In a nutshell
This study examined the influence of alendronate (Fosamax) and betamethasone on bone loss in patients with early rheumatoid arthritis.
Some background
Bone loss is a symptom of rheumatoid arthritis. It can occur as a result of the disease itself or as a result of drugs used to treat the disease. Inflammation in the joints can lead to substances being released which cause the surrounding bone to wear away. Glucocorticoids, such as prednisone, are used as a treatment for patients. They help control inflammation, reduce periarticular bone loss (the bone surrounding joints) and bone erosion. However, systemic glucocorticoid treatment (drug circulates around the whole body) can cause axial bone loss (backbones and skull).
Following a diet rich in vitamin D and calcium can help minimize bone loss. The drug alendronate also helps protect against axial bone loss and fractures in patients treated with glucocorticoids. A new treatment strategy that decreases bone loss around the joints, without leading to problems in other bones, would benefit patients.
Methods & findings
In this study the authors investigated whether injecting glucocorticoids directly into the joint could be a useful strategy for preventing bone loss. One hundred and forty patients with early rheumatoid arthritis were included in the study. All patients had been diagnosed within the previous six months and had active disease. Patients were treated with either, combined methotrexate (Rheumatrex, Trexall) and cyclosporin (Neoral, Sandimmune, Gengraf), or methotrexate only. They also received betamethasone (a glucocorticoid) injections into all swollen joints, vitamin D, and calcium. Additionally, 48% of the patients received alendronate treatment.
The injections of betamethasone led to some bone loss in the hand, hip and lumbar spine bone mass, but this was prevented in patients who received alendronate.
The bottom line
Injection of glucocorticoids directly into swollen joints only leads to minimal bone loss, which can be prevented by treatment with alendronate.
Published By :
Annals of the rheumatic diseases
Date :
Jun 01, 2014
This study was limited to people with early RA, but RA related osteoporosis is more common later on. In addition, I paid special attention to the inclusion of Cyclosporin as a treatment choice. II experienced significant permanent hearing loss during treatment with cyclosporine, an infrequent side effect but one for which physicians should alert patients.