title: BRONJ in patients with rheumatoid arthritis: a multicenter case series.
abstract: OBJECTIVE
  Osteonecrosis of the jaw (ONJ) is a potentially severe adverse effect of various medications (bisphosphonates, anti-resorptive, and anti-angiogenic drugs). ONJ pathogenesis is still unclear although some risk factors have been recognized. Of these, rheumatoid arthritis (RA) has been hypothesized as a potential risk factor for developing ONJ. This observational study will describe a multicenter case series of patients affected with RA and ONJ, and it will attempt to evaluate the association between features of ONJ and pharmacological, systemic, and site variables.
  
  
  METHODS
  Demographic, pharmacological, and clinical data from 18 RA patients with ONJ were collected and registered from three Italian centers (i.e., Palermo, Verona, and Padua) from 2004 to 2013.
  
  
  RESULTS
  Sixteen (88.9%) patients were in therapy for RA: 9 of 18 (50.0%) with systemic steroids, 3 of 18 (16.7%) with methotrexate, and 4 of 18 (22.2%) with both medications. Two patients were not receiving treatment for RA. All patients took NBPs for secondary osteoporosis (average NBP duration of 69 months, range: 20-130): Fifteen (83.3%) patients were treated with single NBPs, while three (16.7%) with different molecules; one patient was also treated with denosumab. Mandible was affected more frequently (66.7%) than maxilla (33.3%); one patient presented multiple ONJ events.
  
  
  CONCLUSIONS
  This is the first multicenter case series in the international literature regarding our topic. Focusing on our data, it could be hypothesized that patients with RA may be more susceptible to ONJ than the majority of osteometabolic patients. In our opinion, it could be important to monitor also denosumab or other biological drug side effects.
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Di Fede
authors.affiliation: Department of Neurosciences, University of Padua, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bedogni
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giancola
authors.affiliation: Department of Neurosciences, University of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Saia
authors.affiliation: Department of Maxillofacial Surgery, University Hospital of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bettini
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Toia
authors.affiliation: Clinical Pharmacology Unit, Azienda Ospedaliera Universitaria Policlinico 'P. Giaccone', Palermo, Italy.
authors.forename: N
authors.initials: N
authors.lastname: D'Alessandro
authors.affiliation: Department of Sciences for Health Promotion and Mother and Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Firenze
authors.affiliation: Department of Sciences for Health Promotion and Mother and Child Care 'G. D'Alessandro', University of Palermo, Palermo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Matranga
authors.affiliation: UCL Eastman Dental Institute, University College London, London, UK.|NIHR University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Fedele
authors.affiliation: Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Campisi
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: ONJ; bisphosphonate; denosumab; jaw; osteonecrosis; osteoporosis; rheumatoid arthritis