The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis

Emkey, Ronald; Lindsay, Robert; Lyssy, Jane; Weisberg, Jerome S.; Dempster, David W.; Shen, Victor

doi:10.1002/art.1780390215

Cited by 92 publications

(29 citation statements)

References 40 publications

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“…The pathogenesis of SEL associated with epidural steroid injection is unknown. Epidural steroid injection has potential systemic effects that suppress the hypothalamicpituitary-adrenal axis, induce hypertension, elevate glucose level, and affect bone growth [18,19]. Injected The authors did not check radiologic image before epidural steroid injection steroids in the epidural space penetrate into the blood stream and may promote fat deposition in the epidural space.…”

Section: Discussionmentioning

confidence: 99%

Rapid progression of spinal epidural lipomatosis

et al. 2011

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Spinal epidural lipomatosis (SEL) is a rare but well-recognized condition. In general, the onset of its symptoms is insidious and the disease progresses slowly. We report two cases of rapid progression of SEL with no history of steroid intake in non-obese individuals after epidural steroid injection. These SEL patients developed neurologic symptoms after less than 5 months; these symptoms were confirmed to be due to SEL by serial MR images. After the debulking of the epidural fat, their symptoms improved.

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Section: Discussionmentioning

confidence: 99%

Rapid progression of spinal epidural lipomatosis

et al. 2011

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“…90 This is evident in a dose-dependent drop in serum osteocalcin in patients with nonmalignant disorders; 91 a drop which can be prompt and substantial even with inhaled drugs 92 or a single intra-articular injection. 93 Steroids also alter the expression of genes that regulate bone turnover, especially the receptor activator of nuclear KB ligand (RANKL) and osteoprotegerin (OPG) that normally binds to RANKL acting as a receptor decoy, 89 resulting in enhancement of bone resorption. 94 By contrast, RANKL and its receptor offer targets for therapeutic intervention.…”

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confidence: 99%

Osteopenia and cancer in children and adolescents

Sala

Barr

2007

Cancer

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The attainment of a satisfactory peak bone mass, which is accomplished largely by the end of adolescence, is the best protection against excessive bone mineral loss in late adulthood. Factors that influence this process include age, race, sex, body size, pubertal status, diet, physical activity, and other lifestyle elements.Cancer and its treatment in children and teenagers adversely impact bone mineralization. In particular, chemotherapy (especially glucocorticosteroids and methotrexate) and cranial irradiation (apparently by reducing growth hormone secretion and by causing hypogonadotropic hypogonadism) interfere with normal bone turnover. Resorption often exceeds formation, resulting in net bone mineral loss and providing a rational basis for the use of antiresorptive drugs. Such osteopenia may be symptomatic, with pain and abnormal gait, and increases the risk of fractures several fold. The disorder is compounded by reduced physical activity, so programs to reduce this deficit are of measurable benefit. All of those engaged in the care of children and adolescents with cancer have an opportunity to improve the bone health of these young people and to limit their risk of developing osteoporosis and fragility fractures in adult life.

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“…A direct inhibition on osteoblast activity by glucocorticoids is the principal mechanisms favored by many [25•]. Prednisone doses as low as 2.5 mg daily orally and intra-articular therapy can suppress osteocalcin, a biochemical marker of bone formation [24,26]. Enhanced osteoclast-mediated bone resorption is the other major pathway that has been advocated by some investigators.…”

Section: Evidence For Bone Toxicity Of Glucocorticoids In Rheumatoid mentioning

confidence: 99%

Glucocorticoid use in rheumatoid arthritis

Saag

2002

Curr Rheumatol Rep

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More than 50 years after their discovery, glucocorticoids continue to be a mainstay of treatment for many patients with rheumatoid arthritis (RA). Although the short- and moderate-term efficacy of glucocorticoids in RA is seldom debated, increasing evidence favors a disease-modifying role of glucocorticoids. Despite renewed enthusiasm based on this newer long-term data, glucocorticoid use is marred substantially by the potential for many serious adverse events. Glucocorticoid-induced osteoporosis is one of the most predictable and serious complications for many chronic and some acute users. The correct identification of patients at high risk for bone complications and the institution of appropriate preventive measures may partially attenuate this adverse outcome.

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The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis

Cited by 92 publications

References 40 publications

Rapid progression of spinal epidural lipomatosis

Rapid progression of spinal epidural lipomatosis

Osteopenia and cancer in children and adolescents

Glucocorticoid use in rheumatoid arthritis

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