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Osteoporosis in Rheumatoid Arthritis

  • J. Dequeker
  • R. Westhovens
  • I. Ravelingien
Chapter

Abstract

Bone loss has been recognized as a complication of the rheumatoid process for more than a century. Barwel was the first to apply the term “osteoporosis” to the bone disease in rheumatoid arthritis (RA) [1]. Osteoporosis, as recognized by Soila [2], McConkey et al. [3], Saville and Kharmosh [4] and Kennedy and Lindsay [5], may be localized, occurring close to the site of inflamed joints, or generalized, involving the whole skeleton.

Keywords

Rheumatoid Arthritis Bone Mineral Density Bone Loss Ankylose Spondylitis Total Joint Arthroplasty 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Barwel H. Disease of the joints. London: Hardwick, 1865.Google Scholar
  2. 2.
    Soila P. Roentgen manifestations of adult rheumatoid arthritis. Acta Rheumatol Scand 1985;Suppl 1.Google Scholar
  3. 3.
    McConckey B, Frazer G, Eligh A. Transparent skin and osteoporosis. A study in patients with rheumatoid disease. Ann Rheum Dis 1965;24:219–223.CrossRefGoogle Scholar
  4. 4.
    Saville PD, Kharmosh P. Osteoporosis of rheumatoid arthritis: influence of age, sex and corticosteroids. Arthritis Rheum 1967;10:423–430.PubMedCrossRefGoogle Scholar
  5. 5.
    Kennedy AC, Lindsay R. Bone involvement in rheumatoid arthritis. Clin Rheum Dis 1977;3:403–420.Google Scholar
  6. 6.
    Bijlsma JWJ. Bone metabolism in patients with rheumatoid arthritis. Clin Rheumatol 1988;7:16–23.PubMedCrossRefGoogle Scholar
  7. 7.
    Dequeker J, Geusens P. Osteoporosis and arthritis. Ann Rheum Dis 1990;49:276–280.PubMedCrossRefGoogle Scholar
  8. 8.
    Mbuyi JM, Dequeker J, Teblick M, Merlevede M. Relevance of urinary excretion of alcian blue glycosaminoglycan complexes and hydroxyproline to disease activity in rheumatoid arthritis. J Rheumatol 1982;9:579–583.PubMedGoogle Scholar
  9. 9.
    Gevers G, Devos P, De Roo M, Dequeker J. Increased levels of osteocalcin (serum bone gla protein) in rheumatoid arthritis. Br J Rheumatol 1986;25:260–262.PubMedCrossRefGoogle Scholar
  10. 10.
    Verstraeten A, Dequeker J. Mineral metabolism in postmenopausal women with active rheumatoid arthritis. J Rheumatol 1986;13:43–46.PubMedGoogle Scholar
  11. 11.
    Gough AKS, Peel NFA, Eastell R, Holder RL, Lilley J, Emery P. Excretion of pyridinium crosslinks correlates with disease activity and appendicular bone loss in early rheumatoid arthritis. Ann Rheum Dis 1994;53:14–17.PubMedCrossRefGoogle Scholar
  12. 12.
    Gough A, Sambrook P, Devlin J, Huissoon A, Njeh C, Robbins S, et al. Osteoclastic activation is the principal mechanism leading to secondary osteoporosis in rheumatoid arthritis. J Rheumatol 1998;25:1282–1289.PubMedGoogle Scholar
  13. 13.
    Oelzner P, Müller A, Deschner F, Hüller M, Abendroth K, Hein G, et al. Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int 1998;62:193–198.PubMedCrossRefGoogle Scholar
  14. 14.
    Westhovens R, Nijs J, Taelman V, Dequeker J. Body composition in rheumatoid arthritis. Br J Rheumatol 1997;36:444–448.PubMedCrossRefGoogle Scholar
  15. 15.
    KrÖger H, Honkanen R, Saarikoski S, Alhava E. Decreased axial bone mineral density in perimenopausal women with rheumatoid arthritis: a population based study. Ann Rheum Dis 1994;53:18–23.PubMedCrossRefGoogle Scholar
  16. 16.
    Lane NE, Pressman AR, Star VL, Cummings SR, Nevitt MC, and the Study of Osteoporotic Fractures Research Group. Rheumatoid arthritis and bone mineral density in elderly women. J Bone Miner Res 1995;10:257–263.PubMedCrossRefGoogle Scholar
  17. 17.
    Hall GM, Spector TD, Griffin AJ, Jawad ASM, Hall ML, Doyle DV. The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women. Arthritis Rheum 1993;36:1510–1516.PubMedCrossRefGoogle Scholar
  18. 18.
    Garton MJ, Reid DM. Bone mineral density of the hip and of the anteroposterior and lateral dimensions of the spine in men with rheumatoid arthritis. Arthritis Rheum 1993;36:222–228.PubMedCrossRefGoogle Scholar
  19. 19.
    Towheed TE, Brouillard D, Yendt E, Anastassiades T. Osteoporosis in rheumatoid arthritis: findings in the metacarpals, spine and hip and a study of the determinants of both localized and generalized osteoporosis. J Rheumatol 1995;22:440–443.PubMedGoogle Scholar
  20. 20.
    Hansen M, Florescu A, Stoltenberg M, Podenphant J, Pedersen-Zbinden B, Horslev-Petersen K, et al. Bone loss in rheumatoid arthritis. Scand J Rheumatol 1996;25:367–376.PubMedCrossRefGoogle Scholar
  21. 21.
    Martin JC, Munro R, Campbell MK, Reid DM. Effects of disease and corticosteroids on appendicular bone mass in postmenopausal women with rheumatoid arthritis: comparison with axial measurements. Br J Rheumatol 1997;36:43–49.PubMedCrossRefGoogle Scholar
  22. 22.
    Mbuyi-Muamba JM, Dequeker J, Burssens A. Massive osteolysis in a case of rheumatoid arthritis: clinical, histologic and biochemical findings. Metab Bone Dis Rel Res 1983;5:101–106.CrossRefGoogle Scholar
  23. 23.
    Compston JE, Crawley EO, Evans C, O’Sullivan MM. Spinal trabecular bone mineral content in patients with non-steroid treated rheumatoid arthritis. Ann Rheum Dis 1988;47:660–664.PubMedCrossRefGoogle Scholar
  24. 24.
    Gough AKS, Lilley J, Eyre S, Holder RL, Emery P. Generalised bone loss in patients with early rheumatoid arthritis. Lancet 1994;344:23–27.PubMedCrossRefGoogle Scholar
  25. 25.
    Eastgate JA, Wood NC, Di Giovine FS, Symons JA, Grinlinton FM, Duff GW. Correlation of plasma interleukin 1 levels with disease activity in rheumatoid arthritis. Lancet 1988;11:706–709.CrossRefGoogle Scholar
  26. 26.
    Dequeker J, Wielandts L, Koentges D, Nijs J. The assessment of bone loss in rheumatoid arthritis. In: Feltkamp TEW, van der Korst JK, editors. Disease evaluation and assessment in rheumatoid arthritis. Alphen aan den Rijn/Brussels: Stafleu’s Scientific Publishing Company, 1979:54–63.Google Scholar
  27. 27.
    Verstraeten A, Dequeker J. Vertebral and peripheral bone mineral content and fracture incidence in postmenopausal patients with rheumatoid arthritis: effect of low dose corticosteroids. Ann Rheum Dis 1986;45:852–857.PubMedCrossRefGoogle Scholar
  28. 28.
    Sambrook PN, Ansell BM, Foster S, Gumpel JM, Hesp R, Reeve J. Bone turnover in early rheumatoid arthritis. 2. Longitudinal bone density studies. Ann Rheum Dis 1985;44:580–584.PubMedCrossRefGoogle Scholar
  29. 29.
    Chan E, Pandith V, Towheed TE, Brouillard D, Zee B, Anastassiades TP. Comparison of the combined cortical thickness of the second metacarpal with Sharp’s method for scoring hand microradiographs in rheumatoid arthritis. J Rheumatol 1998;25: 1290–1294.PubMedGoogle Scholar
  30. 30.
    Peel NFA, Spittlehouse AJ, Bas DE, Eastell R. Bone mineral density of the hand in rheumatoid arthritis. Arthritis Rheum 1994;37:983–991.PubMedCrossRefGoogle Scholar
  31. 31.
    Duff GW. Immune diseases: many roles for interleukin 1. Nature 1985;313:352–353.PubMedCrossRefGoogle Scholar
  32. 32.
    Manolagas SC, Jilka RL. Bone marrow, cytokines and bone remodeling. N Engl J Med 1995;332:305–311.PubMedCrossRefGoogle Scholar
  33. 33.
    Thomson BM, Mundy GR, Chambers TJ. Tumor necrosis factors a and ß induce osteoblastic cells to stimulate osteoclastic bone resorption. J Immunol 1987; 138: 775–779.PubMedGoogle Scholar
  34. 34.
    Lems WF, Dijkmans BAC. Should we look for osteoporosis in patients with rheumatoid arthritis? Ann Rheum Dis 1998;57:325–327.PubMedCrossRefGoogle Scholar
  35. 35.
    Hooyman JR, Melton LJ, Nelson AM, O’Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. Arthritis Rheum 1984;27:1353–1361.PubMedCrossRefGoogle Scholar
  36. 36.
    Cooper C, Coupland C, Mitchell M. Rheumatoid arthritis, corticosteroid-therapy and hip fracture. Ann Rheum Dis 1995;54:49–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Spector TD, Hall GM, McCloskey EV, Kanis JA. Risk of vertebral fracture in women with rheumatoid arthritis. BMJ 1993;306:58.CrossRefGoogle Scholar
  38. 38.
    Michel BA, Bloch DA, Fries JF. Predictors of fractures in early rheumatoid arthritis. J Rheumatol 1991;18:804–808.PubMedGoogle Scholar
  39. 39.
    Cooper C, Carbone L, Michet CJ, Atkinson EJ, O’Fallon WM, Melton LJ III. Fracture risk in patients with ankylosing spondylitis: a population based study. J Rheumatol 1994;21:1877–1882.PubMedGoogle Scholar
  40. 40.
    Dequeker J, Panayi G, Pincus T, Grahame R. Polyarthritis: rheumatoid arthritis and related conditions. In: Dequeker J, Panayi G, Pincus T, Grahame R, editors. Medical management of rheumatic musculoskeletal and connective tissue diseases. New York: Marcel Dekker, 1997:101–152.Google Scholar
  41. 41.
    Boden SD, Dodge LD, Bohlman HH, Rechtine GR. Rheumatoid arthritis of the cervical spine. J Bone Joint Surg Am 1993;75:1282–1297.PubMedGoogle Scholar
  42. 42.
    Casey ATH, Crockard HA, Bland JM, Stevens J, Moskovich R, Ransford AO. Surgery on the rheumatoid cervical spine for the non-ambulant myelopathic patient: too much, too late ? Lancet 1996;347:1004–1007.PubMedCrossRefGoogle Scholar
  43. 43.
    Crockard HA. Surgical management of cervical rheumatoid problems. Spine 1995;20: 2584–2590.PubMedCrossRefGoogle Scholar
  44. 44.
    Lesoin F, Duquesnoy B, Destee A, Leys D, Rousseaux M, Carini S, et al. Cervical neurological complications of rheumatoid arthritis. Surgical treatment techniques and indications. Acta Neurochir 1985;78:91–97.PubMedCrossRefGoogle Scholar
  45. 45.
    Santavirta S, Slätis P, Kankaanpää U, Sandelin J, Laasonen E. Treatment of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 1988;70:658–667.PubMedGoogle Scholar
  46. 46.
    Buckley LM, Leib ES, Cartularo KS, Vacek PM, Cooper SM. The effects of low dose corticosteroids on the bone mineral density of patients with rheumatoid arthritis. J Rheumatol 1995;22:1055–1059.PubMedGoogle Scholar
  47. 47.
    Laan RFJM, Van Riel PLCM, Erning LITHO, Lemmens JAM, Ruijs SHJ, Van de Putte LBA. Vertebral osteoporosis in rheumatoid arthritis patients: effect of low dose prednisone therapy. Br J Rheumatol 1992;31:91–96.PubMedCrossRefGoogle Scholar
  48. 48.
    Laan RFJM, Van Riel PLCM, Van de Putte LBA, Van Erning LITHO, Van’t Hof MA, Lemmens JAM. Low-dose prednisone induces rapid reversible axial bone loss in patients with rheumatoid arthritis. Ann Intern Med 1993;119:963–968.PubMedCrossRefGoogle Scholar
  49. 49.
    Nagant de Deuxchaisnes C, Devogelaer JP, Huaux JP. Influence of the menopausal state and the effect of low-dose glucocorticoids on bone mass in rheumatoid arthritis patients. Arthritis Rheum 1986;29:693–694.CrossRefGoogle Scholar
  50. 50.
    Dykman TR, Gluck OS, Murphy WA, Hahn TJ, Hahn BH. Evaluation of factors associated with glucocorticoid-induced osteopenia in patients with rheumatic diseases. Arthritis Rheum 1985;28:361–368.PubMedCrossRefGoogle Scholar
  51. 51.
    Nagant de Deuxchaisnes C, Devogelaer JP, Esselinckx W, Bouchez B, Depresseux G, Rombouts-Lindemans C, et al. The effect of low dosage glucocorticoids on bone mass in rheumatoid arthritis: a cross-sectional and a longitudinal study using single photon absorptiometry. Adv Exp Med Biol 1984;171:209–239.Google Scholar
  52. 52.
    Sambrook PN, Cohen ML, Eisman JA, Pocock NA, Champion GD, Yeates MG. EffectsGoogle Scholar
  53. of low dose corticosteroids on bone mass in rheumatoid arthritis: a longitudinal study. Ann Rheum Dis 1989;48:535–538.Google Scholar
  54. 53.
    Reid DM, Kennedy NSJ, Smith MA, Nicoli J, Brown N, Tothill P, et al. Bone loss in rheumatoid arthritis and primary generalized osteoarthrosis: effects of corticosteroids, suppressive antirheumatic drugs and calcium supplements. Br J Rheumatol 1986;25: 253–259.PubMedCrossRefGoogle Scholar
  55. 54.
    Dequeker J, Westhovens R. Low dose corticosteroid associated osteoporosis in rheumatoid arthritis and its prophylaxis and treatment: bones of contention. J Rheumatol 1995;22:1013–1019.PubMedGoogle Scholar
  56. 55.
    Karantanas AH, Kalef-Ezra J, Glaros D. Limitations of quantitative CT in corticosteroid induced osteopenia. Acta Radiol 1991;32:339–341.PubMedCrossRefGoogle Scholar
  57. 56.
    Manning P, Evans MC, Reid IR. Axial bone density following cure of Cushing’s syndrome: Evidence for reversibility of steroid osteoporosis. In: Christiansen C, Overgaard K, editors. Osteoporosis. Copenhagen: Osteopress, 1990:1585–1586.Google Scholar
  58. 57.
    Pearce G, Ryan PFJ, Delmas PD, Tabensky DA, Seeman E. The deleterious effects of low-dose corticosteroids on bone density in patients with polymyalgia rheumatica. Br J Rheumatol 1998;37:292–299.PubMedCrossRefGoogle Scholar
  59. 58.
    Saito JK, Davis JW, Wasnich RD, Ross PD. Users of low-dose glucocorticoids have increased bone loss rates: a longitudinal study. Calcif Tissue Int 1995;57:115–119.PubMedCrossRefGoogle Scholar
  60. 59.
    Emkey RD, Lindsay R, Lyssy J, Weisberg JS, Dempster DW, Shen V. The systemic effect of intraarticular administration of corticosteroid on markers of bone formation and bone resorption in patients with rheumatoid arthritis. Arthritis Rheum 1996;39:277–282.PubMedCrossRefGoogle Scholar
  61. 60.
    Geusens P, Dequeker J. Locomotor side-effects of corticosteroids. Baillieres Clin Rheumatol 1991;5:99–118.PubMedCrossRefGoogle Scholar
  62. 61.
    Dequeker J. Kortikoide, Knochenmasse und Frakturen bei rheumatischen Erkrankungen. Akt Rheumatol 1993;18:14–18.CrossRefGoogle Scholar
  63. 62.
    MacAdams MR, White RH, Chipps BE. Reduction of serum testosterone levels during chronic glucocorticoid therapy. Ann Intern Med 1986;104:648–651.PubMedCrossRefGoogle Scholar
  64. 63.
    Olgaard K, Storm T, van Wowern N, Daugaard H, Egfjord M, Lewin E, et al. Glucocorticoid-induced osteoporosis in the lumbar spine, forearm, and mandible of nephrotic patients: a double-blind study on the high-dose long-term effects of prednisone versus deflazacort. Calcif Tissue Int 1992;50:490–497.PubMedCrossRefGoogle Scholar
  65. 64.
    Messina OD, Barreira JC, Zanchetta JR, Maldonado-Cocco JA, Boagado CE, Sebastian ON, et al. Effect of low doses of deflazacort vs prednisone on bone mineral content in premenopausal rheumatoid arthritis. J Rheumatol 1992;19:1520–1526.PubMedGoogle Scholar
  66. 65.
    Blumsohn A, Herrington K, Hannon RA, Shao P, Eyre DR, Eastell R. The effect of calcium supplementation on the circadian rhythm of bone resorption. J Clin Endocrinol Metab 1994;79:730–735.PubMedCrossRefGoogle Scholar
  67. 66.
    van de Voorde M, Dequeker J, Geusens P. Effect of one late evening dose of calcium on bone resorption in postmenopausal women. In: Christiansen C, Overgaard K, editors. Osteoporosis. Copenhagen: Osteopress, 1990:1192–1193.Google Scholar
  68. 67.
    Reid IR, Ibbertson HK. Calcium supplements in the prevention of steroid-induced osteoporosis. Am J Clin Nutr 1986;44:287–290.PubMedGoogle Scholar
  69. 68.
    Bijlsma JWJ, Raymakers JA, Mosch C, Hoekstra A, Derksen RH, Baart de la Faille H, et al. Effect of oral calcium and vitamin D on glucocorticoid-induced osteopenia. Clin Exp Rheumatol 1988;6:113–119.PubMedGoogle Scholar
  70. 69.
    Adams JS, Wahl TO, Luker BP. Effects of hydrochlorothiazide and dietary sodium restriction on calcium metabolism in corticosteroid treated patients. Metabolism 1981;30:217–221.PubMedCrossRefGoogle Scholar
  71. 70.
    Boutsen Y, Jamart J, Esselinckx W, Stoffel M, Devogelaer JP. Primary prevention of glucocorticoid-induced osteoporosis with intermittent intravenous pamidronate: a randomized trial. Calcif Tissue Int 1997;61:266–271.PubMedCrossRefGoogle Scholar
  72. 71.
    Adachi JD, Bensen WG, Brown J, Hanley T, Hodsman A, Josse R, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med 1997;337:382–387.PubMedCrossRefGoogle Scholar
  73. 72.
    Roux C, Oriente P, Laan R, Hughes RA, Ittner J, Goemaere S, et al. Randomized trial of effect of cyclical etidronate in the prevention of corticosteroid-induced bone loss. J Clin Endocrinol Metab 1998;83:1128–1133.PubMedCrossRefGoogle Scholar
  74. 73.
    Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, et al. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 1998;339:292–299.PubMedCrossRefGoogle Scholar
  75. 74.
    Hooyman JR, Melton LJ III, Nelson AM, O’Fallon WM, Riggs BL. Fractures after rheumatoid arthritis. A population-based study. Arthritis Rheum 1991;34:912–915.CrossRefGoogle Scholar
  76. 75.
    Dequeker J, Heylen H, Burssens A. Spontaneous fractures of pelvis in rheumatoid arthritis. BMJ 1972;I:29:314.CrossRefGoogle Scholar
  77. 76.
    Schneider R, Kaye JJ. Insufficiency and stress fractures of the long bones occurring in patients with rheumatoid arthritis. Radiology 1975;116:595–599.PubMedGoogle Scholar
  78. 77.
    Young A, Kinsella P, Boland P. Stress fractures of the lower limb in patients with rheumatoid arthritis. J Bone Joint Surg Br 1981;63:239–243.PubMedGoogle Scholar
  79. 78.
    Reynolds MT. Stress fractures of the tibia in the elderly associated with knee deformity. Proc R Soc Med 1972;65:377–380.PubMedGoogle Scholar
  80. 79.
    Straaton KV, Lopez-Mendez A, Alarcon GS. Insufficiency fractures of the distal tibia misdiagnosed as cellulitis in three patients with rheumatoid arthritis. Arthritis Rheum 1991;34:912–915.PubMedCrossRefGoogle Scholar
  81. 80.
    Semba CP, Mitchell MJ, Sartoris DJ, Resnick D. Multiple stress fractures in the hind-foot in rheumatoid arthritis. J Rheumatol 1989;16:671–676.PubMedGoogle Scholar
  82. 81.
    Kahanpal S, McLeod RA, Luthra HS. Insufficiency-type stress fractures in rheumatoid arthritis: report of an interesting case and review of the literature. Clin Exp Rheumatol 1986;4:151–154.Google Scholar
  83. 82.
    Wordsworth BP, Vipond S, Woods CG, Mowat AG. Metabolic bone disease among inpatients with rheumatoid arthritis. Br J Rheumatol 1984;23:251–257.PubMedCrossRefGoogle Scholar
  84. 83.
    Maenaut K, Westhovens R, Dequeker J. Methotrexate osteopathy: does it exist? J Rheumatol 1996;23:2156–2159.PubMedGoogle Scholar
  85. 84.
    Ragab AH, Fresh RS, Vietti TJ. Osteoporotic fractures secondary to methotrexate therapy of acute leukemia in remission. Cancer 1970;25:580–585.PubMedCrossRefGoogle Scholar
  86. 85.
    Preston SJ, Diamon T, Scott A, Laurent MR. Methotrexate osteopathy in rheumatic disease. Ann Rheum Dis 1993;52:582–585.PubMedCrossRefGoogle Scholar
  87. 86.
    Ansell G, Evans S, Jackson CT, Lewis-Jones S. Cytotoxic drugs for non-neoplastic disease. BMJ 1983;287:762.PubMedCrossRefGoogle Scholar
  88. 87.
    Bologna C, Edno L, Anaya J, Canovas F, Vanden Berghe M, Jorgensen C, et al. Methotrexate concentrations in synovial membrane and trabecular and cortical bone in rheumatoid arthritis patients. Arthritis Rheum 1994;37:1770–1773.PubMedCrossRefGoogle Scholar
  89. 88.
    Friedlaender GE, Tross RB, Doganis AC, Kirkwood JM, Baron R. Effects of chemother-apeutic agents on bone. J Bone Joint Surg 1984;66:602–607.PubMedGoogle Scholar
  90. 89.
    May KP, West SG, McDermott MT, Huffer WE. The effect of low-dose methotrexate on bone metabolism and histomorphometry in rats. Arthritis Rheum 1994;37:201–206.PubMedCrossRefGoogle Scholar
  91. 90.
    Katz JN, Leboff MS, Wade JP, Brown EM, Liang MH. Effect of methotrexate on bone density and calcium homeostasis in rheumatoid arthritis. Clin Res 1989;37:509A.Google Scholar
  92. 91.
    Kirwan JR. The effect of glucocorticoids on joint destruction in rheumatoid arthritis. The Arthritis and Rheumatism Council low-dose glucocorticoid study group. N Engl J Med 1995;333:142–146.PubMedCrossRefGoogle Scholar
  93. 92.
    Boers M, Verhoeven AC, Markusse HM, van de Laar MAFJ, Westhovens R, van Denderen JC, et al. Randomised comparison of combined step down prednisolone methotrexate and sulphasalazine versus sulphasalazine alone in early rheumatoid arthritis. Lancet 1997;350:309–318.PubMedCrossRefGoogle Scholar
  94. 93.
    Sileghem A, Geusens P, Dequeker J. Intranasal calcitonin for the prevention of bone erosion and bone loss in rheumatoid arthritis. Ann Rheum Dis 1992;51:761–764.PubMedCrossRefGoogle Scholar
  95. 94.
    Ralston SH, Hacking L, Willocks L, Bruce F, Pitkeathly DA. Clinical, biochemical and radiographic effects of aminohydropropylidene bisphosphonate treatment in rheumatoid arthritis. Ann Rheum Dis 1989;48:396–399.PubMedCrossRefGoogle Scholar
  96. 95.
    Bird HA, Hill J, Sitton NG, Dixon JS, Wright V. A clinical and biochemical assessment of etidronate disodium in patients with active rheumatoid arthritis. Clin Rheumatol 1988;7:18–23.CrossRefGoogle Scholar
  97. 96.
    Maccagno A, Di Giorgio E, Roldan EJA, Caballero LE, Perez Lloret A. Double blind radiological assessment of continuous oral pamidronic acid in patients with rheumatoid arthritis. Scand J Rheumatol 1994;23:211–214.PubMedCrossRefGoogle Scholar
  98. 97.
    Önsten I, Åkesson K, Besjakov J, Obrant KJ. Migration of the charnley stem in rheumatoid arthritis and osteoarthritis. J Bone Joint Surg Br 1995;77:18–22.PubMedGoogle Scholar
  99. 98.
    Önsten I, Åkesson K, Obrant KJ. Micromotion of the acetabular component and peri-acetabular bone morphology. Clin Orthop 1995;310:103–110.PubMedGoogle Scholar
  100. 99.
    Åkesson K, Önsten I, Obrant KJ. Periarticular bone in rheumatoid arthritis versus arthrosis. Acta Orthop Scand 1994;65:135–138.PubMedCrossRefGoogle Scholar
  101. 100.
    Wolfe F, Zwillich SH. The long-term outcomes of rheumatoid arthritis. Arthritis Rheum 1998;41:1072–1082.PubMedCrossRefGoogle Scholar

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© Springer-Verlag London 2000

Authors and Affiliations

  • J. Dequeker
  • R. Westhovens
  • I. Ravelingien

There are no affiliations available

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