ECTS2013 Poster Presentations Clinical case posters (12 abstracts)
Osteonecrosis of the jaw in a patient with rheumatoid artritis treated with an oral aminobisphosphonate: a clinical case report
Lorena Longato 1 , Loredana Cavalli 2 , Gemma Marcucci 2 , Alessia Metozzi 2 , Francesca Giusti 2 , Maria Luisa Brandi 2 & Prisco Piscitelli 2,
1Local Health Authority ASL, Biella, Italy; 2Department of Internal Medicine, University of Florence, Florence, Italy; 3Euro Mediterranean Biomedical Scientific Institute (ISBEM), Brindisi, Italy.
Osteonecrosis of the jaw (ONJ) has been recently described after i.v. administration of amino-bisphosphonates and – less frequently – in association with the use of oral bisphosphonates. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) may affect mandible bone (65%), maxilla bone (26%) and rarely (9%) both sites simultaneously. Although causality may never be proven, emerging experimental data have established a strong association between monthly i.v. bisphosphonate administration and ONJ. Current level of evidence does not fully support a cause and effect relationship between the use of oral BPs and ONJ. In this paper, we report a clinical case of BRONJ in a 73 years old woman affected by rheumatoid arthritis (RA) and periodontitis, after 3 years of treatment with alendronate 70 mg once a week, plus daily calcium and vitamin D. The patient developed a tooth abscess at the lower jaw, accompanied by increased inflammatory markers, that never returned to normal range despite antibiotic therapy, inducing deterioration of joint synovium. The worsening of joint status after the onset of ONJ was reflected by the progressive increase in the number of swollen (SJ) and tender (TJ) joints, by the deterioration of the score DAS 28 (which passed from 5.46 to 7.07), pain (with VAS increasing from 60 to 90), and by a progressively impaired quality of life, as reported using the HAQ score (from 1.25 to 2.5). The patient was switched to antifracture therapy with strontium ranelate and the osteonecrosis was successfully treated with antibiotics, surgical curettage and local ultrasounds.
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Bone Abstracts
ISSN 2052-1219 (online)
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