Can bone loss in rheumatoid arthritis be prevented?

Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to local joint deformations (bone erosions and joint space narrowing) and to extra-articular phenomena, including generalized osteoporosis. In addition, in patients with RA, the risk of vertebral and nonvertebral fractures is...

Full description

Saved in:
Bibliographic Details
Published in:Osteoporosis international 2013-10, Vol.24 (10), p.2541-2553
Main Authors: Vis, M., Güler-Yüksel, M., Lems, W. F.
Format: Article
Language:English
Subjects:
Antirheumatic Agents - therapeutic use
Arthritis, Rheumatoid - complications
Arthritis, Rheumatoid - drug therapy
Biological products
Biological Products - therapeutic use
Cross-Sectional Studies
Drug Therapy, Combination
Endocrinology
Glucocorticoids - therapeutic use
Humans
Medicine
Medicine & Public Health
Orthopedics
Osteoporosis
Osteoporosis - diagnosis
Osteoporosis - etiology
Osteoporosis - prevention & control
Preventive medicine
Review
Rheumatoid arthritis
Rheumatology
Risk Factors
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to local joint deformations (bone erosions and joint space narrowing) and to extra-articular phenomena, including generalized osteoporosis. In addition, in patients with RA, the risk of vertebral and nonvertebral fractures is doubled. High disease activity (inflammation), immobility, and glucocorticoid use are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on classical risk factors such as high age, low body mass, and female gender. New insights on the links between the immune system and the bone system, the field of osteoimmunology, have shown that local and generalized bone loss share common pathways. The receptor activator of nuclear factor κB ligand/osteoprotegerin pathway (RANKl/OPG) is one of the most important pathways, as it is (strongly) upregulated by inflammation. In modern treatment of RA with biologics, for example, TNFα-blocking agents and combination therapy of conventional disease-modifying antirheumatic drugs (DMARDs), clinical remission is a realistic treatment goal. As a consequence, in recent studies, it has been documented that both local and generalized bone loss is absent or minimal in those patients who are in clinical remission.
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-013-2334-5