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The authors discuss a case of a 79-year-old woman with a 3-year history of rheumatoid arthritis who was treated with bisphosphonate therapy after which she developed spontaneous osteonecrosis of the right jaw (ONJ). She was treated with teriparatide for 8 months but her condition did not improve. Teriparatide is generally used in treatment of ONJ, however, the lack of response to teriparatide in this case could be attributed to the immunosuppressive drugs used to treat her rheumatoid arthritis.

Summary: Data concerning the association between risk factors of vertebral fracture and its presentation are limited. In this study, several fracture risk factors were related to the clinical and radiological presentation of vertebral fractures. The findings suggest that these factors should be considered in patient assessments. Purpose: The aims of this study were to describe the prevalence of fracture risk factors in patients with vertebral fractures (VF) and to analyze their association with VF clinical presentation and severity. Methods: The study design was observational and cross-sectional. Patients were recruited between 2015 and 2018. Fracture risk factors were recorded, including bone mineral density, fracture risk assessment (FRAX) score, pain characteristics, analgesia required, and radiological features such as number, location(s), and grade of VF, affected segment, kyphosis angle, and spine deformity index (SDI). Results: A series of 422 patients was included (mean age, 75 ± 9 years; 74% women). Single VF was present in 59%, previous fragility fracture in 39%, and osteoporosis in 52%. L1 was the most affected location (28%); 38% had grade 2 VF, and 36% had grade 3. Acute onset back pain was present in 81%. Older age, history of previous fragility fracture, body mass index ≤ 20 kg/m2, low bone mineral density, smoking habit, and high FRAX score were significantly associated with the presence of multiple VF, greater kyphosis angle, and higher SDI. Gradual onset back pain was associated with higher SDI and irradiated pain with greater kyphosis angle. Conclusions: Previously unpublished associations were observed between clinical and radiological characteristics of fragility VF and several fracture risk factors. The results could lead to a better understanding of the complex relationships between these risk factors and clinical presentation, and should be considered when assessing patients with VF. [ABSTRACT FROM AUTHOR]

Summary: Determination of different forms of 25-OHD (total, free and bioavailable) in healthy young women does not offer additional advantages over standard 25-OHD for evaluating vitamin D deficiency. In these subjects 25-OHD values <15 ng/ml would be more appropriate for defining this deficiency. Introduction: Determination of 25-OH vitamin D serum levels (25-OHD) constitutes the method of choice for evaluating vitamin D deficiency. However, vitamin D-binding protein (DBP) may modulate its bioavailability thereby affecting correct evaluation of 25-OHD status. We analysed the impact of the determination of 25-OHD (total, free and bioavailable) on the evaluation its biologic activity (estimated by serum PTH determination) in healthy young women. Methods: 173 premenopausal women (aged 35-45 yrs.) were included. We analysed serum values of total 25-OHD (25-OHD), DBP, albumin, PTH and bone formation (PINP,OC) and resorption (NTx,CTx) markers. Free(25-OHD) and bioavailable (25-OHD) serum 25-OHD levels were estimated by DBP and albumin determinations and also directly by ELISA (25-OHD). We analysed threshold PTH values for the different forms of 25-OHD and the correlations and differences according to 25-OHD levels <20 ng/ml. Results: 62% of subjects had 25-OHD values <20 ng/ml and also had significantly lower 25-OHD and 25-OHD values, with no significant differences in bone markers and PTH values. The PTH threshold value was similar for all forms of 25-OHD (∼70 pg/ml). Women with PTH values >70 had lower 25-OHD (15.4 ± 1.4 vs. 18.3 ± 2.7, p < 0.05) and 25OHD values (1.7 ± 0.2 vs. 2.2 ± 0.09, p < 0.05). The different forms of 25OHD were significantly intercorrelated, with marginal correlations between PTH and 25-OHD ( r = −0.136, p = 0.082). Conclusions: Determination of different forms of 25-OHD in healthy young women does not offer additional advantages over standard 25-OHD for evaluating vitamin D deficiency. In these subjects 25-OHD values <15 ng/ml would be more appropriate for defining this deficiency. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis ( RA) is a chronic polygenic inflammatory disease associated with accelerated atherosclerosis and high risk of cardiovascular disease ( CVD). In this study, we evaluated the potential association of 9p21.3 single-nucleotide polymorphisms ( SNPs) - previously linked to coronary artery disease - and CVD risk in 2001 Spanish RA patients genotyped for 9p21.3 SNPs using TaqMan™ assays. Carotid intima media thickness ( cIMT) and presence of carotid plaques were also analyzed. Cox regression model did not disclose significant differences between patients who experienced CVD and those who did not. Neither association was found between cIMT or carotid plaques and SNPs allele distribution. In conclusion, results do not support a role of rs10116277 or rs1537375 SNPs in CVD risk in Spanish RA patients. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis ( RA) is an inflammatory disease associated with high risk of cardiovascular ( CV) events. Recently, the rs964184 polymorphism has been associated with coronary artery disease in nonrheumatic Caucasian individuals. 2160 Spanish RA patients were genotyped for the rs964184 polymorphism. Sex, age at diagnosis and traditional CV risk factors (diabetes mellitus, dyslipidemia and smoking habit) were associated with increased risk of CV events. Interestingly, RA patients carrying the rs964184 GG genotype had significantly higher risk of CV events than those with CC genotype [hazard ratio ( HR) = 2.91, 95% confidence interval ( CI): 1.36-6.26, P = 0.006] after adjusting the results for sex, age at diagnosis and traditional CV risk factors. Our results indicate that rs964184 polymorphism is associated with CV disease in RA. [ABSTRACT FROM AUTHOR]

Objective: The methionine sulfoxide reductase A ( MSRA) gene is related to oxidative stress that has been involved in the susceptibility to rheumatoid arthritis (RA) in genome-wide pathway analysis and replication studies. The aim of the present study was to determine whether the MSRA gene is implicated in susceptibility to cardiovascular (CV) disease in RA patients. Methods: A total of 1302 patients fulfilling the 1987 American College of Rheumatism classification criteria for RA were genotyped for the MSRA rs10903323 (G/A) polymorphism. Two hundred and thirty-three (17.9%) patients experienced CV events. Human leucocyte antigen (HLA)-DRB1 genotyping was performed using molecular-based methods. Multiple logistic regression models were constructed with adjustments for gender, age at RA diagnosis, follow-up, rheumatoid shared epitope, and traditional CV risk as potential confounders. Results: There were no statistically significant differences in the allele or genotype frequencies for the MSRA rs10903323 polymorphism between RA patients who experienced CV events and those who did not. However, an adjusted logistic regression model disclosed that the minor allele G yielded a marginally significant increased risk of CV events in this series of patients with RA [p = 0.05, odds ratio (OR) 1.68, 95% confidence interval (CI) 1.00-2.85]. When the logistic regression model was adjusted for anti-cyclic citrullinated peptide (anti-CCP) antibody status instead of for shared epitope, an increased risk of having ischaemic heart disease was found in patients carrying the minor allele G (p = 0.04, OR 2.00, 95% CI 1.03-3.88). Conclusion: The MSRA rs10903323 gene polymorphism may be implicated in the increased risk to develop CV events, in particular ischaemic heart disease, observed in RA patients. [ABSTRACT FROM AUTHOR]

Interleukin-6 (IL-6) is a key mediator of inflammation in rheumatoid arthritis (RA) and its actions may be controlled by the IL-6 receptor (IL-6R). IL-6 transducer (IL-6ST/ gp130) is the signal transducing subunit of the IL-6R. We assessed the influence of the IL6R and the IL6ST/gp130 genes in the risk of cardiovascular (CV) disease in RA. For this purpose, 1250 Spanish patients with RA were genotyped for the IL6R rs2228145 and IL6ST/gp130 rs2228044 functional gene polymorphisms. Patients were stratified according to the presence or absence of CV events. Also, a subgroup of patients without CV events was assessed for the presence of subclinical atherosclerosis using two surrogate markers of atherosclerosis (flow-mediated endothelium-dependent vasodilatation and carotid intima-media thickness). No significant differences in the genotype and allele frequencies for both gene polymorphisms between patients with and without CV events were observed. It was also the case when values of surrogate markers of atherosclerosis were compared according to IL6R and IL6ST genotype frequencies. In conclusion, our results do not confirm an association of IL6R rs2228145 and IL6ST/gp130 rs2228044 polymorphisms with CV disease in RA. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article in the February 8, 2007 issue about acute sarcoidosis.