A 55-year-old postmenopausal woman has had seropositive rheumatoid arthritis for 15 years, with persistently active disease despite methotrexate and

Question

A 55-year-old postmenopausal woman has had seropositive rheumatoid arthritis for 15 years, with persistently active disease despite methotrexate and several biologic DMARDs. She remains ambulant and has not received systemic glucocorticoids for 5 years. DXA demonstrates osteoporosis, and spinal imaging confirms two atraumatic vertebral fractures. Which mechanism best explains how rheumatoid arthritis itself contributes to her skeletal disease?

Accepted Answer

TNF and IL-6 promote RANKL-dependent osteoclastogenesis and systemic bone resorption independently of current glucocorticoid use

Answer

Synovial pannus extends directly into vertebral bodies and thereby produces generalized axial osteoporosis

Answer

Inflammation causes sarcopenia and falls but has no direct adverse effect on skeletal remodelling

Answer

Methotrexate-induced folate antagonism suppresses osteoblast replication and is the principal cause of generalized bone loss

Answer

Remote glucocorticoid exposure causes persistent osteoblast suppression, with no contribution from ongoing rheumatoid inflammation

Inflammatory Osteoporosis in RA — SCE Rheumatology MCQ