Bone modeling and remodeling: potential as therapeutic targets for the treatment of osteoporosis
The adult skeleton is renewed by remodeling throughout life. Bone remodeling is a process where osteoclasts and osteoblasts work sequentially in the same bone remodeling unit. After the attainment of peak bone mass, bone remodeling is balanced and bone mass is stable for one or two decades until age-related bone loss begins. Age-related bone loss is caused by increases in resorptive activity and reduced bone formation. The relative importance of cortical remodeling increases with age as cancellous bone is lost and remodeling activity in both compartments increases. Bone modeling describes the process whereby bones are shap...
Source: Therapeutic Advances in Musculoskeletal Disease - November 20, 2016 Category: Orthopaedics Authors: Langdahl, B., Ferrari, S., Dempster, D. W. Tags: Review Source Type: research

The clinical characteristics of sarcoid arthropathy based on a prospective cohort study
Conclusions: Inflammatory arthritis occurs in a majority of patients with sarcoidosis. Acute arthritis with bilateral ankle involvement is the most common pattern of sarcoid arthropathy. Sarcoidosis can mimic many primary rheumatic diseases or may coexist with them. Sarcoidosis should be considered not only as a mimicker but also as a Th1-mediated primary rheumatologic pathology. (Source: Therapeutic Advances in Musculoskeletal Disease)
Source: Therapeutic Advances in Musculoskeletal Disease - November 20, 2016 Category: Orthopaedics Authors: Kobak, S., Sever, F., Usluer, O., Goksel, T., Orman, M. Tags: Original Research Source Type: research

Exploratory analysis of osteoarthritis progression among medication users: data from the Osteoarthritis Initiative
Conclusions: Users of neurovascular, antilipemic, or hormonal interventions may have less disease progression compared with nonusers. (Source: Therapeutic Advances in Musculoskeletal Disease)
Source: Therapeutic Advances in Musculoskeletal Disease - November 20, 2016 Category: Orthopaedics Authors: Driban, J. B., Lo, G. H., Eaton, C. B., Lapane, K. L., Nevitt, M., Harvey, W. F., McCulloch, C. E., McAlindon, T. E., for the Osteoarthritis Initiative Investigators Group Tags: Original Research Source Type: research

Combination therapy with biologic agents in rheumatic diseases: current and future prospects
Strategies in rheumatoid arthritis (RA) based on ‘treat to target’ aim to control disease activity, minimize structural damage, and promote longer life. Several disease-modifying antirheumatic drugs (DMARDs) have been shown to be effective including biological DMARDs (bDMARDs). Treatment guidelines and recommendations for RA have also been published. According to those guidelines, conventional synthetic DMARDs (csDMARDs), as monotherapy or combination therapy, should be used in DMARD-naïve patients, irrespective of the addition of glucocorticoids (GCs). Combination therapies with bDMARDs are also essent...
Source: Therapeutic Advances in Musculoskeletal Disease - September 21, 2016 Category: Orthopaedics Authors: Inui, K., Koike, T. Tags: Reviews Source Type: research

Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations
Patients with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, have higher rates of cardiovascular mortality. While the increased cardiovascular risk is only explained to some extent, a lot of research is currently conducted to improve our understanding of its pathogenesis, risk stratification, and optimal cardiovascular risk management. This review sought to report epidemiological data pertaining to the cardiovascular disease burden in patients with inflammatory arthritis, underlying mechanisms accounting for excessive cardiovascular risk, along with recommendations reg...
Source: Therapeutic Advances in Musculoskeletal Disease - September 21, 2016 Category: Orthopaedics Authors: Tournadre, A., Mathieu, S., Soubrier, M. Tags: Reviews Source Type: research

Combination leflunomide and methotrexate in refractory rheumatoid arthritis: a biologic sparing approach
Conclusions: LEF/MTX was effective in the majority of patients in this cohort of mainly Black African women who failed other combination synthetic DMARDs, particularly in those with moderate disease activity at the time of addition of LEF. Infections and hypertension were important complications. In a setting where biologic DMARDs are not readily accessible, the combination of LEF/MTX is a cost-effective approach. (Source: Therapeutic Advances in Musculoskeletal Disease)
Source: Therapeutic Advances in Musculoskeletal Disease - September 21, 2016 Category: Orthopaedics Authors: Hodkinson, B., Magomero, K. R., Tikly, M. Tags: Original Research Source Type: research

Best performing definition of accelerated knee osteoarthritis: data from the Osteoarthritis Initiative
Conclusions: A comprehensive KL-based definition of AKOA may be ideal because it represents a broader definition of joint deterioration compared with those focused on just joint space or osteophytes alone. (Source: Therapeutic Advances in Musculoskeletal Disease)
Source: Therapeutic Advances in Musculoskeletal Disease - September 21, 2016 Category: Orthopaedics Authors: Driban, J. B., Stout, A. C., Lo, G. H., Eaton, C. B., Price, L. L., Lu, B., Barbe, M. F., McAlindon, T. E. Tags: Original Research Source Type: research

Treatment of hyperuricemia in gout: current therapeutic options, latest developments and clinical implications
Despite being the most common type of inflammatory arthritis, gout is often poorly managed. Except for febuxostat and pegloticase, research in new therapeutic agents for the management of hyperuricemia in gout remained insufficient for several decades. With emerging evidence of possible roles of hyperuricemia in cardiometabolic comorbidities, as well as more convincing evidence regarding poor outcomes (e.g. disability, recurrent hospital admissions) in patients with uncontrolled gout, several agents are current under development. Increasing knowledge regarding renal urate transporters has resulted in the development of new...
Source: Therapeutic Advances in Musculoskeletal Disease - July 12, 2016 Category: Orthopaedics Authors: Sattui, S. E., Gaffo, A. L. Tags: Reviews Source Type: research

Selected aspects of the current management of myositis
The idiopathic inflammatory myopathies (IIM) are a rare and heterogeneous group of acquired autoimmune muscle disorders, often referred to as ‘myositis’. Clinical assessment, together with muscle biopsy findings and autoantibody status are key factors to consider when making a diagnosis of IIM, and in stratification of the ‘IIM spectrum’ into disease subgroups. Treatment stratified according to serotype (and in the future, likely also genotype) is increasingly being used to take account of the heterogeneity within the IIM spectrum. Subgroup classification is also important in terms of monitoring for...
Source: Therapeutic Advances in Musculoskeletal Disease - July 12, 2016 Category: Orthopaedics Authors: Lilleker, J., Murphy, S., Cooper, R. Tags: Reviews Source Type: research

Maternal vitamin D levels during pregnancy and neonatal health: evidence to date and clinical implications
Low maternal vitamin D levels during pregnancy have been associated with a plethora of adverse neonatal outcomes, including small for gestational age and preterm births, detrimental effect on offspring bone and teeth development, and risk of infectious diseases. Although most observational studies indicate a significant linear relationship between maternal 25-hydroxyvitamin D and the above outcomes, some randomized controlled trials to date are inconclusive, mostly due to differences in study design and supplementation regimen. The currently available results indicate that vitamin D supplementation during pregnancy reduces...
Source: Therapeutic Advances in Musculoskeletal Disease - July 12, 2016 Category: Orthopaedics Authors: Karras, S. N., Fakhoury, H., Muscogiuri, G., Grant, W. B., van den Ouweland, J. M., Colao, A. M., Kotsa, K. Tags: Reviews Source Type: research

Intravenous zoledronate for osteoporosis: less might be more
Annual administration of 5 mg intravenous zoledronate is moderately effective in reducing fracture risk in older adults, decreasing the relative risk of clinical fracture by 33%. However, almost 10 years after its approval for use in clinical practice there remain very substantial uncertainties about the optimal treatment regimen, that is, the lowest dose and/or longest dosing interval that is efficacious. Several pieces of clinical research suggest that the current recommendation for annual administration of 5 mg zoledronate might represent overtreatment. Clinical trials to clarify the optimal use of zoledronate for reduc...
Source: Therapeutic Advances in Musculoskeletal Disease - July 12, 2016 Category: Orthopaedics Authors: Grey, A. Tags: Reviews Source Type: research

Remission-induction therapies for early rheumatoid arthritis: evidence to date and clinical implications
Recent guidelines on rheumatoid arthritis (RA) point to the importance of achieving remission as soon as possible during the course of the disease. The appropriate use of antirheumatic drugs is critical, particularly in early RA patients, before 24 weeks, since this is a ‘window of opportunity’ for treatment to modify disease progression. A treat-to-target strategy added to an aggressive therapeutic approach increases the chance of early remission, particularly in early RA patients. We conducted an overview of current therapeutic strategies leading to remission in early RA patients. We also provide interesting ...
Source: Therapeutic Advances in Musculoskeletal Disease - July 12, 2016 Category: Orthopaedics Authors: Espinoza, F., Fabre, S., Pers, Y.-M. Tags: Reviews Source Type: research

Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication facto...
Source: Therapeutic Advances in Musculoskeletal Disease - May 5, 2016 Category: Orthopaedics Authors: Zegkos, T., Kitas, G., Dimitroulas, T. Tags: Reviews Source Type: research

How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: current thoughts
The objectives of osteoarthritis (OA) management are to reduce pain and inflammation, slow cartilage degradation, improve function and reduce disability. Current strategies for managing knee OA include nonpharmacological interventions, oral pharmacological treatments, localized intra-articular injections, and surgery. It has become evident that the inflammatory response is a key contributor to the development and progression of knee OA. Signaling pathways involving growth factors and cytokines are being investigated for the development of new therapies that target the underlying biological processes causing the disease. Th...
Source: Therapeutic Advances in Musculoskeletal Disease - May 5, 2016 Category: Orthopaedics Authors: Wehling, P., Moser, C., Maixner, W. Tags: Reviews Source Type: research

Bone repair with skeletal stem cells: rationale, progress to date and clinical application
Bone marrow (BM) contains stem cells for both hematopoietic and nonhematopoietic lineages. Hematopoietic stem cells enable hematopoiesis to occur in a controlled manner in order to accurately compensate for the loss of short- as well as long-lived mature blood cells. The physiological role of nonhematopoietic BM stem cells, often referred to as multipotential stromal cells or skeletal stem cells (SSCs), is less understood. According to an authoritative current opinion, the main function of SSCs is to give rise to cartilage, bone, marrow fat and hematopoiesis-supportive stroma, in a specific sequence during embryonic and po...
Source: Therapeutic Advances in Musculoskeletal Disease - May 5, 2016 Category: Orthopaedics Authors: Jones, E. A., Giannoudis, P. V., Kouroupis, D. Tags: Reviews Source Type: research