Low-dose methotrexate in rheumatoid arthritis: a potential risk factor for bisphosphonate-induced osteonecrosis of the jaw
| Autor: | Neha Aggarwal, Neelam N. Andrade, Shibani Nerurkar, Paul C. Mathai, Prathmesh Kapoor |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Anemia medicine.medical_treatment Osteoporosis Administration Oral Gastroenterology Arthritis Rheumatoid 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Diabetes mellitus medicine Humans Aged Chemotherapy Diphosphonates business.industry 030206 dentistry Bisphosphonate Middle Aged medicine.disease Methotrexate Otorhinolaryngology 030220 oncology & carcinogenesis Rheumatoid arthritis Tooth Extraction Surgery Bisphosphonate-Associated Osteonecrosis of the Jaw Female Oral Surgery business Osteonecrosis of the jaw medicine.drug |
| Zdroj: | Oral and maxillofacial surgery. 22(2) |
| ISSN: | 1865-1569 |
| Popis: | Bisphosphonate-induced osteonecrosis of the jaw [BIONJ] is a relatively new pathological condition which was first described in the year 2003. The prevalence of BIONJ in patients on oral formulations is around 0.05% within the first 3 years and increases up to 0.2% after 4 years of consumption. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases [e.g., high doses of methotrexate up to 30 mg daily] significantly increase the chances of acquiring BIONJ. We present three patients with osteoporosis and rheumatoid arthritis [RA] who consumed oral bisphosphonates [alendronate] for less than 1 year and developed BIONJ within 2 to 5 months of undergoing a traumatic dental procedure. The patients also gave a history of consuming low doses of methotrexate [disease-modifying anti-rheumatic drugs] up to 20 mg weekly for 4 to 10 years. No history of steroid consumption was given by any of the patients. This case series highlights the possibility of rheumatoid arthritis and low-dose methotrexate being potential risk factors for BIONJ. This may be on account of the synergistic effect of methotrexate and bisphosphonates and the pro-inflammatory state created by RA which increased the risk of acquiring BIONJ. |
| Databáze: | OpenAIRE |
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