Osteoporosis treatment and pain relief: A scoping review

BACKGROUND AND OBJECTIVE

Anti-osteoporosis (OP) drugs have been suggested to contribute to pain reduction during OP management. This scoping review aimed at mapping the literature on pain relief with anti-OP drugs in OP treatment.

DATABASES AND DATA TREATMENT

Medline, Pubmed and Cochrane databases were searched by two reviewers with keywords combinations. Randomized controlled and real-life English studies, pain as an endpoint, antiosteoporosis drugs were inclusion criteria. Case reports, surveys, comment letters, conference abstracts, animal studies and grey literature were excluded. Predetermined data were extracted by two reviewers and disagreement solved through discussion.

RESULTS

A total of 130 articles were identified, 31 publications were included, 12 randomized clinical trials and 19 observational studies. Pain reduction was assessed by different tools: Visual Analogue Scale, Verbal Rating Scale, Facial Scale or as a domain of quality of life questionnaires including Short form 8, 36, mini-OP, Japanese OP, Qualeffo, Roland Morris Disability questionnaires. Collective data show that anti-OP drugs may display an analgesic effect that may be linked to the local mode of action of drugs on bone and consecutive modulation of pain sensitization. The methodology of the studies showed a heterogeneity of endpoints, comparators, statistical approaches and follow-up duration.

CONCLUSION

Considering the limitations of the literature, there is a need for more rigorous trials and larger real-life studies taking into account the recommendations published for research in rheumatology and in pain medicine. The identification of responders, patient subtypes, and of analgesic-effect doses would allow optimization and individualization for pain relief in patients with OP.

SIGNIFICANCE STATEMENT

This scoping review shows that anti-OP drugs may improve pain and quality of life of patients with OP. The heterogeneity in design, choice of endpoints, methodology, comparators and follow-up duration of included randomized clinical trials and real-life studies does not allow so far to identify a predominant antiosteoporosis drug or an optimal dosage for pain relief. These gaps need to be addressed and warrant further research in the future for optimizing pain improvement in the course of OP drug treatment.

Comparison of the cardiovascular risk profile of rheumatoid arthritis versus hand osteoarthritis patients

It is clear that there is an increased cardiovascular (CV) risk in rheumatoid arthritis (RA) as a result of systemic inflammation. Hand osteoarthritis (HOA) patients, also have an increased CV risk, but the causes are still debated. Our objective was to compare CV risk factors and risk scores between HOA and RA patients. Thirty-five HOA patients were matched by age (< 3 years) and sex to 35 RA patients in a case-control study. We compared their CV risk profiles and their risk of occurrence of CV events at 10 years using the risk equations SCORE1, SCORE2, and QRISK3. There was a significant increase in SCORE1, SCORE2, but not in QRISK3 in the RA group compared to the HOA group, provided that the multiplication coefficient for RA was applied. This increase was found to no longer be significant for SCORE1 when RA patients have low disease activity (DAS28 ≤ 3.2; n = 8). There was no difference between groups in the frequency of metabolic syndrome, blood pressure, abdominal circumference, body mass index, uricemia, triglyceridemia, HDL cholesterolemia, or pain intensity. Conversely, HOA patients had higher LDL cholesterol and fasting blood glucose levels, in the main analysis and in the subgroup of moderate/high RA activity patients (DAS28 > 3.2; n = 26). We found a higher CV risk in RA compared to HOA patients with moderate/high disease activity. The increased CV risk reported in OA remains to be confirmed in HOA, but these patients appear to have a pro-atherogenic lipid and glycemic profile.

Survey of adolescents' needs and parents' views on sexual health in juvenile idiopathic arthritis

BACKGROUND

Although the advent of new therapeutics for juvenile idiopathic arthritis (JIA) patients has considerably lessened the impact of the disease and reduced its sequelae, the outcomes of JIA remain important in their lives. Disease repercussions and side effects of treatments may affect sexual health and cause psychological distress. This aim of the study was to determine the expectations of adolescent JIA patients and the perceptions of their parents regarding knowledge and communication with healthcare providers (HCPs) in the field of sexual health (SH).

METHODS

In France, from September 2021 to April 2022, a survey was conducted, using anonymous self-administered questionnaires, among JIA patients (adults (aged 18-45 years) to provide insights from their recollection of their adolescence) and their parents in nine rheumatology centers and three patient associations.

RESULTS

The responses to the 76 patient questionnaires and 43 parent questionnaires that were collected were analyzed. Half of the patients thought JIA impacted their romantic relationships, but the results were less clear-cut for their sexual activity; and 58.7% of the patients said they would be comfortable discussing the subject with HCPs, but only 26.3% had done so, mainly regarding biomedical issues. The patients and their parents thought that ideally, the topic should be addressed in an individual patient education session at the hospital (51.3% and 34.9%, respectively), in a regular consultation (47.4% and 53.5%), or in a dedicated consultation requested by the adolescent without the adolescent's parents being informed (38.2% and 20.9%). Most of the respondents thought HCPs should be proactive in SH (77.6% of the patients and 69.8% of their parents). More patients than parents said the following digital information tools must be used: videos (29.0% vs. 9.3%, p = 0.0127) and smartphone applications (25.0% vs. 9.3%, p = 0.0372).

CONCLUSION

HCPs should consider addressing the unmet need for SH discussions during their patient encounters. To meet this need, we propose concrete actions in line with the wishes of patients and parents.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04791189.

POS0587 TRAJECTORIES AND FACTORS INFLUENCING THE EVOLUTION OF HAND GRIP AMONG PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is characterized by an early reduced grip strength which persists over time despite the remission of the disease suggesting the presence of a sarcopenia.

Objectives

To study the evolution of the grip strength measured by the handgrip. by identifying different trajectories and associated factors.

Methods

Patients with active RA who visited the Rheumatology Department of Clermont-Ferrand University Hospital for initiating bDMARD were invited to participate to the longitudinal cohort RCVRIC analyzing cardiovascular risk and chronic inflammatory rheumatic disease. Within the RCVRIC cohort 175 RA initially underwent a handgrip determination. 143 patients had at least 2 handgrip measurements over 2 years, allowing analysis of trajectories by the “Group Based Trajectory Modeling” method. For the trajectories, handgrip was expressed in terms of percentage of the theoretical value defined according to age and sex. The clinical characteristics of the disease, the therapeutic response, and the body composition associated with each trajectory were analyzed.

Results

At inclusion, the handgrip was normal among only 4% of patients, with an alteration of 51% of its theoretical value. After 2 years of follow-up, a majority of patients improved their handgrip trajectory to reach an average of 68% of the theoretical one, but only 15.7% of the patients normalized their handgrip. Four trajectories have been identified along with associated factors:

1st trajectory consists of low handgrip with little improvement and was composed of: 9 patients (6.3%), median age 60 years [53.6;69.3], 88% women, disease duration 17.99 years [6.78;24.9], DAS 28 ESR 4.68 ± 1.29, and initial handgrip 21% of the theoretical value [8;24].

2nd trajectory shows good improvement (+72%) and was composed of: 70 patients (49%), median age 58.9 years [54.4;64.3], 84% women, disease duration 5.99 years [1.46;14.8], DAS 28 ESR 4.43 ± 1.07, and initial handgrip 32% of the theoretical value [17.8;46.4].

3rd trajectory shows moderate improvement (+25%) and was composed of: 43 patients (30%), median aged 60.7 years [45.7;69.4], 79% women, disease duration 3.5 years [1.25;9.9], DAS 28 ESR 4.0 ± 1.03 and initial handgrip 60% of the theoretical value [48.2;76].

4th trajectory shows high handgrip and was composed of: 21 patients (14.7%), 57% women, median age 57.9 years old [49.7; 67.4], disease duration 3.81 years [2.14; 10.7], DAS 28 ESR 3.68 ±1.29 and initial hand grip 92% of the theoretical value [85; 100].

Significant differences at inclusion between the 4 trajectories were observed. The 4th trajectory was characterized by a higher proportion of men (p=0.05), lower disease activity (DAS 28 ESR (p=0.02), SDAI (p=0.04)), better initial handgrip (p=0.03) and 6 min walk test (p=0.0001), and a lower percentage of fat mass (p=0.04). In contrast, a higher disability (HAQ, p=0.002), a lower total lean body mass (p=0.001) and poorer therapeutic response (p=0.04) were noted in trajectories 1 and 2.

Conclusion

After 2 years of follow-up, a majority of patients improved their handgrip trajectory. However, very few patients normalized their hand grip. Four trajectories of handgrip were identified; the main indicators of hand grip’s improvement were the control of the disease activity, low functional disability, walking performance, a low percentage of fat mass and high lean mass.

References

[1]Cruz-Jentoft AJ, and al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. janv 2019

[2]An HJ, and al. Sarcopenia in Autoimmune and Rheumatic Diseases: A Comprehensive Review. Int J Mol Sci. 7 août 2020

[3]Shiratori AP and al. Evaluation protocols of hand grip strength in individuals with rheumatoid arthritis: systematic review. Rev Bras Reumatol. avr 2014

[4]Dodds RM, et al. Grip strength across the life course: normative data from twelve British studies. PloS One. 2014;

Acknowledgements

I thank the department of rheumatology of Clermont Ferrand.

Disclosure of Interests

None declared.