Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Dose escalation of the anti-TNF-alpha agents in patients with rheumatoid arthritis. A systematic review.

OBJECTIVE: To estimate the proportion of rheumatoid arthritis (RA) patients on anti-tumour necrosis factor (anti-TNF) who require dose escalation. METHODS: Systematic review of the scientific literature. Infliximab, etanercept and adalimumab studies in RA were considered. Primary outcome was the proportion of patients requiring dose escalation. American College Rheumatology (ACR) and Disease activity score (DAS) responses post-escalation were assessed when available. RESULTS: From 1801 references, 16 studies with 8510 patients were included. Of all the infliximab patients, 53.7% underwent dose escalation. Fourty-four per cent of the infliximab patients experienced dose increase and 8.3%, frequency increase. The ACR20 response to dose escalation ranged from 27 to 36% and DAS28 improved from 5.2 to 4.5 in one study and from 4.1 to 3.7 in another. Of the etanercept patients, 17.5% experienced a dose increase but changes on the mean dose were not statistically significant. CONCLUSIONS: Dose escalation is common in patients treated with infliximab, and less frequent with etanercept. In a proportion of patients, the dose escalation seems effective. The design and evidence level of the available studies limit the strength of the conclusions.

Inhibidores de los leucotrienos: los nuevos antiinflamatorios en el tratamiento de la artrosis / Leukotriene inhibitors: the new anti-inflammatory agents in the treatment of osteoarthritis

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Horizontes en el tratamiento farmacológico de la osteoporosis / Horizons in the pharmacological treatment of osteoporosis

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Eficacia y seguridad de los aminobifosfonatos en el tratamiento de la osteoporosis postmenopáusica / Efficacy and safety of the aminobisphosphonate in the treatment of postmenopausal osteoporosis

Los aminobifosfonatos son una familia de fármacos muy utilizados en el tratamiento de la osteoporosis postmenopáusica, una enfermedad con elevada incidencia y prevalencia debido fundamentalmente al envejecimiento de la población. En esta revisión se recogen los hallazgos más importantes en cuanto a eficacia y seguridad de la experimentación preclínica y clínica con los aminobifosfonatos más estudiados en osteoporosis postmenopáusica, con especial foco en el alendronato por ser el más utilizado en nuestro país.Los bifosfonatos aminados son eficaces en la prevención de las fracturas osteoporóticas, tanto vertebrales como no vertebrales, presentando los máximos niveles de evidencia entre los métodos actualmente aprobados para el tratamiento de la osteoporosis postmenopáusica. Las acciones positivas sobre fracturas se mantienen durante toda la duración del tratamiento a muy largo plazo (datos disponibles hasta 10 años con alendronato y 7 años con risedronato), lo que sumado a los resultados de estudios histomorfométricos y microrradiográficos de biopsias en animales y humanos tratados, hacen muy improbable que el tratamiento continuado con bifosfonatos aminados durante largos períodos tenga efectos deletéreos sobre la calidad ósea. En conjunto, los aminobifosfonatos son una de las herramientas terapéuticas más útiles actualmente disponibles para el tratamiento de la osteoporosis postmenopáusica (AU)

Impacto de la introducción de rofecoxib en el tratamiento de la artrosis: resultados del estudio VICOXX / Impact of the introduction of rofecoxib in the treatment of osteoarthritis: results of the VICOXX study

Objetivos: Conocer el impacto de la introducción de rofecoxib sobre la satisfacción de pacientes y médicos y sobre la coprescripción de fármacos gastrointestinales, en pacientes con artrosis sintomática, en un entorno de práctica clínica en centros de atención primaria españoles. Pacientes y métodos: Estudio prospectivo, multicéntrico y observacional de seguimiento de una cohorte de 562 pacientes diagnosticados de artrosis en tratamiento con antiinflamatorios no esteroideos (AINE) no selectivos, en el que han participado 29 centros de atención primaria españoles. El período de seguimiento incluye 3 meses en tratamiento con AINE no selectivos y 3 meses tras el cambio a rofecoxib. Resultados: Durante el período en tratamiento con rofecoxib, se observa una reducción del 67,8 por ciento en la aparición de efectos adversos gastrointestinales atribuibles al antiinflamatorio y una reducción próxima al 50 por ciento en la utilización de fármacos gastrointestinales. Más del 80 por ciento de los pacientes refiere encontrarse satisfecho con el tratamiento durante el período con rofecoxib frente a un 48 por ciento durante el tratamiento con AINE. El porcentaje de médicos y pacientes que valoran como bueno o muy bueno el estado de salud del paciente aumenta tras la inclusión de rofecoxib: el 59 y el 52 por ciento, respectivamente, frente al 27 y el 21 por ciento con AINE. Asimismo, las puntuaciones del cuestionario WOMAC evidencian una mejoría en la sintomatología de los pacientes. Conclusiones: En los pacientes con artrosis sintomática, la introducción de rofecoxib produce disminución de los efectos adversos gastrointestinales, reducción de la coprescripción de medicación profiláctica y terapéutica gastrointestinal, así como un incremento de los Impacto de la introducción de rofecoxib en el tratamiento de la artrosis: resultados del estudio VICOXX valores de satisfacción de pacientes y médicos. Estos hechos, tomados en su conjunto, deberán tenerse en cuenta al analizar el coste comparativo de las diferentes intervenciones terapéuticas. (AU)

Documento de la sociedad española de reumatología sobre la osteoporosis posmenopáusica . Panel de expertos / Postmenopausal osteoporosis: Expert's opinion on diagnostic, prevention and treatment

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[Effect of alendronate on bone mineral density and incidence of fractures in postmenopausal women with osteoporosis. A meta-analysis of published studies]. / Efecto del alendronato sobre la densidad mineral ósea y la incidencia de fracturas en mujeres posmenopáusicas con osteoporosis. Un metaanálisis de los estudios publicados.

BACKGROUND: To perform a systematic review, completed with a meta-analysis, of the published evidences about the effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal women with low bone mass. METHODS: We search for all alendronate clinical trials in postmenopausal women with low bone mass which were randomized, double blind, placebo controlled, with a duration of one year or more and with bone mineral density measurement and/or fractures as outcomes. We used the weighted average of individual study results as an estimation of the global effect. RESULTS: Seven studies meet all the inclusion criteria. Relative Risks (RR) with 95% Confidence Intervals (CI 95%) for the combined effect under fixed effects model were: RR 0.54 (CI 95%: 0.45 to 0.66) for vertebral fractures, RR 0.81 (CI 95%: 0.72 to 0.92) for non vertebral fractures and RR 0.64 (CI 95%: 0.40 to 1.01) for hip fractures. CONCLUSIONS: Our results demonstrate that alendronate reduces the risk of vertebral, non vertebral and hip fractures in postmenopausal women with low bone mass. This meta-analysis allows the classification of alendronate anti-fracture evidences in the highest level.

Extramedullary hematopoiesis related to Paget's disease.

Extramedullary hematopoiesis usually occurs in hematological diseases but may also be found as an uncommon complication of Paget's disease, probably due to bone effraction mechanism. We present a case of intrathoracic extramedullary hematopoiesis related to Paget's disease. To our knowledge, this is the seventh case reported in the literature. We describe and correlate the conventional X-ray, CT, MR imaging, and cytological findings.

[Epidemiology of the osteoporotic fracture of the hip in the province of Palencia]. / Epidemiología de la fractura osteoporótica de cadera en la provincia de Palencia.

BACKGROUND: Hip fracture is the most severe consequence of osteoporosis. The aim of the present study was to know the incidence of osteoporotic hip fracture in the Palencia province, its direct economical consequences and characteristics associated with the origin episode. PATIENTS AND METHODS: All patients aged over 49 years who had a nontraumatic hip fracture during the second semester of 1994 and the first semester of 1995 were included in the study. An analysis of costs was performed and each patient received a questionnaire to know the circumstances associated with the episode. RESULTS: During the study period the overall incidence of hip fracture was 83/100,000 inhabitants/year, which corresponds to an adjusted incidence of 240.9/100,000 inhabitants older than 49 years (336.8 women and 120.7 men). There was an exponential growth, with peak values starting at 80 years. The female/male ratio was 2.8 and the mean age 80.8 years. Twenty-four percent of fractures occurred in institutionalized persons, with an adjusted incidence of 1,107/100,000 inhabitants/year, which corresponds to a relative risk of 13.57 (95% CI: 10.06-18.28). No significant differences were observed between trochanteric and neck fractures. Ninety-seven percent of fractures occurred after a fall, usually in the morning or afternoon (86%), with lateral direction and impact on the greater trochanter (89%). The mortality rate during admission was 5.9%. The mean cost of care during admission was 1,170,000 pesetas. CONCLUSIONS: The incidence of hip fracture in Palencia is slightly higher than the national mean, probably due to populational ageing. The risk of fracture reaches alarming proportions in the institutionalized population. The implementation of efficient preventive measures, particularly among the exposed populations, is necessary.

[The treatment of Paget's disease of bone with second-generation bisphosphonates via intravenous infusion]. / Tratamiento de la enfermedad ósea de Paget con bifosfonatos de segunda generación en infusión intravenosa.

We compared the biochemical effects and safety of pamidronate (30 mg a day for 3 consecutive days) versus clodronate (300 mg a day for 3 consecutive days) via intravenous infusion in 14 patients with Paget's disease of bone (PDB). Both drugs induced a decrease in serum alkaline phosphatase levels as well as the elimination of hydroxyproline from urine, an effect most marked in the group treated with pamidronate. The response was maintained for 6 months after the infusion in the majority of the patients. No relevant side effects were found, except post-infusion febricula and in one patient, self-limiting thrombopenia 6 months after the infusion. We conclude that the intravenous infusion of either of the two drugs may constitute a safe and effective alternative for treatment of PDB with marked biochemical activity or resistant to conventional therapy.

Suprascapular nerve entrapment of occupational etiology: clinical and electrophysiological characteristics.

In this paper we report the clinical and electrophysiological study of a patient with suprascapular nerve entrapment. The patient was initially diagnosed as having shoulder pain due to tendinitis, since his job involved continuous loading of the affected shoulder with heavy weights. Later, clinical exploration revealed wasting of the supra and infraspinatus muscles. Electrophysiological study confirmed the diagnosis of a neuropathy of the suprascapular nerve at the level of the coracoid notch, which improved with conservative treatment. This case report stresses the importance of suprascapular nerve entrapment as a causal factor for shoulder pain; it has an occupational origin which should be taken into account in the differential diagnosis of shoulder pain syndromes.

Goodpasture's syndrome in a patient receiving penicillamine and carbimazole.

A 51-year-old woman with advanced rheumatoid arthritis developed a Goodpasture's syndrome during treatment with penicillamine and carbimazole. Circulating antiglomerular basement membrane antibodies (anti-GBM) were present. Renal biopsy showed focal necrotizing glomerulonephritis with crescents, and HLA typing showed the presence of DR3 and DR4. The patient responded dramatically to pulse methylprednisolone and cyclophosphamide, with both clinical remission and disappearance of anti-GBM antibodies.