Current Consensus Recommendations for RA Therapy: A Blind Spot for Osteoporosis Prevention and Treatment

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" Current Consensus Recommendations for Rheumatoid Arthritis Therapy: A

Blind Spot for Osteoporosis Prevention and Treatment

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BRIGITTE M. JOLLES, MD,

Hôpital Orthopédique de la Suisse Romande, CHUV, University of Lausanne,

Lausanne, Switzerland;

EARL R. BOGOCH, MD, MSc, FRCSC,

Professor, The Mobility Program, Department of Surgery,

St. 's Hospital, University of Toronto,

Toronto, Ontario, Canada.

Dr. Jolles is supported by the Ligue Vaudoise contre le Rhumatisme Award

for her work in rheumatoid arthritis.

Address reprint requests to Prof. E.R. Bogoch, 55 Queen Street East,

Suite 800, Toronto, Ontario M5C 1R6, Canada.

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In response to new developments in therapy for rheumatoid arthritis

(RA), there have been recent international consensus publications

recommending guidelines for the treatment of RA1,2. Two symposia in

2000, in Chicago in February and Nice in June, came to similar

conclusions1,2. The general goal of treatment was explained as

elimination of synovitis and disease activity, or control to the fullest

extent possible in order to diminish symptoms and prevent articular

damage. Recommendations were made for all patients (with few exceptions)

to begin treatment promptly after initial diagnosis of RA with a disease

modifying antirheumatic drug (DMARD) or a biologic agent1. An algorithm

for optimizing DMARD use alone or in combination was also published3.

The American College of Rheumatology4 and Homik, et al in the Cochrane

Database Systematic Review 20005 provided an update for the prevention

and treatment of glucocorticoid induced osteoporosis. The consensus

recommendations presented in Chicago1 recommend that corticosteroids not

be used in RA without biological agents and mentions " unacceptable

levels of toxicity, " but does not describe effects on bone other than

erosions. Neither consensus document1,2 provided direction for the

prevention or treatment of an important adverse outcome in RA (whether

glucocorticoids have been prescribed or not): loss of bone and

alteration of bone structure, which leads to fracture and severe

morbidity in many patients. The authors' vision for the recommended

management of RA apparently did not encompass managing bone quantity and

quality... "

Read the rest of this editorial from the current issue of the Journal of

Rheumatology at:

http://www.jrheum.com/subscribers/02/09/1814.html