Search

Background and Objective Clodronate is a nitrogen-free bisphosphonate that is widely and effectively used in the treatment of many osteo-metabolic disorders. The objective of our study was to evaluate the effectiveness of clodronate in reducing pain and bone marrow edema in knee osteoarthritis. Methods In total, 74 patients were included in the study. Group 1 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 11.5 months; group 2 received intramuscular clodronate 200 mg daily for 15 days and then once weekly for the next 2.5 months. Visual analog scale (VAS) scores were recorded at baseline (T0) and after 30 days (T1), 3 months (T2), 6 months (T3), 9 months (T4), and 12 months (end of study; T5). We also evaluated functional status and use of paracetamol (T0, T1, T2, T3, T4, and T5) and changes in Whole Organ Magnetic Resonance Imaging Score (WORMS; T0, T2, and T5). Results Both groups had a statistically significant reduction in VAS score until 3 months. Group 1 then experienced further VAS reductions, whereas VAS scores for group 2 progressively increased. Pain, stiffness, and physical function also showed the same trend, as did bone marrow edema extension, which was evaluated with WORMS. Conclusion Our study indicates that intramuscular administration of a therapeutic dose of clodronate followed by a maintenance dose is effective in the management of symptomatic knee osteoarthritis, improving functional outcomes and reducing pain and bone marrow edema. Prolonged treatment increases the long-term efficacy of clodronate compared with the shorter schedule.

Background juxta-articularosteoporosis, erosionsand systemic osteoporosis are the three main radiological features in patients affected by rheumatoid arthritis. A series of studies have emphasized the close relationship between disease activity and bone loss, suggesting a common pathogenetic mechanism regardinosteoporosis and joints erosion. Tocilizumab is a interleukin-6 receptor-inhibiting monoclonal antibody, able to bind with high affinity to both soluble form and membrane receptor. Currently there are no data regarding the efficacy of tocilizumab on fracture risk and bone mass. Objectives The aim of our study was to evaluate the changes in BMD and some markers of bone metabolism in patients with active rheumatoid arthritis treated with tocilizumab. Methods All patients referred to our outpatent clinic fromNovember 2010to November2011 affected with rheumatoid arthritis, according to ACR 1987 criteria and eligible to receive tocilizumab infusion were enrolled to the study.Patients underwent infusion therapy with tocilizumab, 8 mg/kg, monthly and performed a bone densitometry at baseline and after 1 year of therapy. ESR, CRP, IL6, crosslaps and a whole series of bone metabolism markers (OPG, RANKL, DKK1) were evaluated at baseline, after six months and at 1 year after beginning of the therapy. The following pivariables were assessed and recorded: sex, age, disease duration, previous or contemprorary use of DMARDs steroids. Results 18 patients were enrolled, but of these 6 patients discontinued therapy in the first year of treatment, 3 patients due for ineffectiveness and 3 because of infectious complications. The data of 12 patients were used for the statistic analysis. One patient was osteoporotic, 9 osteopenic and 2 had a normal bone mineralization. All patients had failed at least one anti-TNF alpha. After one year of treatment a significant increase in bone mineral density at L1-L4 (p=0.02) was detected. An increase, although not significant was also highlighted for the BMD of the total femour, with no variation in total body BMD and femoral neck. The ESR and CRP decreased at 6 months and remained low at 1 year. No statistically significant change was observed for serum IL-6, serum crosslaps, OPG, DKK1, RANKL during the observation period; there was a downward trend for the Serum Cross Laps, IL6 and DKK1. There was a negative statistically significant correlation between the BMD of the lumbar spine and IL6 (-0.70, p=0.04) and between BMD of the lumbar spine and serum Cross Laps (-0.59, p=0.05). There was a positive non significant correlation between the total and neck femur with osteoprotegerin (0.45). There was a negative non significant correlation between ESR and CRP (decreased) and bone mineral density, osteoprotegerin/RANKL, DKK1 (increased). Conclusions Our work shows that Tocilizumab has a protective effect on bone, resulting in reduced bone resorption process and increased bone formation. More studies are needed to confirm our preliminary data References C. J. Edwards and E. Williams. The role of interleukin-6 in rheumatoid arthrtitis-assiociated osteoporosis. Osteoporos Int (2010); 21: 1287-93 K. Katsuaki, N. Atsushi, I. Yasuo and H. Kaori. Osteoprotegerin expression in bone marrow by treatment with tocilizumab in rheumatoid arthrtitis. Rheumatolo Int 2011 Jul 26 Disclosure of Interest None Declared

Clodronate is a bisphosphonate used for the treatment of postmenopausal osteoporosis and all conditions characterized by excess bone resorption. We have previously reported that intramuscular (IM) therapy with clodronate at a dose of 100 mg/week displays significant effects on bone mineral density (BMD) although a plateau effect is observed after 1 year of treatment. Previous reports indicate that the densitometric effects of bisphosphonates directly correlate with the drug dosage and suggest that using IM clodronate at doses higher than 100 mg/week may result in improved efficacy. However, to the best of our knowledge, this has never been proved.The primary endpoint of the study was the effect on BMD of IM clodronate 100 mg once weekly or 100 mg twice weekly in patients with postmenopausal osteoporosis. The incidence of non-traumatic vertebral fractures and adverse events was also reported.The present study was a randomized, open-label, parallel-group trial conducted between January 2007 and December 2009 in the Osteoporosis and Osteoarticular Instrumental Diagnosis Centre (University of Siena, Siena, Italy). The study involved 60 women, aged 57-78 years, with a history of postmenopausal osteoporosis for more than 5 years. Patients were randomized to receive IM clodronate 100 mg once weekly (Group A, 30 patients) or 100 mg twice weekly (Group B, 30 patients), for 2 years.Significant increases compared with baseline in BMD were observed for both groups at 1 and 2 years, with significantly higher increases for Group B compared with Group A. Group B displayed a BMD increase (± SD) at the lumbar spine of +4.0 % (± 2.1) and +5.9 % (± 2.0) at 1 and 2 year(s), respectively, compared with +2.8 % (± 1.7) and +3.5 % (± 2.2), respectively, observed for Group A. Similarly, Group B showed better performance compared with Group A for BMD increase at the femoral neck, with an observed increase of +3.5 % (± 1.7) and +5.4 % (± 1.8) at 1 and 2 year(s), respectively, compared with a change of +2.3 % (± 1.9) and +2.5 % (± 1.9), respectively, registered in Group A. Consistently, the BMD increase measured at the total femur was significantly higher for Group B [+3.4 % (± 1.9) and +4.9 % (± 2.1) at years 1 and 2, respectively] compared with Group A [+1.6 % (± 0.9) and +2.4 % (± 1.9) at years 1 and 2, respectively]. When the change in BMD from year 1 to year 2 was compared, a significant increase of BMD was seen in Group B in all the analysed regions, contrary to that observed for Group A where a plateau effect resulted in no significant change from year 1 to year 2. Three non-traumatic vertebral fractures occurred during the study: two in Group A and one in Group B.The present study indicates the superior performance of IM clodronate 200 mg weekly (100 mg twice weekly) compared with 100 mg once weekly in BMD in women with postmenopausal osteoporosis. This work demonstrated that administration of twice the drug dosage in a week significantly improved the efficacy of the treatment without inducing serious adverse events. Therefore, IM clodronate 200 mg weekly may be considered a valid therapeutic choice for the treatment of postmenopausal osteoporosis.

Background. Bone damage in rheumatoid arthritis (RA) and in psoriatic arthritis (PsA) includes an accelerated bone mineral density (BMD) reduction. The objective was to evaluate BMD variations of the metacarpophalangeal joints (MCPs) in patients starting treatment with methotrexate (MTX) or etanercept. Methods. Patients affected by RA or PsA with hand joints involvement and with moderate or high disease activity, were enrolled in this study. All patients underwent clinical examination, laboratory exams, and a DXA scan of the most affected hand, as assessed with an ultrasound examination at the baseline, at the time of enrolment and after 1, 3, 6, and 12 months. Patients non-responders to MTX received combination therapy, while patients with no previous treatment initiated MTX. Results. 22 patients were enrolled. In both RA and PsA groups, BMD increased independently of the treatment. However, in the patients affected by RA, a slight BMD decrease was observed at the last checkup. Globally, the BMD variations of the MCPs were strongly correlated with the disease activity. At the reduction of DAS28, the scores corresponded an increase of BMD. Conclusions. MCPs BMD is inversely correlated to disease activity. BMD increase seems to be correlated with the response to treatment and not with the drug itself.

L'articolo si concentra sugli strumenti di misurazione che corredano le varie allegorie dell'Iconologia di Cesare Ripa. Il compasso, in particolare, viene indagato nelle sue articolate sfaccettature che ne spiegano l'impiego in una serie precisa di allegorie.