Di Fede O, Bedogni A, Giancola F, Saia G, Bettini G, Toia F, D'Alessandro N, Firenze A, Matranga D, Fedele S, Campisi G
Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Department of Neurosciences, University of Padua, Padua, Italy.
Oral Dis. 2016 Sep;22(6):543-8. doi: 10.1111/odi.12490. Epub 2016 May 27.
Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of various medications (bisphosphonates, anti-resorptive, and anti-angiogenic drugs). ONJ pathogenesis is still unclear although some risk factors have been recognized. Of these, rheumatoid arthritis (RA) has been hypothesized as a potential risk factor for developing ONJ. This observational study will describe a multicenter case series of patients affected with RA and ONJ, and it will attempt to evaluate the association between features of ONJ and pharmacological, systemic, and site variables.
Demographic, pharmacological, and clinical data from 18 RA patients with ONJ were collected and registered from three Italian centers (i.e., Palermo, Verona, and Padua) from 2004 to 2013.
Sixteen (88.9%) patients were in therapy for RA: 9 of 18 (50.0%) with systemic steroids, 3 of 18 (16.7%) with methotrexate, and 4 of 18 (22.2%) with both medications. Two patients were not receiving treatment for RA. All patients took NBPs for secondary osteoporosis (average NBP duration of 69 months, range: 20-130): Fifteen (83.3%) patients were treated with single NBPs, while three (16.7%) with different molecules; one patient was also treated with denosumab. Mandible was affected more frequently (66.7%) than maxilla (33.3%); one patient presented multiple ONJ events.
This is the first multicenter case series in the international literature regarding our topic. Focusing on our data, it could be hypothesized that patients with RA may be more susceptible to ONJ than the majority of osteometabolic patients. In our opinion, it could be important to monitor also denosumab or other biological drug side effects.
颌骨骨坏死（ONJ）是多种药物（双膦酸盐、抗吸收和抗血管生成药物）潜在的严重不良反应。尽管已识别出一些风险因素，但ONJ的发病机制仍不清楚。其中，类风湿关节炎（RA）被认为是发生ONJ的潜在风险因素。本观察性研究将描述一组多中心RA合并ONJ患者的病例系列，并试图评估ONJ特征与药理学、全身及部位变量之间的关联。
收集并记录了2004年至2013年期间来自意大利三个中心（即巴勒莫、维罗纳和帕多瓦）的18例RA合并ONJ患者的人口统计学、药理学和临床数据。
16例（88.9%）患者正在接受RA治疗：18例中有9例（50.0%）使用全身用类固醇，18例中有3例（16.7%）使用甲氨蝶呤，18例中有4例（22.2%）同时使用这两种药物。2例患者未接受RA治疗。所有患者均因继发性骨质疏松服用双膦酸盐类药物（双膦酸盐类药物平均使用时长69个月，范围：20 - 130个月）：15例（83.3%）患者使用单一双膦酸盐类药物，3例（16.7%）使用不同分子的双膦酸盐类药物；1例患者还接受了地诺单抗治疗。下颌骨受累更为常见（66.7%），而上颌骨受累较少（33.3%）；1例患者出现多处ONJ事件。
这是国际文献中关于本主题的首个多中心病例系列。基于我们的数据，可以推测RA患者可能比大多数骨代谢患者更容易发生ONJ。我们认为，监测地诺单抗或其他生物药物的副作用也可能很重要。
