA and OP was reported (P = 0.005). Multiple regression analysis indicated that RA was significantly associated with OP (P = 0.013, OR = 3.191 95% CI: 1.284-7.932). The men with RA had a significant higher prevalence of OP.
The findings indicated that RA was independently and significantly associated with OP. The prevalence of OP was less frequent in Chinese men without RA.
Available from: Emilio Russo
- "Glucocorticoids (e.g., dexamethasone and prednisone) are anti-inflammatory and immune suppressor agents that are able to reduce the inflammation and the progression of RA, through the inhibition of cytokines secretion and osteoclasts activation          . However, even if they represent a first-line treatment in patients with RA, their use is limited for the development of serious ADRs such as loss of bone mass, increased risk of fractures, infections, diabetes and hypertension   . The DMARDs group, includes both nonbiological and biological drugs; between the DMARDs, methotrexate (MTX) due to "
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ABSTRACT: Methotrexate (MTX) is a nonbiological disease-modifying antirheumatic drug that has shown both a good control of clinical disease and a good safety. Usually drug-drug interactions (DDIs) represent the most limiting factor during the clinical management of any disease, in particular when several drugs are coadministered to treat the same disease. In this paper, we report the interactions among MTX and the other drugs commonly used in the management of rheumatoid arthritis. Using Medline, PubMed, Embase, Cochrane libraries, and Reference lists, we searched for the articles published until June 30, 2012, and we reported the most common DDIs between MTX and antirheumatic drugs. In particular, clinically relevant DDIs have been described during the treatment with MTX and NSAIDs, for example, diclofenac, indomethacin, or COX-2 inhibitors, and between MTX and prednisone or immunosuppressant drugs (e.g., leflunomide and cyclosporine). Finally, an increase in the risk of infections has been recorded during the combination treatment with MTX plus antitumor necrosis factor-
agents. In conclusion, during the treatment with MTX, DDIs play an important role in both the development of ADRs and therapeutic failure.
Available from: Theodoros Dimitroulas
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ABSTRACT: Chronic inflammation affects bone metabolism leading to disequilibrium in the rates of bone resorption and repair and subsequently to local and generalized bone loss. Osteoporosis represents an important co-morbidity of Rheumatoid Arthritis (RA) patients, which exhibit increased fracture risk. Osteoclasts play a pivotal role in the development and progression of bone loss, while resident synovial cells such as T cells, monocytes and synovial fibroblasts have been identified as sources of osteoclast differentiation signals in RA. This process is mainly mediated through the receptor activator of nuclear-κappa B ligand (RANKL) signalling system, which is upregulated by numerous proinflammatory cytokines involved in the pathogenesis of RA. Improved knowledge of the association between cells and cytokines of the immune system and their relationship to bone remodelling has revealed several promising targets for the treatment of inflammatory bone loss in RA. In this respect, initiation of biologic therapies targeting inflammatory cytokines and/or lymphocyte activation have modified RA therapy not only by blocking local and systemic inflammatory cascades but also by providing beneficial effects against bone and joint degradation. In this article we briefly present the modern view of the mechanisms that govern inflammatory bone loss, highlighting the role of cytokine-induced molecular pathways, and discuss in detail the effects of different biologic treatment strategies on bone mass in RA patients.
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