1
|
Gao X, Wu Q, Zhang X, Tian J, Liang D, Min Y, Lu J, Zhang X, Cui L, Xu B, Liu Y. Salvianolate Ameliorates Osteopenia and Improves Bone Quality in Prednisone-Treated Rheumatoid Arthritis Rats by Regulating RANKL/RANK/OPG Signaling. Front Pharmacol 2021; 12:710169. [PMID: 34552485 PMCID: PMC8450458 DOI: 10.3389/fphar.2021.710169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/23/2021] [Indexed: 01/01/2023] Open
Abstract
Rheumatoid arthritis (RA) is closely associated with periarticular osteopenia and leads to a high risk of generalized osteoporosis. Although glucocorticoid (GC) treatment ameliorates joint degradation and manages inflammation in RA, GC application may induce further bone quality deterioration in RA patients. Current treatments for RA lack relevant strategies for the prevention and treatment of osteopenia in RA. In this study, we aimed to investigate whether salvianolate treatment ameliorated osteopenia in prednisone-treated RA rats. Lewis rats with collagen-induced arthritis (CIA) were administered prednisone (PDN) or PDN plus salvianolate (PDN+Sal) treatment for 90 days. The effects of Sal were investigated in PDN-treated CIA rats. To further evaluate the effects of Sal under inflammatory conditions, we investigated the effects of Sal treatment on the TNF-α-induced inflammatory response in MC3T3-E1 osteoblasts. Bone histomorphometry, bone mineral density (BMD), bone biomechanical properties, micro-computed tomography (micro-CT), immunohistochemistry, RT-PCR and western blot analyses were performed to evaluate the effects of Sal. The results demonstrated that RA induced bone loss and bone quality deterioration, with high bone turnover in CIA rats. PDN+Sal treatment significantly increased BMD and trabecular/cortical bone mass, suppressed inflammation, and improved bone biomechanical properties compared to CIA control and PDN treatment. PDN+Sal treatment significantly suppressed bone resorption and the RANKL and RANKL/OPG ratios compared to PDN. PDN+Sal and PDN treatment significantly inhibited TNF-α by 82 and 83%, respectively, and both suppressed inflammation in CIA rats. However, there was no significant difference between PDN+Sal and PDN treatment alone in regard to bone formation parameters or the management of inflammation and arthropathy. Sal significantly increased Osterix, OPN, and Col1a1 while decreasing RANKL, TRAF6, and TRAIL gene in TNF-α-induced MC3T3-E1 osteoblasts. Sal significantly increased Osterix, OPN and RUNX2 while decreasing NF-κB, TRAF6 and IL-1β protein in TNF-α-induced MC3T3-E1 osteoblasts. The results suggested that salvianolate treatment ameliorated osteopenia and improved bone quality in prednisone-treated RA rats, and the potential mechanism may be related to the regulation of the RANKL/RANK/OPG signaling pathway, TRAIL-TRAF6-NFκB signal axis, and downregulation of inflammatory cytokines. Salvianolate could be used as a promising supplemental therapeutic strategy to ameliorate osteopenia and improve bone quality in GC-treated RA patients.
Collapse
Affiliation(s)
- Xiang Gao
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China.,Stem Cell Research and Cellular Therapy Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qingyun Wu
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China.,Department of Pharmacy, Yangjiang People's Hospital, Yangjiang, China
| | - Xinle Zhang
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Jia Tian
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Dahong Liang
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Yalin Min
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Jiaqi Lu
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Xuemei Zhang
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Liao Cui
- Stem Cell Research and Cellular Therapy Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Bilian Xu
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China
| | - Yanzhi Liu
- Department of Pharmacology, Guangdong Key Laboratory for Research and Development of Natural Drug, Guangdong Medical University, Zhanjiang, China.,Clinic Research Institute of Zhanjiang, Affiliated Central People's Hospital of Zhanjiang of Guangdong Medical University, Zhanjiang, China
| |
Collapse
|
2
|
Drevinge C, Scheffler JM, Koro-Arvidsson C, Sundh D, Carlsten H, Gjertsson I, Lindholm C, Lorentzon M, Rudin A, Ekwall AKH, Islander U. Intermediate monocytes correlate with CXCR3+ Th17 cells but not with bone characteristics in untreated early rheumatoid arthritis. PLoS One 2021; 16:e0249205. [PMID: 33770137 PMCID: PMC7996983 DOI: 10.1371/journal.pone.0249205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is associated with development of generalized osteoporosis. Bone-degrading osteoclasts are derived from circulating precursor cells of monocytic lineage, and the intermediate monocyte population is important as osteoclast precursors in inflammatory conditions. T cells of various subsets are critical in the pathogenesis of both RA and associated osteoporosis, but so far, no studies have examined associations between circulating intermediate monocytes, T cell subsets and bone characteristics in patients with RA. The aim of this study was to investigate the frequency of intermediate monocytes in patients with untreated early rheumatoid arthritis (ueRA) compared to healthy controls (HC), and to explore the correlation between intermediate monocytes and a comprehensive panel of T helper cell subsets, bone density and bone microarchitecture in ueRA patients. Methods 78 patients with ueRA fulfilling the ACR/EULAR 2010 criteria were included and compared to 29 age- and sex-matched HC. Peripheral blood samples were obtained before start of treatment and proportions of monocyte subsets and CD4+ helper and regulatory T cell subsets were analyzed by flow cytometry. Bone densitometry was performed on 46 of the ueRA patients at inclusion using DXA and HR-pQCT. Results Flow cytometric analyses showed that the majority of ueRA patients had frequencies of intermediate monocytes comparable to HC. The intermediate monocyte population correlated positively with CXCR3+ Th17 cells in ueRA patients but not in HC. However, neither the proportions of intermediate monocytes nor CXCR3+ Th17 cells were associated with bone density or bone microarchitecture measurements. Conclusions Our findings suggest that in early RA, the intermediate monocytes do not correlate with bone characteristics, despite positive correlation with circulating CXCR3+ Th17 cells. Future longitudinal studies in patients with longer disease duration are required to fully explore the potential of intermediate monocytes to drive bone loss in RA.
Collapse
Affiliation(s)
- Christina Drevinge
- Centre for Bone and Arthritis Research, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Julia M Scheffler
- Centre for Bone and Arthritis Research, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catalin Koro-Arvidsson
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Sundh
- Centre for Bone and Arthritis Research, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Carlsten
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catharina Lindholm
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lorentzon
- Centre for Bone and Arthritis Research, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Anna Rudin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Karin Hultgård Ekwall
- Centre for Bone and Arthritis Research, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulrika Islander
- Centre for Bone and Arthritis Research, Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Krefting Research Center, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
3
|
Yan S, Cui Y, Zhang X, Zhang G, Dong G, Feng Y, Song Y. The incidence of extra-articular manifestations in southern Chinese patients with inflammatory joint diseases. Int J Rheum Dis 2019; 22:1686-1694. [PMID: 31328410 DOI: 10.1111/1756-185x.13657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/17/2019] [Accepted: 06/23/2019] [Indexed: 02/05/2023]
Abstract
AIM Inflammatory joint diseases (IJDs) are chronic arthritis, but frequently present with co-morbidities of other organs and systems, which is known as extra-articular manifestations (EAMs). It is still unclear which clinical characteristics or bio-markers can predict the development of EAMs. The aim of this study was to estimate the proportion of EAMs in southern Chinese patients with IJDs and to explore the risk factors. METHODS This was a retrospective cohort study of a total 1135 IJDs patients, including 788 rheumatoid arthritis (RA) patients, 307 ankylosing spondylitis (AS) patients and 40 psoriatic arthritis (PsA) patients. Demographic data, disease characteristics, laboratory blood tests, medical imaging, and the presence of EAMs were recorded. RESULTS We found 459 (40.44%) patients presented with EAMs: 30.84% had cardiovascular involvement, 7.67% had pulmonary involvement, 5.29% had osteoporosis/low bone mineral density, 2.29% had ocular, 0.79% had gastrointestinal and 0.26% had renal involvements. Multivariate logistic regression showed older age (odds ratio [OR] 1.06, P < .001) and higher anti-cyclic citrullinated peptide antibody (anti-CCP) levels (OR 1.003, P = .019) were independent risks of EAMs in RA patients. In the AS group, older age (OR 1.07, P < .001) and higher disease activity (OR 3.24-7.42, both P < .05), were independent risks of EAMs. In the PsA group, longer disease duration (OR 1.01, P = .036) and higher disease activity (OR 1.15, P = .004) were univariate associated factors. CONCLUSION These results suggested the high prevalence of EAMs, and it is important to regularly screen for EAMs, as they influence treatment decisions and impact on patients' quality of life.
Collapse
Affiliation(s)
- Siyu Yan
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yang Cui
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Xiao Zhang
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guangfeng Zhang
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Guangfu Dong
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yuan Feng
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Yingyu Song
- Department of Rheumatology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| |
Collapse
|
4
|
Bojincă VC, Popescu CC, Decianu RD, Dobrescu A, Bălănescu ȘM, Bălănescu AR, Bojincă M. A novel quantitative method for estimating bone mineral density using B-mode ultrasound and radiofrequency signals-a pilot study on patients with rheumatoid arthritis. Exp Ther Med 2019; 18:1661-1668. [PMID: 31410123 PMCID: PMC6676208 DOI: 10.3892/etm.2019.7746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/31/2019] [Indexed: 11/23/2022] Open
Abstract
The objective of the present study was to evaluate whether an innovative quantitative ultrasound (QUS) technique, Radiofrequency Echographic Multi Spectromety, which combines B-mode ultrasound and radiofrequency signals, is reliable in typical Romanian patients compared to previous results obtained using dual-energy X-ray absorptiometry (DXA). The study prospectively included previously unscreened post-menopausal females with rheumatoid arthritis (RA) and age-matched healthy controls. Bone mineral density (BMD) measurements were performed with an EchoS machine (Echolight®), which combines B-mode ultrasound and radiofrequency signals. The study included 106 RA patients, with a median disease duration of 3.2 (0.5–22) years and 119 controls. RA patients had a significantly lower body weight, body mass index (BMI) and basal metabolic rate (BMR) than the controls, while the prevalence of obesity and body fat differed insignificantly. RA patients had a significantly lower spine and hip BMD, higher fracture risk and higher prevalence of osteoporosis. Compared to RA patients without osteoporosis, those with osteoporosis were significantly older and had a longer menopause duration, but they had a significantly lower BMI, body fat, BMR and prevalence of obesity. Among the controls and RA patients, the median spine and hip BMD became significantly higher as the BMI increased from underweight to obesity. In conclusion, osteoporosis is prevalent among RA patients, as a part of a complex transformation of body mass composition, involving BMI and fat mass. The novel QUS scanning technique was able to replicate the results of the established DXA measurement of BMD and is potentially suitable for screening wide populations for osteoporosis.
Collapse
Affiliation(s)
- Violeta-Claudia Bojincă
- Internal Medicine and Rheumatology Department, Sfânta Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 011172, Romania
| | - Claudiu C Popescu
- Ion Stoia Clinical Centre for Rheumatic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest 031167, Romania
| | - Raluca-Daniela Decianu
- Internal Medicine and Rheumatology Department, Sfânta Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 011172, Romania
| | - Andrei Dobrescu
- Internal Medicine and Rheumatology Department, Sfânta Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 011172, Romania
| | - Șerban Mihai Bălănescu
- Cardiology Department, Elias University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 011461, Romania
| | - Andra-Rodica Bălănescu
- Internal Medicine and Rheumatology Department, Sfânta Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 011172, Romania
| | - Mihai Bojincă
- Rheumatology Department, Dr I. Cantacuzino Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest 030167, Romania
| |
Collapse
|
5
|
Gong X, Xu SQ, Tong H, Wang XR, Zong HX, Pan MJ, Ten YZ, Xu JH, Wei W. Correlation between systemic osteoporosis and local bone erosion with rheumatoid arthritis patients in Chinese population. Rheumatology (Oxford) 2019:kez042. [PMID: 30847477 DOI: 10.1093/rheumatology/kez042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/22/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE RA is a systemic auto-immune inflammatory disease that can lead to local bone erosions and generalized osteoporosis (OP). The aim of this study was to investigate the relationship between systemic osteoporosis and local bone erosion with RA patients in the Chinese population. METHODS In total, 1235 patients with RA and 158 normal subjects were enrolled in this study. Clinical and laboratory features were recorded in detail. Information about functional class and physical activity was collected using specific questionnaires. Dual-energy X-ray absorptiometry was used to measure BMD. The MECALL castor-50-hf model X-ray scanner was used for two-hand (including wrist) photographs. RESULTS The median Sharp scores differed significantly between the normal bone mass group, osteopenia group and OP group (P < 0.001). There was a modest negative linear correlation between Sharp and HAQ scores and longer disease duration (P < 0.001). There was a clear increasing trend in Sharp score, incidence of OP and HAQ score in the different DAS in 28 joints (DAS28) activity groups (P < 0.001). Spearman's correlation test showed that Sharp and HAQ scores were negatively correlated with BMD at all measured sites (femoral neck, total hip and L1-4) (P < 0.001). Logistic regression indicated that age, female gender, and Sharp and HAQ scores were independent risk factors in the occurrence of OP in RA patients. The use of DMARDs and BMI were protective factors for OP. CONCLUSION These results suggest that BMD is associated with local bone erosion among Chinese patients with RA. Local bone erosion is closely related to clinical symptoms and BMD in patients with RA.
Collapse
Affiliation(s)
- Xun Gong
- Institute of Clinical pharmacology, Anhui Medical University
| | - Sheng-Qian Xu
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Hui Tong
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Xin-Rong Wang
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - He-Xiang Zong
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Mei-Juan Pan
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Yu-Zhu Ten
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Jia-Hua Xu
- Department of Rheumatology & Immunology, The First Affiliated Hospital of Anhui Medical University
| | - Wei Wei
- Institute of Clinical pharmacology, Anhui Medical University
- Key Laboratory of Anti-Inflammatory and Immune Medicine, Ministry of Education
- Anhui Collaborative Innovation Centre of Anti-Inflammatory and Immune Medicine, Hefei, China
| |
Collapse
|
6
|
Abbasi S, Asl JF, Zadeh LM, Mirdoraghi M. Measurement bone mineral density (BMD) of patients with beta thalassemia. Data Brief 2018; 19:1021-1024. [PMID: 29904717 PMCID: PMC5998177 DOI: 10.1016/j.dib.2018.05.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 11/04/2022] Open
Abstract
The aim of the study is determining bone mineral density (BMD) of Patients with beta thalassemia in order to find the prevalence and related factors on the conditions. Z-Score of femoral neck and lumbar vertebrae were reported comparing normal matched subjects. Age and bone mineral density were significantly correlated. Moreover, the disease had significantly higher severity in men than in women. A negative significant correlation was detected between BMD and the mean of hematocrit in the last 5 years. There was significant differences between sex hormone and bone density. A significant correlation between hydroxy urea and BMD were found. A significant relationship between the use of bisphosphonates and bone density were found. Osteopenia and osteoporosis were highly prevalent in our participants. Therefore, regular tests are required to examine bone mineral density in these patients. Furthermore, the exact effect of age on bone mineral density need to be clarified.
Collapse
Affiliation(s)
- Sakineh Abbasi
- Department of Laboratory Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Fatahi Asl
- School of Para medicine, Department of Radiologic Technology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Moein Zadeh
- Thalassemia ward of Shafa hospital in Ahvaz, M.Sc in Hematology, Ahvaz, Iran
| | - Mohammad Mirdoraghi
- Committee of Student Researches, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
7
|
Heinlen L, Humphrey MB. Skeletal complications of rheumatoid arthritis. Osteoporos Int 2017; 28:2801-2812. [PMID: 28779302 DOI: 10.1007/s00198-017-4170-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/20/2017] [Indexed: 12/27/2022]
Abstract
Rheumatoid arthritis (RA) is associated with local and systemic inflammation that induces many changes in the skeletal health. Locally, periarticular bone loss and juxta-articular bone erosions may occur while joint ankylosis, generalized bone loss, osteoporosis, and fractures may develop secondary to inflammation. The aim of this narrative review is to summarize the clinical evidence for abnormal skeletal health in RA, the effects of disease modifying anti-rheumatic drugs (DMARDS) on bone health, and the effects of drugs for the prevention or treatment of osteoporosis in the RA population.
Collapse
Affiliation(s)
- L Heinlen
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M B Humphrey
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Veterans Affairs Medical Center, Oklahoma City, OK, USA.
| |
Collapse
|
8
|
Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Bak KH, Chun HJ. Influence of systemic bone mineral density on atlantoaxial subluxation in patients with rheumatoid arthritis. Osteoporos Int 2017; 28:1931-1938. [PMID: 28255666 DOI: 10.1007/s00198-017-3972-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/14/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines. INTRODUCTION Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. This study aimed to evaluate the association between atlantodental interval (ADI), atlantoaxial subluxation (AAS), and systemic bone mineral density (BMD) based on BMI variations among established patients with RA. METHODS The ADI was transformed to the natural log scale to normalize distributions for all analyses. Multivariable linear regression analyses were used to identify independent predictive factors for ADI based on each BMD classification. Multivariate Cox regression analyses were also performed to identify independent predictive factors for the risk of AAS, which were classified by tertile groups of BMI. RESULTS A total of 1220 patients with RA who had undergone at least one or more cervical radiography and BMD assessments were identified and enrolled. We found that the association between BMD and ADI (β, -0.029; 95% CI, -0.059 to 0.002; p = 0.070) fell short of achieving statistical significance. However, the ADI showed a 3.6% decrease per 1 BMI increase in the osteoporosis group (β, -0.036; 95% CI, -0.061 to -0.011; p = 0.004). The osteopenia and osteoporosis groups showed about a 1.5-fold and a 1.8-fold increased risk of AAS occurrence among the first tertile of the BMI group. CONCLUSIONS Our study showed a possible association between lower BMD and AAS occurrence in patients with RA with lower BMI. Further studies are needed to confirm our findings.
Collapse
Affiliation(s)
- M H Han
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J I Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea.
| | - C H Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J M Kim
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - J H Cheong
- Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyeonggi-do, 471-701, South Korea
| | - K H Bak
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
| | - H J Chun
- Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea
| |
Collapse
|
9
|
Giraldo H, Benetti-Pinto C, Ferreira V, Garmes H, Yela D, Giraldo P. Standard hormone therapy is inadequate for bone density in premature ovarian insufficiency. Gynecol Endocrinol 2017; 33:283-286. [PMID: 27910707 DOI: 10.1080/09513590.2016.1257602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
To assess standard dose hormone therapy (HT) and bone mass in premature ovarian insufficiency (POI), 239 women with POI, 132 using standard estrogen dose HT and 107 women without HT, were evaluated. All underwent bone mineral density (BMD) evaluation in the lumbar spine (LS) and total femur (TF). Mean age, age at last period and body mass index (BMI) for the untreated and for the HT groups were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 kg/m2, respectively, (p=NS). The women taking standard dose HT started treatment at the age of 33.8 ± 6.3 years and had been on hormone treatment for 3 years at the time of the bone densitometry examination. The BMD in LS was 1.06 ± 0.15 and 1.00 ± 0.17 g/cm2 (p = 0.003); the BMD in TF was 0.92 ± 0.19 and 0.91 ± 0.13 g/cm2 (p = 0.039), respectively, for the untreated and HT groups. A 45% altered BMD (osteopenia/osteoporosis) in LS was verified in women without treatment and 60.1% in those using the standard dose TH (p = 0.01). The BMD in TF was altered in 32.3% in those without HT and 36.4% in the HT users (p = 0.34). In conclusion, standard dose HT was not adequate to reduce impaired bone mass in the spine and femur of women with POI.
Collapse
Affiliation(s)
- Helena Giraldo
- a Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Brazil and
| | - Cristina Benetti-Pinto
- a Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Brazil and
| | - Valeska Ferreira
- a Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Brazil and
| | - Heraldo Garmes
- b Department of Clinics , School of Medical Sciences, University of Campinas , Brazil
| | - Daniela Yela
- a Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Brazil and
| | - Paulo Giraldo
- a Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Brazil and
| |
Collapse
|