Effects of low dose corticosteroids on bone mass in rheumatoid arthritis: a longtitudinal study

Article Abstract:

Rheumatoid arthritis (RA) is a joint disease characterized by inflammation of the joints, stiffness, swelling, enlargement of the cartilage, and pain. Because of the adverse side effects of corticosteroids, these drugs should only be used as a last resort to treat patients who do not respond to more conventional RA therapies. However, a recent study reported that up to 30 percent of patients with RA were taking low-dose corticosteroid treatment. Although corticosteroids relieve joint inflammation, these agents also produce widespread osteoporosis, reduction in bone mass. RA patients are already at high risk for bone loss. It is not clear whether low doses of corticosteroids have similar adverse effects on the bone. Bone mass was evaluated in 15 RA patients treated with low-dose corticosteroids, 15 RA patients who did not receive these drugs, and in 15 normal subjects. Bone loss was assessed by measuring changes in bone mineral density (BMD) in the spine and hip in all of the subjects for up to two years. At the beginning of the study, the initial BMD in the spine and hip was lower in RA patients when compared with normal subjects. However, after a year of follow-up, the rates of bone loss in the spine and hip did not differ among the three groups. These findings suggest that low-dose corticosteroid treatment for RA is not associated with an increased risk for osteoporosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Adrenocortical hormones

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Reduced bone formation in non-steroid treated patients with rheumatoid arthritis

Article Abstract:

Rheumatoid arthritis (RA), an inflammatory joint disease, is characterized by stiffness, swelling, hypertrophy (enlargement) of cartilage tissue, and pain. The prevalence of osteoporosis (bone loss) is higher among patients with RA, and may result from the disease process, the use of steroid therapy, or physical inactivity. Studies have shown that bone loss from the hip occurs in patients with RA, and may result from decreased bone formation, or increased bone turnover, which is the process of production and subsequent breakdown of bone. One study showed that bone loss in RA patients taking salicylates was due to decreased bone formation. Bone remodelling is the resorption or dissolution of old bone followed by the formation of new bone. New bone formation can be determined by measuring the thickness of the trabecular bone in the hip. The causes of trabecular bone loss in rheumatoid arthritis were assessed in 45 non-steroid treated patients. The results show that the thickness of the trabecular bone, which reflects the formation of new bone, was decreased in patients with RA as compared with the same measurement for normal subjects. However, bone resorption and remodelling did not differ among patients and normal subjects. The findings suggest that decreased bone formation is the cause of bone loss in patients with RA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bone diseases

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Adjuvant oestrogen treatment increases bone mineral density in postmenopausal women with rheumatoid arthritis

Article Abstract:

Estrogen may be an effective treatment for reduced bone mineral density in postmenopausal women with rheumatoid arthritis (RA). RA is a chronic inflammatory disorder that affects the joints. Among 33 postmenopausal women with active RA, 15 were treated with estrogen and 18 were treated with a placebo, or an inactive substance, for 52 weeks. Bone mineral density in the lumbar spine and the hip joint increased more in the women treated with estrogen than those who received a placebo. Women in the estrogen group experienced a drop in their blood levels of osteocalcin and an increase in blood levels of sex hormone binding globulin. These changes signify shifts in bone metabolism. Patients in the early stages of RA often experience bone loss around the site of an inflamed joint. RA patients also have a higher risk of developing generalized osteoporosis than other individuals.

Care and treatment, Bone density, Postmenopausal women, Estrogen, Estrogens

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