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Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons

Osteoporosis has been classically considered a comorbidity of rheumatoid arthritis (RA). However, recent advances in the pathogenesis of osteoporosis in RA have shown a close interplay between cells of the immune system and those involved in bone remodeling, introducing new actors into the classic r...

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Autores principales: Llorente, Irene, García-Castañeda, Noelia, Valero, Cristina, González-Álvaro, Isidoro, Castañeda, Santos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719815/
https://www.ncbi.nlm.nih.gov/pubmed/33330566
http://dx.doi.org/10.3389/fmed.2020.601618
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author Llorente, Irene
García-Castañeda, Noelia
Valero, Cristina
González-Álvaro, Isidoro
Castañeda, Santos
author_facet Llorente, Irene
García-Castañeda, Noelia
Valero, Cristina
González-Álvaro, Isidoro
Castañeda, Santos
author_sort Llorente, Irene
collection PubMed
description Osteoporosis has been classically considered a comorbidity of rheumatoid arthritis (RA). However, recent advances in the pathogenesis of osteoporosis in RA have shown a close interplay between cells of the immune system and those involved in bone remodeling, introducing new actors into the classic route in which osteoclast activation is related to the RANK/RANKL/OPG pathway. In fact, the inflammatory state in early stages of RA, mediated by interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α has the ability to activate and differentiate osteoclasts not only through their relationship with RANKL, but also through the Wnt/DKK1/sclerostin pathway, leading to bone loss. The role of synovial fibroblasts and activated T lymphocytes in the expression of the RANKL system and its connection to bone destruction is also depicted. In addition, autoantibodies such as rheumatoid factor and anti-citrullinated protein antibodies are other pathogenic mechanisms for the development of bone erosions and systemic osteoporosis in RA, even before the onset of arthritis. The aim of this review is to unravel the relationship between different factors involved in the development of osteoporosis in RA patients, both the classic factors and the most novel, based on the relationship of autoantibodies with bone remodeling. Furthermore, we propose that bone mineral density measured by different techniques may be helpful as a biomarker of severity in early arthritis patients.
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spelling pubmed-77198152020-12-15 Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons Llorente, Irene García-Castañeda, Noelia Valero, Cristina González-Álvaro, Isidoro Castañeda, Santos Front Med (Lausanne) Medicine Osteoporosis has been classically considered a comorbidity of rheumatoid arthritis (RA). However, recent advances in the pathogenesis of osteoporosis in RA have shown a close interplay between cells of the immune system and those involved in bone remodeling, introducing new actors into the classic route in which osteoclast activation is related to the RANK/RANKL/OPG pathway. In fact, the inflammatory state in early stages of RA, mediated by interleukin (IL)-1, IL-6, IL-8 and tumor necrosis factor (TNF)-α has the ability to activate and differentiate osteoclasts not only through their relationship with RANKL, but also through the Wnt/DKK1/sclerostin pathway, leading to bone loss. The role of synovial fibroblasts and activated T lymphocytes in the expression of the RANKL system and its connection to bone destruction is also depicted. In addition, autoantibodies such as rheumatoid factor and anti-citrullinated protein antibodies are other pathogenic mechanisms for the development of bone erosions and systemic osteoporosis in RA, even before the onset of arthritis. The aim of this review is to unravel the relationship between different factors involved in the development of osteoporosis in RA patients, both the classic factors and the most novel, based on the relationship of autoantibodies with bone remodeling. Furthermore, we propose that bone mineral density measured by different techniques may be helpful as a biomarker of severity in early arthritis patients. Frontiers Media S.A. 2020-11-23 /pmc/articles/PMC7719815/ /pubmed/33330566 http://dx.doi.org/10.3389/fmed.2020.601618 Text en Copyright © 2020 Llorente, García-Castañeda, Valero, González-Álvaro and Castañeda. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Llorente, Irene
García-Castañeda, Noelia
Valero, Cristina
González-Álvaro, Isidoro
Castañeda, Santos
Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title_full Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title_fullStr Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title_full_unstemmed Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title_short Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons
title_sort osteoporosis in rheumatoid arthritis: dangerous liaisons
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719815/
https://www.ncbi.nlm.nih.gov/pubmed/33330566
http://dx.doi.org/10.3389/fmed.2020.601618
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