Ringe J D
Medizinische Klinik IV, Klinikum Leverkusen, Akademisches Lehrkrankenhaus, Universität zu Köln.
Z Rheumatol. 1996 May-Jun;55(3):149-57.
Juxtaarticular osteoporosis is a typical x-ray symptom of rheumatoid arthritis and is an early radiological criterion of the disease before destructive changes of joints can be seen. A systemic osteoporosis, independent from corticoid treatment, will develop significantly later. Nevertheless both conditions have some pathogenetic mechanisms in common. The risk of generalized osteoporosis in rheumatoid arthritis correlates with the degree of inflammatory activity. Different cytokines originating from the affected joints can be measured in plasma at increased levels and augment osteoclastic activity in bone tissue. During the early phase of disease the best prevention of osteoporosis is therefore adequate suppression of inflammation. Taking into account these mechanisms, corticoid treatment may be osteoprotective. Clinical manifestation of systemic osteoporosis in rheumatic patients depends on bone mass at onset of disease, on the activity of inflammation, and on additional negative effects on bone mass due to corticoids and immobility.
关节周围骨质疏松是类风湿关节炎典型的X线表现，是在关节出现破坏改变之前该疾病早期的影像学标准。全身性骨质疏松与皮质类固醇治疗无关，其出现时间要晚得多。然而，这两种情况在某些发病机制上有共同之处。类风湿关节炎中全身性骨质疏松的风险与炎症活动程度相关。血浆中可检测到来自受累关节的不同细胞因子水平升高，这些细胞因子会增强骨组织中的破骨细胞活性。因此，在疾病早期，预防骨质疏松的最佳方法是充分抑制炎症。考虑到这些机制，皮质类固醇治疗可能具有骨保护作用。风湿性疾病患者全身性骨质疏松的临床表现取决于疾病发作时的骨量、炎症活动以及皮质类固醇和活动减少对骨量产生的额外负面影响。
