Repair of bone erosion in rheumatoid arthritis by denosumab: A high-resolution peripheral quantitative computed tomography study



To compare the bone healing effects of denosumab and alendronate in female rheumatoid arthritis (RA) patients by high-resolution peripheral quantitative computed tomography (HR-pQCT).


This is a post-hoc analysis of a randomized-controlled trial (NCT01770106). 40 patients were randomized in a 1:1 ratio to receive either subcutaneous denosumab (60mg) once or oral alendronate (70mg) weekly for 6 months. The size of individual bone erosions and the presence and extent of erosion-associated sclerosis (marginal osteosclerosis) were measured in the second metacarpal head of the non-dominant hand at baseline, 3 and 6 months.


42 erosions were identified at baseline. After 6 months, the width, depth and volume of erosion significantly decreased in the denosumab group (-0.23mm, -0.16mm, -0.91mm3, respectively: all p<0.01), whereas these parameters significantly increased in the alendronate group (0.19mm, 0.32mm, 1.38mm3 respectively, all p<0.01; between group differences: all p<0.01). Quantitative analysis showed that the bone mineral density (BMD) of the erosion margin significantly increased only after treatment by denosumab (denosumab: 19.75 mg/cm3, p<0.05, alendronate: -5.44 mg/cm3, p=0.51, between group differences: p<0.05).


Inhibition of receptor activator of nuclear factor kappa B ligand by denosumab can induce partial repair of erosions in patients with RA, while erosions continued to progress in patients treated with alendronate. Combining denosumab with disease modifying anti-rheumatic drugs may be considered for RA patients with progressive bone erosions. This article is protected by copyright. All rights reserved.

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Are foot and ankle characteristics associated with falls in people with rheumatoid arthritis? A prospective study


Objective: To determine whether foot and ankle characteristics are associated with falls in people with rheumatoid arthritis (RA).

Methods: Two hundred and one adults with RA were recruited from rheumatology outpatient clinics in Auckland, New Zealand. Clinical characteristics, common fall risk factors, and foot and ankle variables were measured. Participants were prospectively studied for 12 months, to record the occurrence of falls using falls diaries. Logistic regression analysis identified baseline variables which were independent predictors of falls over the 12 months.

Results: Eighty-four (42%) participants fell at least once and 39 (19%) experienced multiple (>1) falls over the 12-month follow-up period. In logistic regression analysis, including age and significant baseline variables in bivariate analysis but not baseline fall history, presence of foot or ankle tender joints (odds ratio (OR) 1.95, P=0.034) and psychotropic medication (OR 2.35, P=0.025) were independent predictors of prospective falls. However, when baseline fall history was included in the analysis, psychotropic medication (OR 2.34, P=0.025) and baseline fall history (over the preceding 12 months) (OR 2.27, P=0.008) were independent predictors of prospective falls.

Conclusion: Foot and ankle characteristics are not associated with falls in people with RA, independent of prior falls. Enquiry about prior falls and psychotropic medications may assist in identifying patients with RA who are at high risk of future falls. This article is protected by copyright. All rights reserved.

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Epidemiology of Polymyalgia Rheumatica 2000-2014 and Examination of Incidence and Survival Trends over 45 Years: A Population Based Study


Objective: To determine time trends in the incidence and survival of polymyalgia rheumatica (PMR) over a 15 year period in Olmsted County, Minnesota, USA and to examine trends in incidence of PMR in the population by comparing this time period to a previous incidence cohort from the same population base.

Methods: All cases of incident PMR among Olmsted County, Minnesota residents in 2000-2014 were identified to extend the previous 1970-1999 cohort. Detailed review of all individual medical records was performed. Incidence rates were age and sex adjusted to the US white 2010 population. Survival rates were compared with the expected rates in the population of Minnesota.

Results: There were 377 incident cases of PMR during the 15 year study period. Of these 64% were female and the mean age at incidence was 74.1 years. The overall age and sex adjusted annual incidence of PMR was 63.9 (95% confidence interval [CI] 57.4, 70.4) per 100,000 population aged ≥50 years. Incidence rates increased with age in both sexes, but incidence fell after age 80 years. There was a slight increase in incidence of PMR in the recent time period compared to 1970-1999 (p=0.063). Mortality among individuals with PMR was not significantly worse than that expected in the general population (standardized mortality ratio: 0.70; 95% CI: 0.57, 0.85).

Conclusion: The incidence of PMR has increased slightly in the past 15 years compared to previous decades. Survivorship in patients with PMR is not worse than in the general population. This article is protected by copyright. All rights reserved.

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The Tale of Two Thumbs, a Dog, And a Wooden Table


A 55 year-old African American man presented to the Emergency Room with acute-onset fevers, chills, and bilateral thumb pain, swelling, and redness. MRI revealed extensive cellulitis involving bilateral hands and wrists, along with fluid collection and carpal bone erosion on the left. Given concerns for septic arthritis and osteomyelitis, patient underwent surgical debridement revealing an abscess in the wrist without osteomyelitis. Blood cultures grew Pasteurella multocida. Subsequently, patient noted two pet dogs at home, but no history of bites. He was treated with ceftriaxone for two weeks, followed by two weeks of ciprofloxacin with complete resolution of symptoms. This article is protected by copyright. All rights reserved.

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Hyaluronic Acid Product Market: Global Analysis, Segments, Growth and Value Chain, 2014 – 2020 detailed in new research report

Orthopedic surgery, rheumatology, ophthalmology … France, UK, China, Japan, India, and Brazil. This segmentation includes demand for hyaluronic acid product based on individual products and applications in all the regions and countries.
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