BRONJ in patients with rheumatoid arthritis: a multicenter case series

Abstract

OBJECTIVE: Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of various medications (bisphosphonates, anti-resorptive, and anti-angiogenic drugs). ONJ pathogenesis is still unclear although some risk factors have been recognized. Of these, rheumatoid arthritis (RA) has been hypothesized as a potential risk factor for developing ONJ. This observational study will describe a multicenter case series of patients affected with RA and ONJ, and it will attempt to evaluate the association between features of ONJ and pharmacological, systemic, and site variables. METHODS: Demographic, pharmacological, and clinical data from 18 RA patients with ONJ were collected and registered from three Italian centers (i.e., Palermo, Verona, and Padua) from 2004 to 2013. RESULTS: Sixteen (88.9%) patients were in therapy for RA: 9 of 18 (50.0%) with systemic steroids, 3 of 18 (16.7%) with methotrexate, and 4 of 18 (22.2%) with both medications. Two patients were not receiving treatment for RA. All patients took NBPs for secondary osteoporosis (average NBP duration of 69 months, range: 20-130): Fifteen (83.3%) patients were treated with single NBPs, while three (16.7%) with different molecules; one patient was also treated with denosumab. Mandible was affected more frequently (66.7%) than maxilla (33.3%); one patient presented multiple ONJ events. CONCLUSIONS: This is the first multicenter case series in the international literature regarding our topic. Focusing on our data, it could be hypothesized that patients with RA may be more susceptible to ONJ than the majority of osteometabolic patients. In our opinion, it could be important to monitor also denosumab or other biological drug side effects.

Cloud-Based Multicenter Data Collection and Epidemiologic Analysis of Bisphosphonate-Related Osteonecrosis of the Jaws in a Central European Population

“…BRONJ was diagnosed at a significantly younger age in breast cancer patients compared to the rest of the malignant group. Although in our investigation there were only two rheumatoid arthritis patients (mean: 39.0 years SD: 1 years), there was still a surprisingly huge age difference when it was compared to the results of Di Fede (n = 18 mean: 68 years SD: 8 years) [17].…”

“…The literature on BRONJ is enormous and growing, but most of these papers are case presentations or reports on a small series of patients. Data are not statistically significant in most of these studies due to the low number of patients included [17][18][19][20].…”

Assessment of Distal Radius Bone Mineral Density in Osteoporosis Patients Receiving Denosumab, Including Those with Rheumatoid Arthritis and Those Receiving Oral Glucocorticoids

“…Recently, it has been reported that RA is a risk factor for ONJ, and ONJ should be especially mentioned to long-term denosumab or bisphosphonate-treated RA patients (median 69 months, range 20–130 months) [19]. …”

BRONJ In A Patient with Rheumatoid Arthritis: An Unnamed Association

“…DiFede et al reported that female gender, age older than 60 years and increased duration of BPs use are related with BRONJ development in RA patients [4].…”