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This observation supports the concept that the duration of inflammation is critical for peripheral bone loss in RA.
See related research by Hoff et al., In a well documented and extensive study of peripheral bone loss in established rheumatoid arthritis (RA), Hoff and colleagues [ 1] evaluated bone loss in the hand using digital X-ray radiogrammetry (DXR) and dual energy X-ray absorptiometry (DXA).
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The current study indicates, nevertheless, that axial and peripheral trabecular bone loss are connected in AS.
This carefully conducted study revealed significant peripheral hand bone loss (estimated by DXR), independent of disease duration.
In this study, patients with PsA were carefully characterized to identify patterns of peripheral joint bone loss and bone formation, and the relation between these patterns of bone pathology and soluble mediators of bone remodeling was analyzed.
Consistent with the work of Ritchlin et al. [ 12], our study also implicates RANKL in the pathogenesis of bone erosion in PsA, noting the modest correlation between circulating RANKL concentrations and measures of peripheral-joint bone loss.
They compared peripheral demineralization with central bone loss (quantified by axial DXA measurements) at the lumbar spine and femoral neck, considering disease duration over an observation period of 2 years.
Anyway, TZDs should not be considered a first-line approach and should be avoided in patients at high risk of weight gain, peripheral edema, heart failure, and bone loss and in those with history of osteoporosis or bladder cancer.
In studies using peripheral qCT at the forearm, trabecular bone loss was more prominent than cortical bone loss in RA patients using GCs [ 79, 80].
Osteoporosis of the axial skeleton is a known complication of ankylosing spondylitis (AS), but bone loss affecting the peripheral skeleton is less studied.
Our data indicate that the extent of bone loss at the peripheral joint is associated with elevated circulating M-CSF and RANKL concentrations, but that these factors are not associated with the extent of systemic bone loss in PsA.
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