Intrinsic alteration in immunoregulation in patients with rheumatoid arthritis has implications for treating osteolysis
Patients with rheumatoid arthritis (RA) who undergo joint replacement due to bone loss around an implant exhibit a distinct cellular response to implant wear debris compared to non-RA patients. This reaction is unrelated to differences in the type or amount of debris and was mitigated by anti-tumor necrosis factor (TNF) therapy. These results suggest an intrinsic alternation in immunoregulation in RA and have implications for treatment of osteolysis in RA patients, according to a new study.
This bone loss (called peri-implant osteolysis) and loss of fixation of the prosthetic joint are considered the main reasons for failure of total joint replacements. Joint replacement failure has been attributed to a cellular inflammatory reaction to wear particles from the implant (prosthetic wear debris), although dramatic differences in the rates of bone loss are seen between patients. The researchers compared responses in 38 patients who had undergone total elbow arthroplasty (TEA).
Among these patients, 25 had RA and 13 did not have inflammatory arthritis. The amount and type of wear particles in the tissue surrounding the failed implant did not differ between the RA patients and those without inflammatory disease. However, the patients with RA who were not receiving anti-TNF therapy showed a different histologic pattern (interstitial and sheet-like infiltrates of lymphocytes, with many plasma cells) from the patients without RA (perivascular infiltrates, with few plasma cells). Patients with RA who were being treated with anti-TNF showed a mixed pattern of perivascular and interstitial infiltrates. Based on their findings, the researchers suggest that immunologic treatment might be successful in preventing more rapid osteolysis in the patients with RA.
The surgical specimens and clinical data were for patients who had primary revisions of TEA at the Hospital for Special Surgery in New York City. The study was funded in part by AHRQ (HS16075) to the Cornell Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit www.certs.hhs.gov.
More details are in "Cellular response to prosthetic wear debris differs in patients with and without rheumatoid arthritis," by Anant Vasudevan, B.S., Edward F. DiCarlo, M.D., Lisa A. Mandl, M.D., M.P.H., and others in the April 2012 Arthritis & Rheumatism 64(4), pp. 1005-1014.