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Won Park, Seong Ryul Kwon |
한림의대 한강성심병원 내과 |
의학강좌 : 개원의를 위한 모범처방전 ; 관절염환자에서의 골다공증과 치료 (Current Clinical Practice : Management of the arthritis related osteoporosis) |
박원, 권성렬 |
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Abstract |
The osteoporosis is frequently observed in the patients with the inflammatory arthritis and painful
rheumatism. The treatment of the osteoporosis for them is different from that for the patients without
the arthritis or rheumatism. The recently developed biologic agents blocking tumor necrosis factor,
interleukin(IL)-1, IL-6, or receptor activator of nuclear factor-kappaB ligand (RANKL) which are
designed to treat the inflammatory arthritis are also expected to heal the osteoporosis in the
inflammatory arthritis. The early use of the bisphosphonate is useful to prevent the glucocorticoid
induced bone loss and to treat the spondyloarthropathy including the SAPHO (synovitis, acne,
pustulosis, hyperostosis, osteitis) syndrome. The clacitonin is useful for the painful rheumatism and
osteoporotic fracture. The estrogen replacement is disputed because the stroke is known to occur
more commonly in chronic inflammatory rheumatism than in general population. Moreover the
pathogenesis of the most rheumatism may be partly related to the hormone. The parathyroid hormone
therapy needs caution in the patients with calcium deposition disease and the hyperuricemia. We are
reviewing the recent trend and development in the management of the primary, secondary and
inflammatory osteoporosis in the patients with arthritis. |
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