Clin Osteol 2012; 17(4): 143-149
Role of biological therapy for osteoporosis in rheumatoid arthritisReview articles
Rheumatoid arthritis (RA) is a frequent, severe inflammatoryjoint disease affecting all age groups, with the peak incidence in young people and premenopausal women. The causes of the disease are multifactorial, including certain genetic predispositions. It is cha racterized by chronic inflammation initiated and maintained by autoimmune mechanisms. The course of RA is rather variable. Acute exacerbations may alternate with periods of remission. Generally, however, the course is progressive, frequently leading to disability The disease may shorten life by tens of years. Rheumatoid arthritis is a heterogeneous disease, with varied disease activity as well as varied pace of the development of structural changes. At the same time, perception of subjective complaints and the impact of disabi lity on the quality of life is also varied. Therapy, aimed at achieving remission, must be timely and aggressive. Apart from traditional DMARDs, better treatment modalities are available, such as biological therapy. Continuous monitoring and safety of RA therapy must be taken into consideration. Comprehensive treatment of RA is complicated by osteoporosis associated with bone destruction, the key sign of RA accompanied by increased osteoclast activity, contributing to local and systemic abnormalities in bone remodeling, such as bone erosion, juxtaarticular osteopenia and systemic osteoporosis. The discovery of the RANK/RANKL/OPG system has brought a new perspective on the mechanism of erosion development in RA. Denosumab is a fully human monoclonal antibody against RANKL, with high specificity and affinity binding to RANKL and inhibiting osteoclast function and survival and thus reducing bo ne resorption. Results of a phase II study confirmed that denosumab therapy added to MTX twice a year, when compared to placebo, inhibits structural damage, improves BMD and decreases bone turnover in RA patients, without an increase in the incidence of ad verse effects.
Keywords: rheumatoid arthritis, clinical picture, basic treatment, biological therapy, osteoporosis
Published: December 11, 2012 Show citation
References
- Gravallese EM, Manning C, Tsay A et al. Synovial tissue in rheumatoid arthritis is a source 43:250-258.
- Schett G, Hayer S, Zwerina J, Redlich K, Smolen JS. Mechanisms of disease: link between RANKL and arthritic bone disease. Nat Clin Pract Rheumatol 2005; 1:47-54.
Go to original source... - Romas E, Gillespie MT, Martin TJ. Involvement of receptor activator of NF kappa B ligand and tumor necrosis factor-alpha in bone destruction in rheum arthritis. Bone 2002;30:340-346. Go to original source...
- McClung MR, Lewiecki EM, Cohen SB, Bolognese MA, Woodson GC, Moffett AH et al. Denosumab in postmenopausal women with low bone mineral density. N Engl J Med 2006;354:821-831. Go to original source...
- Foley-Nolan D, Stack JP, Ryan M et al. Magnetic resonance imaging in the assessment of rheumatoid arthri Br J Rheumatol 1991;30:101-106. Go to original source...
- Cohen SB, Dore RK, Lane NE et al. Denosumab Treatment Effects on Struct Damage, Bone Mineral Density, and Bone Turnover in Rheumatoid Arthritis A Twelve-Month, Multicenter, Randomized, Double-Blind, Placebo-Controlled, Phase II Clinical Trial. Arthritis Rheum 2008;5:1299-1309. Go to original source...
- Deodhar A, Dore RK, Mandel D et al. Denosumab-Mediated Increase in Hand Bone Mineral Density Associated With Decreased Progression ofBone Erosion Rheumatoid Arthritis Patients. Arthritis Care & Research 2010;62:569-574. Go to original source...