地舒单抗在类风湿性关节炎中的应用

骨质疏松是类风湿性关节炎的常见并发症。地舒单抗是一种可与核因子kappa-B受体激动剂配体结合的全人源性单克隆抗体，能抑制破骨细胞活性，增加骨密度，减少骨折发生率，并且安全性良好。地舒单抗越来越多的用于类风湿性关节炎的治疗。地舒单抗可以增加类风湿关节炎患者的骨密度，阻止骨侵蚀和关节周围骨质流失的发生，降低骨折的发生率，但不影响滑膜炎症和关节活动度。地舒单抗与治疗类风湿性关节炎的药物联合应用可协同抑制骨侵蚀，且耐受性良好，感染的发生率并未增加，同时需关注颌骨坏死和非典型股骨骨折等罕见副作用，建议补充维生素D及钙剂预防低钙血症。地舒单抗在停药后，警惕骨密度下降及锥体骨折等风险，建议在医师指导下停药，可在停药后转换为双膦酸盐等继续治疗。

Denosumab in the Treatment of Rheumatoid Arthritis

Osteoporosis is a common complication of rheumatoid arthritis （RA）.Denosumab，a human antibody against receptor activator of nuclear factor-kappa B ligand，cansuppress the differentiation and activation of osteoclast，increase bone mineral density （BMD），and reduce the incidence of fracture. Denosumab can be used in the treatment of rheumatoidarthritis. In the patients with RA，it can efficiently increase bone mineral density，suppressthe progression of bone erosion，but it does not affect synovitis and disease activity. Thecombination of denosumab and disease-modifying anti-rheumatic drugs，can inhibit bone erosionsynergistically with good tolerance and no increases in infection rates. We should concern aboutrare side effects，such as osteonecrosis of the jaw and atypical femoral fracture. Calcium andvitamin D supplementation with denosumab treatment is beneficial to prevent hypocalcemia. Weshould pay attention to the risk of bone mineral density decline and vertebral fractures after drugdiscontinuation. Denosumab discontinuation might be considered under the guidance of doctors.Administration of a bisphosphonate after denosumab discontinuation is recommended.