Efficacy of methotrexate in reducing the risk of bone erosion in patients with rheumatoid arthritis: a systematic review
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REVIEW
Efficacy of methotrexate in reducing the risk of bone erosion in patients with rheumatoid arthritis: a systematic review of randomized controlled trials D.P. Destiani 1,2 & S. Naja 1 & S. Dewi 3,4 & A. R. Rahmadi 4 & S. A. S. Sulaiman 5,6 & R. Abdulah 1,2 Received: 12 August 2020 / Accepted: 12 November 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Even though new drugs for the treatment of rheumatoid arthritis (RA) have been developed, methotrexate (MTX) remains a commonly used drug for RA management. In addition to monitoring disease activity during RA treatment, bone erosion should be closely assessed throughout long-term RA management. In this review article, we present a systematic review of MTX effectiveness in reducing the risk of bone erosion. We reviewed randomized controlled trial studies that involved MTX monotherapy or MTX in combination with placebo. Evaluation of the progression of bone erosion was examined by radiographic assessment such as total Sharp score (TSS) or van der Heijde score (SvdH or vdH TSS), joint space narrowing (JSN), erosion score (ERO), and proportion of radiographic nonprogressors. Several key factors were found to influence the response to MTX treatment, such as gene polymorphism. The exact mechanism of the prevention of bone erosion by MTX remains unclear, which warrants future investigations. The variability of RA disease activity in study subjects resulted in variations in the results reported by individual studies. Collective analysis suggests that MTX could slow down the progression of bone erosion based on a radiographic score of less than 0.5–1/year. Keywords Bone Erosion . Methotrexate . Rheumatoid arthritis
Introduction Rheumatoid arthritis (RA) is an autoimmune inflammatory condition that is characterized by the increased production of
* R. Abdulah [email protected] 1
Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung Sumedang KM. 21, Jatinangor, Bandung 45363, Indonesia
2
Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
3
Immunology Study Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
4
Division of Rheumatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
5
Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
6
Advance Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
pro-inflammatory cytokine or other mechanisms that are regulated by estrogen [1–3]. RA, left untreated, causes cartilage and juxtarticular tissue damage and chronic inflammation of the small joint synovium such as fingers [4]. Bone erosion in RA is a pathologic characteristic of local bone damage driven by inflammatory cells produced infiltrating the pannus. In addition, RA induces systemic chronic inflammation that could lead to secondary osteoporosis
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