Osteogenesis and osteoclast inhibition in rheumatoid arthritis patients treated with bisphosphonates alone or in combination with pitavastatin over an 18-month follow-up after more than 4 years of treatment with bisphosphonates.

INTRODUCTION: To investigate the effects of bisphosphonates (Bis) (etidronate, alendronate, and risedronate), alone and in combination with statin, on the BMD (bone mineral density) and bone metabolism of rheumatoid arthritis (RA) patients. METHODS: Seventy-seven RA patients who had been receiving prednisolone (PSL) and Bis for over 4 years were divided into two groups: Bis and Bis + statin (n = 42 and 35; average age, 66.4 and 65.3 years; average disease duration, 24.9 and 20.8 years; average PSL dose, 2.4 and 2.7 mg, respectively). Serum levels of NTX (N-terminal telopeptide of type I collagen), TRACP-5b (tartrate-resistant acid phosphate-5b), PICP (C-terminal propeptide of type I procollagen), and RANKL (receptor activator of NF-κB ligand) were measured over an 18-month period of treatment and follow-up. The BMD levels of the two groups at the radius, lumbar spine, and femoral neck were compared using DXA (dual-energy x-ray absorptiometry). RESULTS: A significant increase was only observed in the BMD of the lumbar spine at 18-months, but the BMDs of the radius and femoral neck decreased during the follow-up period in the Bis group. Meanwhile, a significant increase was observed in the BMD of the lumbar spine in the Bis + statin group during administration and the BMDs of the radius and femoral neck stayed at baseline. Among the markers of bone metabolism, serum NTX was up-regulated after 6 months in the Bis + statin group. Serum TRACP-5b was significantly increased during the follow-up period in the Bis + statin group, but only at 18 months in the Bis group. Serum PICP recovered to base line in the Bis + statin group, whereas that in the Bis group did not observably recover during the post-administration follow-up, but rather decreased. CONCLUSION: Our findings suggest that both bone resorption and bone formation were inhibited by long-term administration of Bis alone, whereas combination therapy with Bis + statin may be associated with a less marked inhibition of bone metabolism. Cardiovascular disease is highly prevalent in RA patients and some patients are prescribed statins and bisphosphonate. Bis + statin may confer more benefit to the bone metabolism of these patients compared to Bis alone.

Osteoclast inhibitory effects of vitamin K2 alone or in combination with etidronate or risedronate in patients with rheumatoid arthritis: 2-year results.

OBJECTIVE: To investigate the effects of vitamin K2 (Vit K2) alone or in combination with etidronate and risedronate on bone loss, osteoclast induction, and inflammation in patients with rheumatoid arthritis (RA). METHODS: Subjects comprised 79 patients with RA who were receiving prednisolone, divided into 3 groups: Group K, Vit K2 alone; Group KE, Vit K2 plus etidronate; and Group KR, Vit K2 plus risedronate. During a 24-month treatment and followup period, levels of N-terminal telopeptide of type I collagen (NTx) and bone alkaline phosphatase were measured. Bone mineral density (BMD) of the 3 groups was measured using dual-energy x-ray absorptiometry. Damage score to fingers on radiographic findings were measured according to the Larsen method. Serum levels of receptor activator of nuclear factor-kappaB ligand (RANKL) and osteoprotegerin (OPG) were measured. RESULTS: Falls in rate of change of BMD decreased after 18 months in groups KR and KE. Larsen damage scores indicated a significant difference between Group KE and other groups. Significant decreases in serum NTx were observed in groups KE and KR at all timepoints, but not in Group K. Levels of RANKL decreased significantly in all 3 groups. CONCLUSION: Vit K2 alone or in combination with bisphosphonates for treatment of osteoporosis in patients with RA may inhibit osteoclast induction via decreases in levels of RANKL.

Comparative study between thromboembolism and total knee arthroplasty with or without tourniquet in rheumatoid arthritis patients.

INTRODUCTION: To investigate whether the occurrence of pulmonary embolism (PE) and/or deep vein thrombosis (DVT) are influenced by use of a tourniquet or not in the patients who underwent total knee arthroplasty for rheumatoid arthritis (RA). PATIENTS AND METHODS: The patients were randomly divided into a with-tourniquet group (19 patients) and a without-tourniquet group (18 patients). In the first group, snowstorm-like echogenic particles were observed after deflation of the tourniquet in all patients according to the transesophageal echocardiography. RESULTS: In addition, the PaO(2) level was significantly decreased. Also, one had a PE, and DVT was confirmed in two patients. In the without-tourniquet group, none of these conditions was noted. CONCLUSION: These results suggest that the use of a tourniquet will promote the risk of developing postoperative PE and/or DVT after total knee arthroplasty.

Expression and localization of vascular endothelial growth factor-C in rheumatoid arthritis synovial tissue.

OBJECTIVE: Vascular endothelial growth factor-C (VEGF-C), a member of the VEGF family, induces lymphangiogenesis through VEGF receptor-3 (VEGFR-3/Flt-4). We examined the expression and localization of VEGF-C to clarify its role in synovial tissues in rheumatoid arthritis (RA). METHODS: Reverse transcription-polymerase chain reaction (RT-PCR), Western blot analysis, immunohistochemical staining, and in situ hybridization for VEGF-C were performed on synovial tissue specimens obtained from 10 patients with RA and 4 with osteoarthritis (OA). VEGFR-3 expression was determined using Western blot analysis. RESULTS: RT-PCR analysis showed that VEGF-C mRNA was expressed in all RA and OA synovial tissues. Based on Western blot analysis, the mature form of VEGF-C was found in RA synovial tissues, but not in OA synovial tissues, and VEGFR-3 was detected in RA and OA synovial tissues. Immunohistochemical staining showed that the VEGF-C protein was localized in many synovial lining cells, endothelial cells, and stromal cells in RA synovial tissues. In OA synovial tissues, the VEGF-C protein was localized in synovial lining cells and endothelial cells. A large number of synovial lining cells and stromal cells surrounding microvessels in RA synovial tissues expressed VEGF-C mRNA, as determined by in situ hybridization. CONCLUSION: Mature VEGF-C and VEGFR-3 expression may contribute to lymphangiogenesis in RA.