Correlation between systemic osteoporosis and local bone erosion with rheumatoid arthritis patients in Chinese population

Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons

“…Other risk factors that can account for OP in RA include systemic inflammation associated with disease activity, local effect of immune cells leading to bone erosions, glucocorticoid (GC) therapy and impairment of physical activity (14). Therefore, OP and fractures are more frequent in patients with high disease activity (according to DAS28), presence of periarticular bone erosions and cumulative structural damage, RA disease duration ≥ 10 years, high HAQ score or high titers of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF) positivity (6,9,10,(14)(15)(16). In one study, vertebral fracture risk in RA patients was related to longer disease duration, dose and duration Abbreviations: ACPA, anti-citrullinated protein antibodies; ACR, American College of Rheumatology; Anti-CarPA, anti-carbamylated protein antibodies; BMD, bone mineral density; BMI, body mass index; CI, confidence interval; CTX-I, carboxy-terminal telopeptide of type 1 collagen; CXCL8, C-X-C motif chemokine ligand 8; DAS28, disease activity score counted over 28 joints; DDK-1, Dickkopf-1 protein; DMARD(s), disease modifying anti-rheumatic drug(s); DXA, dual X-ray densitometry; DXR, dual X-ray radiogrammetry; EULAR, European league against Rheumatism; FRAX, fracture risk assessment tool; GC(s), glucocorticoid(s); HAQ, health assessment questionnaire; hTNF-tg, human tumor necrosis factor transgenic; Ig, immunoglobulins; IL, interleukin; IFN-, interferon gamma; M-CSF, macrophage colony-stimulating factor; OP, osteoporosis; OPG, osteoprotegerin; PEARL, Princesa early arthritis register longitudinal; PINP, procollagen type 1 N-terminal propeptide; RA, rheumatoid arthritis; RANK/RANK-L, receptor activator of nuclear factor (NF)-kB (RANK) and its ligand; RF, rheumatoid factor; TNF-α, tumor necrosis factor; TNFi, TNF-α inhibitors; Th, T helper lymphocytes; Treg, regulatory T cells; uNTx, cross-linked N-telopeptide of type I collagen; Wnt, drosophila segment polarity gene wingless and integrated or int-1 of the vertebrate homolog.…”

“…Interestingly, GCs also suppress osteoclast activity, certainly increased in active arthritis patients, which might have a protective effect in some cases (19). In fact, some studies show that GC use in RA could even be beneficial, with a low impact on BMD due to their anti-inflammatory and suppressive effect on arthritis activity (13,14,16,20). Therefore, low doses of GCs could provide protection from inflammatory bone loss during polyarthritis flares and might counteract their unfavorable effects on bone resorption leading to neutral or even positive net skeletal balance (20,21).…”

“…During the inflammatory process, their production exceeds the synthesis of their physiologic inhibitors and decoy receptor OPG. Therefore, the imbalance between osteoblast and osteoclast activity is directly responsible for bone loss and local erosions in RA (15,16). Nevertheless, this imbalance can also occur at systemic level.…”

Factors associated with osteoporosis medication use in Japanese patients with rheumatoid arthritis: Results from the Institute of Rheumatology Rheumatoid Arthritis cohort study

“…We observed a significant association between the use of osteoporosis medications or antiresorptive agents and the JHAQ-DI of Japanese patients with RA ( Table 2 ). Previously, we and others have reported that the HAQ-DI or JHAQ-DI was significantly correlated with osteoporosis and fragility fractures [ 18 , 29 ]. HAQ-DI was negatively associated with the BMD score, and JHAQ-DI was associated with vertebral fractures in patients with RA [ 18 , 29 ].…”

“…Previously, we and others have reported that the HAQ-DI or JHAQ-DI was significantly correlated with osteoporosis and fragility fractures [ 18 , 29 ]. HAQ-DI was negatively associated with the BMD score, and JHAQ-DI was associated with vertebral fractures in patients with RA [ 18 , 29 ]. Based on our study results, we suggest that Japanese patients with RA and a high JHAQ-DI require BMD monitoring and initiation of osteoporosis treatment as deemed medically appropriate.…”