The Osteoclast as a New Target in the Treatment of Rheumatoid Arthritis: A Role for the Bisphosphonates?
Jan Van Offel,
Wim J. Stevens,
Luc De Clerck.
There is a lot of evidence that osteoclasts have a pivotal role in the subchondral, periarticular and general bone loss in rheumatoid arthritis. Bisphosphonates have a high affinity for bone where they are strong inhibitors of osteoclast mediated bone resorption. There is no doubt that bisphosphonates are useful in patients with postmenopausal or glucocorticoid induced osteoporosis certainly if these patients also suffer from RA. Bisphosphonates appear to have beneficial effects on subchondral bone loss and joint destruction in animal models of arthritis. However in human studies these effects remain largely unclear although some antiinflammatory influence seems to be confirmed. An explanation for this discrepancy might be the possibility that more potent agents, or higher doses of existing agents, need to be used. Additional research is necessary to reveal if bisphosphonates possess disease-modifying properties in RA.
Keywords: rheumatoid arthritis, osteoporosis, joint destruction, bisphosphonates, osteoclasts, cytokines
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