Bone Mass Change During Methotrexate Treatment in Patients with Juvenile Rheumatoid Arthritis

Bianchi, Maria Luisa; Cimaz, Rolando; Galbiati, E.; Corona, Fabrizia; Cherubini, R.; Bardare, M

doi:10.1007/s001980050189

Cited by 60 publications

(12 citation statements)

References 21 publications

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“…Femoral neck BMAD values, however, were significantly lower in patients with systemic JRA. The smaller and less mineralized skeletons observed in our polyarticular JRA cohort are consistent with findings in previous studies (15)(16)(17).…”

Section: Discussionsupporting

confidence: 93%

“…Methotrexate (MTX), a disease-modifying antirheumatic drug, is currently pre-scribed to an estimated 25,000 children in the US, or 39% of patients with JRA (13). Low-dose MTX therapy has been reported to have a sparing effect on wholebody and lumbar spine (L-spine) BMC when used instead of or in addition to systemic glucocorticoids (14)(15)(16)(17). In children also treated with glucocorticoids, a slower rate of bone mineral acquisition has been observed.…”

mentioning

confidence: 99%

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Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

Arthritis & Rheumatism

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Objective. To characterize local bone geometry, density, and strength, using peripheral quantitative computed tomography (pQCT), compared with general bone characteristics as measured using dual x-ray absorptiometry (DXA), and to assess their relationship to disease-related factors in children with juvenile rheumatoid arthritis (JRA).Methods. Forty-eight children ages 4-18 years with JRA (17 pauciarticular, 23 polyarticular, 8 systemic) were compared with age-matched healthy controls (n ‫؍‬ 266). Measurements included cortical and trabecular bone geometry, density, and strength at the distal and midshaft tibia determined by pQCT, and whole-body, lumbar spine, and femoral neck measurements by DXA.Results. Methotrexate (MTX) was prescribed to 23 of 48 patients (47.9%) and glucocorticoids and MTX were prescribed to 15 of 48 patients (31.3%), with the greatest use in children with systemic JRA. All JRA patients had decreased tibia trabecular bone density, cortical bone size and strength, and muscle mass. Children with systemic JRA had lower femoral neck densities. Systemic JRA was associated with a shorter, less mineralized skeleton, while a narrower, less mineralized skeleton was observed in polyarticular JRA. The tibia diaphysis was narrower with decreased muscle mass, but normal, size-adjusted bone mineral in all subtypes indicated a localized effect of JRA on bone. Patients exposed to glucocorticoids and MTX or to glucocorticoids or MTX alone had greatly reduced trabecular density, cortical bone geometry properties, and bone mineral content, muscle mass, and bone strength.Conclusion. Children with JRA have decreased skeletal size, muscle mass, trabecular bone density, cortical bone geometry, and strength. Not surprisingly, these bone abnormalities are more pronounced in children with greater disease severity.

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Section: Discussionsupporting

confidence: 93%

mentioning

confidence: 99%

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Felin¹,

Prahalad²,

Askew³

et al. 2007

Arthritis & Rheumatism

View full text Add to dashboard Cite

show abstract

“…The mineral content and therefore the mineral density within the trabeculae or the cortical shelf is decreased [41]. Bone density is defined as the mineral mass per volume in g/cm 3 . In clinical practice, the results obtained by "dual energy X-ray absorptiometry" (DXA) are also called "bone mineral density" (BMD) despite the fact that they actually reflect a measurement of bone mass in gram related to the bone area in cm 2 .…”

Section: Definition Of Osteopenia Osteomalacia Bone Density and Bonmentioning

confidence: 99%

Osteoporosis in juvenile idiopathic arthritis- a practical approach to diagnosis and therapy

et al. 2007

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In all subgroups of juvenile idiopathic arthritis, a decrease in bone mass has been described in a high percentage of children. Recently, new pathogenetic concepts have identified muscle mass as the strongest predictor of bone mass and bone is now recognized as part of the musculoskeletal system. In addition, the sophisticated use of bone densitometry in pediatrics, including new measurement techniques, has provided the tools for a reliable assessment. A standardized diagnostic approach to the musculoskeletal system, including prophylaxis and therapy, is, therefore, mandatory in all children with JIA who do not achieve rapid remission. In this review, diagnostic and therapeutic options are being described and possibilities to incorporate them into clinical practice are suggested.

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“…It is associated with decreased areal bone mineral density (BMD a ) 1,2,3,4,5,6 . Known risk factors for low BMD a and fragility fractures in children with JIA include the inflammatory process 7 , nutrition 8 , growth impairment 9 , reduced physical activity 8 , and treatment, especially corticosteroids 5,10 .…”

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confidence: 99%

Bone Health in Adult Men and Women with a History of Juvenile Idiopathic Arthritis

Thornton¹,

Pye²,

O'Neill³

et al. 2011

J Rheumatol

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Objective.Our aim was to determine areal bone mineral density (BMDa) and disease-related factors linked with BMDa in adults with a history of juvenile idiopathic arthritis (JIA).Methods.Men and women with a history of JIA attending a young adult rheumatology clinic in Newcastle, UK, underwent dual energy x-ray absorptiometry (DEXA) of the lumbar spine and total hip. Information was obtained about disease duration and subtype, previous treatment including corticosteroid and methotrexate therapy, and large-joint replacement. Subjects completed the modified Health Assessment Questionnaire (HAQ). Blood was taken for assessment of C-reactive protein, erythrocyte sedimentation rate, and rheumatoid factor (RF).Results.Seventy-one women and 16 men, mean age 28.7 and 31.4 years, and mean disease duration 20.6 and 24.0 years, respectively, were studied. Mean BMDa was 0.982 (Z-score = −0.328; 95% CI −0.657, 0.001) and 1.028 g/cm2 (Z-score = −0.251; 95% CI −1.266, 0.764) in women and men, respectively, at the spine and 0.817 (Z-score = −0.542; 95% CI −0.975, −0.109) and 0.857 g/cm2 (Z-score = −0.176; 95% CI −2.323, 1.971) at the hip. After adjusting for age and sex, increasing HAQ score was associated with both lower spine BMDa and hip BMDa. Compared with patients with oligoarticular disease, those with enthesitis-related arthritis had higher BMDa at the spine, while those with extended oligoarticular and polyarticular RF-negative disease had lower hip BMDa. Oral corticosteroids and the presence of a large-joint replacement were associated with lower BMDa at both the spine and hip.Conclusion.There was a trend toward low BMDa in women with a history of JIA. These patients may be at risk of the complications of osteoporosis including fragility fractures and should be considered for targeted preventive measures.

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Bone Mass Change During Methotrexate Treatment in Patients with Juvenile Rheumatoid Arthritis

Cited by 60 publications

References 21 publications

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Musculoskeletal abnormalities of the tibia in juvenile rheumatoid arthritis

Osteoporosis in juvenile idiopathic arthritis- a practical approach to diagnosis and therapy

Bone Health in Adult Men and Women with a History of Juvenile Idiopathic Arthritis

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