Department of Rheumatology, North West Clinics , Alkmaar, The Netherlands.
Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Rheumatology and Immunology Center , Amsterdam, The Netherlands.
Expert Opin Pharmacother. 2020 Oct;21(14):1725-1737. doi: 10.1080/14656566.2020.1787381. Epub 2020 Jul 1.
Rheumatoid arthritis (RA) is a chronic disabling disease characterized by a symmetrical articular involvement due to ongoing joint inflammation, if left insufficiently treated. Local and generalized bone loss is one of the main extra-articular complications of RA and leads to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy. Therefore, there is an urgent need for good fracture risk management in the vulnerable RA patient.
The authors review: the epidemiology and pathophysiology (i.e. risk factors) of osteoporosis (OP), fracture, and vertebral fracture risk assessment, the effects of anti-rheumatic drugs on bone loss, pharmacological treatment of OP in RA including both bisphosphonates (BP) and newer drugs including anti-resorptives and osteoanabolic treatment options.
Patients with active RA have elevated bone resorption and local bone loss. Moreover, these patients are at increased risk for generalized bone loss, vertebral and non-vertebral fractures. Since general risk factors (such as low BMI, fall risk) and RA-related factors play a role, optimal fracture prevention in RA patients is based on optimal diagnostics based on both of these factors, and on the use of adequate non-medical and medical treatment options.
类风湿关节炎（RA）是一种慢性致残性疾病，其特征为关节炎症持续存在，导致关节对称性受累，如果治疗不充分。局部和全身骨质流失是 RA 的主要关节外并发症之一，会增加脆性骨折的风险，进一步损害功能能力、生活质量和预期寿命。因此，RA 患者这一脆弱群体亟需良好的骨折风险管理。
作者回顾了：骨质疏松症（OP）、骨折和椎体骨折风险评估的流行病学和病理生理学（即危险因素）、抗风湿药物对骨质流失的影响、RA 中 OP 的药物治疗，包括双膦酸盐（BP）和新型药物，包括抗吸收药物和促合成代谢治疗选择。
活动期 RA 患者存在骨吸收增加和局部骨质流失。此外，这些患者发生全身骨质流失、椎体和非椎体骨折的风险增加。由于一般危险因素（如低 BMI、跌倒风险）和 RA 相关因素起作用，RA 患者的最佳骨折预防基于基于这些因素的最佳诊断，以及适当的非药物和药物治疗选择的使用。
