Остеопороз и саркопения у больных ревматоидным артритом: как предотвратить костно-мышечные потери
Остеопороз и саркопения у больных ревматоидным артритом: как предотвратить костно-мышечные потери
Мурадянц А.А., Шостак Н.А., Кондрашов А.А., Тимофеев В.Т. Остеопороз и саркопения у больных ревматоидным артритом: как предотвратить костно-мышечные потери. Consilium Medicum. 2016; 18 (2): 134–140. DOI: 10.26442/2075-1753_2016.2.134-140
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Muradyants A.A., Shostak N.A., Kondrashov A.A., Timofeev V.T. Osteoporosis and sarcopenia in patients with rheumatoid arthritis: the ways to prevent musculoskeletal loss. Consilium Medicum. 2016; 18 (2): 134–140. DOI: 10.26442/2075-1753_2016.2.134-140
Остеопороз и саркопения у больных ревматоидным артритом: как предотвратить костно-мышечные потери
Мурадянц А.А., Шостак Н.А., Кондрашов А.А., Тимофеев В.Т. Остеопороз и саркопения у больных ревматоидным артритом: как предотвратить костно-мышечные потери. Consilium Medicum. 2016; 18 (2): 134–140. DOI: 10.26442/2075-1753_2016.2.134-140
________________________________________________
Muradyants A.A., Shostak N.A., Kondrashov A.A., Timofeev V.T. Osteoporosis and sarcopenia in patients with rheumatoid arthritis: the ways to prevent musculoskeletal loss. Consilium Medicum. 2016; 18 (2): 134–140. DOI: 10.26442/2075-1753_2016.2.134-140
Ревматоидный артрит (РА) относится к числу наиболее распространенных и тяжелых хронических иммуновоспалительных заболеваний, приводящих к ранней инвалидизации больных и высокому уровню преждевременной смертности. Больные РА наряду с остеопорозом и остеопенией имеют значимое снижение мышечной массы в виде саркопении и/или кахексии. Костно-мышечные потери при РА обусловливают высокий риск падений и переломов, что значительно ухудшает прогноз. В статье рассмотрены основные патогенетические механизмы развития остеопороза и саркопении при РА, факторы риска, а также основные подходы к лечению и профилактике костно-мышечных потерь у больных РА.
Ключевые слова: остеопороз, саркопения, ревматоидный артрит, препараты кальция и витамин D.
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Rheumatoid arthritis (RA) is one of the most common and serious chronic immunoinflammatory diseases, leading to early disability of patients and the high levels of premature mortality. Patients with RA along with osteoporosis and osteopenia have shown significant reductions in muscle mass of sarcopenia and/or cachexia. Musculoskeletal loss in RA causes a high risk of falls and fractures, which significantly worsens the prognosis. In the article the basic pathogenetic mechanisms of the development of osteoporosis and sarcopenia in RA risk factors, as well as the main approaches to treatment and prevention of bone and muscle loss in RA patients are covered.
Key words: osteoporosis, sarcopenia, rheumatoid arthritis, calcium supplements and vitamin D.
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25. Giles JT, Allison M, Blumenthal RS et al. Abdominal adiposity in rheumatoid arthritis: Association with cardiometabolic risk factors and disease characteristics. Arthritis Rheum 2010; 62 (11): 3173–82.
26. Marcora SM, Chester KR, Mittal G et al. Randomized phase 2 trial of anti-tumor necrosis factor therapy for cachexia in patients with early rheumatoid arthritis. Am J Clin Nutr 2006; 84: 1463–72.
27. Crepaldi G, Maggi S. Sarcopenia and osteoporosis: A hazardous duet. J Endocrinol Invest 2005; 28 (10): 66–8.
28. Binkley N, Buehring B. Beyond FRAX: it's time to consider "sarco-osteopenia". J Clin Densitom 2009; 12: 413–6.
29. Drey M, Sieber CC, Bertsch T et al. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res 2015 Nov 12. [Epub ahead of print]
30. Walsh MC, Hunter GR, Livingstone MB. Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density. Osteoporos Int 2006; 17: 61–7.
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37. Minaur NJ, Kounali D, Vedi S et al. Methotrexate in the treatment of rheumatoid arthritis. II. In vivo effects on bone mineral density. Rheumatol (Oxford) 2002; 41 (7): 741–9.
38. Di Munno O, Mazzantini M, Sinigaglia L et al. Effect of low dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study. J Rheumatol 2004; 31 (7): 1305–9.
39. O’Dell JR, Mikuls TR, Taylor TH et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med 2013; 369 (4): 307–18.
40. Kobayashi Y, Ueyama S, Arai Y et al. The active metabolite of leflunomide, A771726, inhibits both the generation of and the bone-resorbing activity of osteoclasts by acting directly on cells of the osteoclast lineage. J Bone Miner Metab 2004; 22 (4): 318–28.
41. Sakthiswary R, Das S. The effects of TNF a antagonist therapy on bone metabolism in rheumatoid arthritis: a systematic review. Curr Drug Targ 2013; 14 (13): 1552–7.
42. Chopin F, Garnero P, le Henanff A et al. Long-term effects of infliximab on bone and cartilage turnover markers in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67 (3): 353–7.
43. Kim SY, Schneeweiss S, Liu J et al. Effects of disease-modifying antirheumatic drugs on nonvertebral fracture risk in rheumatoid arthritis: A population‐based cohort study. J Bone Min Res 2012; 27 (4): 789–96.
44. Kume K, Amano K, Yamada S et al. The effect of tocilizumab on bone mineral density in patients with methotrexate-resistant active rheumatoid arthritis. Rheumatol 2014; 53 (5): 900–3.
45. Garnero P, Thompson E, Woodworth T et al. Rapid and sustained improvement in bone and cartilage turnover markers with the anti-interleukin-6 receptor inhibitor tocilizumab plus methotrexate in rheumatoid arthritis patients with an inadequate response to methotrexate: Results from a substudy of the multicenter double-blind, placebo-controlled trial of tocilizumab in inadequate responders to methotrexate alone. Arthritis Rheum 2010; 62 (1): 33–43.
46. Wheater G, Hogan VE, Teng YK et al. Suppression of bone turnover by B-cell depletion in patients with rheumatoid arthritis. Osteoporosis Int 2011; 22 (12): 3067–72.
47. Klein RG, Arnaud SB, Gallagher JC et al. Intestinal absorption in exogenous hypercortisolism: role of 25-hydroxyvitamin D and corticosteroid dose. J Clin Invest 1977; 60: 253–9.
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1. Revmatologiia. Klinicheskie rekomendatsii. Pod red. E.L.Nasonova. M.:GEOTAR-Media, 2010; s. 90–230. [in Russian]
2. Мikuls TR, Fay BT, Michaud K et al. Associations of disease activity and treatments with mortality in men with rheumatoid arthritis: results from the VARA registry. Rheumatology (Oxford) 2011; 50: 101–9.
3. Nasonov E.L., Skripnikova I.A., Nasonova V.A. Problema osteoporoza v revmatologii. M.: Stin, 1997. [in Russian]
4. Gough AK, Lilley J, Eyre S et al. Generalized bone loss in patient with early rheumatoid arthritis. Lancet 1994; 344 (8914): 23–7.
5. Goldring SR. The effects of inflammatory arthritis on bone remodeling. Arthritis Res 2005; 7 (Suppl. 1): S12.
6. Bezerra MC, Carvalho JF, Prokopowitsch AS, Pereira RM. RANK, RANKL and osteoprotegerin in arthritic bone loss. Braz J Med Biol Res 2005; 38 (2): 161–70
7. Forsblad d'Elia H, Larsen A, Waltbrand E et al. Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis. Ann Rheum Dis 2003; 62 (7): 617–23.
8. Solomon DH, Finkelstein JS, Shadick N et al. The relationship between focal erosions and generalized osteoporosis in postmenopausal women with rheumatoid arthritis: the osteoporosis in rheumatoid arthritis (OPiRA) cohort study. Arthr Rheum 2009; 60: 1624–31.
9. Fardellone P, Séjourné A, Paccou J, Goëb V. Bone Remodelling Markers in Rheumatoid Arthritis. Med Inflam 2014, Article ID 484280. http://dx.doi.org/10.1155/2014/484280
10. Taskina E.A., Alekseeva L.I., Dydykina I.S. i dr. Faktory riska razvitiia osteoporoza u bol'nykh revmatoidnym artritom. Nauch.-prakt. revmatologiia. 2014; 52 (4): 393–7. [in Russian]
11. Gukasian D.A., Balabanova R.M., Smirnov A.V., Nasonov E.L. Izuchenie vzaimosviazi mezhdu mineral'noi plotnost'iu kostnoi tkani i kliniko-laboratornymi pokazateliami aktivnosti revmatoidnogo artrita. Nauch.-prakt. revmatologiia. 2005; 1: 18–21. [in Russian]
12. Sinigaglia L, Nervetti A, Mela Q et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 2000; 27: 2582–9.
13. Güler-Yüksel M, Allaart CF, Goekoop-Ruiterman YP et al. Changes in hand and generalised bone mineral density in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis 2009; 68 (3): 330–6.
14. Deodhar AA, Woolf AD. Bone mass measurement and bone metabolism in rheumatoid arthritis: a review. Br J Rheumatol 1996; 35 (4): 309–22.
15. Muradiants A.A., Shostak N.A. Vtorichnyi osteoporoz: osobennosti techeniia i terapii pri revmatoidnom artrite. Vestn. RGMU. 2005; 8 (47): 70–4. [in Russian]
16. Benevolenskaia L.I. Problema osteoporoza v sovremennoi meditsine. Nauch.-prakt. revmatologiia. 2005; 1: 4–7. [in Russian]
17. Haugeberg G, Strand A, Kvien TK, Kirwan JR. Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis: results from a randomized placebo-controlled trial. Arch Intern Med 2005; 165 (11): 1293–7.
18. Habib GS, Haj S. Bone mineral density in patients with early rheumatoid arthritis treated with corticosteroids. Clin Rheumatol 2005; 24 (2): 129–33.
19. Kanis JA, Burlet N, Cooper C et al. European guidance for the diagnosis and management of оsteoporosis in postmenopausal women. Osteoporos Int 2008; 19: 399–428.
20. Van Staa TP, Geusens P, Bijlsma JW et al. Clinical assessment of the long-term risk of fracture in patients with rheumatoid arthritis. Arthritis Rheum 2006, 54: 3104–12.
21. Evans WJ, Morley JE, Argiles J et al. Cachexia: a new defenition. Clin Nutr 2008; 27 (6): 793–9.
22. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39 (4): 412–23.
23. Baumgartner RN, Koehler KM, Romero LJ et al. Epidemiology of sarcopenia in elderly people in New Mexico. Am J Epidemiol 1998; 147: 744–63.
24. Roubenoff R. Sarcopenia: effects on body composition and function. J Gerontol A Biol Sci Med Sci 2003; 58 (11): 1012–7.
25. Giles JT, Allison M, Blumenthal RS et al. Abdominal adiposity in rheumatoid arthritis: Association with cardiometabolic risk factors and disease characteristics. Arthritis Rheum 2010; 62 (11): 3173–82.
26. Marcora SM, Chester KR, Mittal G et al. Randomized phase 2 trial of anti-tumor necrosis factor therapy for cachexia in patients with early rheumatoid arthritis. Am J Clin Nutr 2006; 84: 1463–72.
27. Crepaldi G, Maggi S. Sarcopenia and osteoporosis: A hazardous duet. J Endocrinol Invest 2005; 28 (10): 66–8.
28. Binkley N, Buehring B. Beyond FRAX: it's time to consider "sarco-osteopenia". J Clin Densitom 2009; 12: 413–6.
29. Drey M, Sieber CC, Bertsch T et al. Osteosarcopenia is more than sarcopenia and osteopenia alone. Aging Clin Exp Res 2015 Nov 12. [Epub ahead of print]
30. Walsh MC, Hunter GR, Livingstone MB. Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density. Osteoporos Int 2006; 17: 61–7.
31. Di Monaco M, Vallero F, Di Monaco R, Tappero R. Prevalence of sarcopenia and its association with osteoporosis in 313 older women following a hip fracture. Arch Gerontol Geriatr 2011; 52: 71–4.
32. Kostoglou-Athanassiou I, Athanassiou P, Lyraki A et al. Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab 2012; 3 (6): 181–7.
33. Burton LA, Sumukadas D. Optimal management of sarcopenia. Clin Interv Aging 2010; 5: 217–28.
34. Jankosky C, Deussing E, Gibson R, Haverkos H. Viruses and vitamin D in the etiology of type 1 diabetes mellitus and multiple sclerosis. Virus Res 2012; 163: 424–30.
35. Smolen JS, Breedveld FC, Burmester GR et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis 2016; 75 (1): 3–15.
36. Vis M, Güler-Yüksel M, Lems WF. Can bone loss in rheumatoid arthritis be prevented? Osteoporosis Int 2013; 24 (10): 2541–53.
37. Minaur NJ, Kounali D, Vedi S et al. Methotrexate in the treatment of rheumatoid arthritis. II. In vivo effects on bone mineral density. Rheumatol (Oxford) 2002; 41 (7): 741–9.
38. Di Munno O, Mazzantini M, Sinigaglia L et al. Effect of low dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study. J Rheumatol 2004; 31 (7): 1305–9.
39. O’Dell JR, Mikuls TR, Taylor TH et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med 2013; 369 (4): 307–18.
40. Kobayashi Y, Ueyama S, Arai Y et al. The active metabolite of leflunomide, A771726, inhibits both the generation of and the bone-resorbing activity of osteoclasts by acting directly on cells of the osteoclast lineage. J Bone Miner Metab 2004; 22 (4): 318–28.
41. Sakthiswary R, Das S. The effects of TNF a antagonist therapy on bone metabolism in rheumatoid arthritis: a systematic review. Curr Drug Targ 2013; 14 (13): 1552–7.
42. Chopin F, Garnero P, le Henanff A et al. Long-term effects of infliximab on bone and cartilage turnover markers in patients with rheumatoid arthritis. Ann Rheum Dis 2008; 67 (3): 353–7.
43. Kim SY, Schneeweiss S, Liu J et al. Effects of disease-modifying antirheumatic drugs on nonvertebral fracture risk in rheumatoid arthritis: A population‐based cohort study. J Bone Min Res 2012; 27 (4): 789–96.
44. Kume K, Amano K, Yamada S et al. The effect of tocilizumab on bone mineral density in patients with methotrexate-resistant active rheumatoid arthritis. Rheumatol 2014; 53 (5): 900–3.
45. Garnero P, Thompson E, Woodworth T et al. Rapid and sustained improvement in bone and cartilage turnover markers with the anti-interleukin-6 receptor inhibitor tocilizumab plus methotrexate in rheumatoid arthritis patients with an inadequate response to methotrexate: Results from a substudy of the multicenter double-blind, placebo-controlled trial of tocilizumab in inadequate responders to methotrexate alone. Arthritis Rheum 2010; 62 (1): 33–43.
46. Wheater G, Hogan VE, Teng YK et al. Suppression of bone turnover by B-cell depletion in patients with rheumatoid arthritis. Osteoporosis Int 2011; 22 (12): 3067–72.
47. Klein RG, Arnaud SB, Gallagher JC et al. Intestinal absorption in exogenous hypercortisolism: role of 25-hydroxyvitamin D and corticosteroid dose. J Clin Invest 1977; 60: 253–9.
48. Reid IR, Bolland MJ, Grey A. Effects of vitamin D supplements on bone mineral density: a systematic review and meta-analysis. Lancet 2014; 383 (9912): 146–55.
49. Avenell A, Mak JC, O’Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev 2014; 4.
50. Gallagher JC, Sai A, Templin T et al. Dose response to vitamin D supplementation in postmenopausal women: a randomized trial. Annals of Internal Medicine 2012; 156 (6): 425–37.
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ГБОУ ВПО Российский национальный исследовательский медицинский университет им. Н.И.Пирогова Минздрава России. 117997, Россия, Москва, ул. Островитянова, д. 1
*elitarsoft@list.ru
N.I.Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation. 117997, Russian Federation, Moscow, ul. Ostrovitianova, d. 1
*elitarsoft@list.ru