Sjögrens Forum

QUESTION:

I have been diagnosed with sjogren's (2 years) and multiple sclerosis (5+
years), plus fibromyalgia (15+ years) and some form of spondyloarthropathy (20+
years and HLA-B27.  Somehow I broke a bone in my wrist a few days ago: distal
radial head fracture, right wrist. I was literally sitting on the couch and it
began to hurt. my primary xrayed and splinted it, with follow-up in two weeks.
saw my rheumatologist today, he ordered a dexa-scan and basically said this is
the beginning, i will probably break bones frequently. I see my neurologist on tues/wed
for ivig treatment and am wondering what her take will be.

My question is: are these auto-immune diseases really related to this bone break and do I really
need to be prepared for more?   I am active, working horses 5-6 days a week. i am
as fit as I can get.  Yes, i have pain, fatigue, and all the normal symptoms but I have
made a conscious effort to fight these diseases very hard ... use it or lose it.
What should I expect next?

DR. CARTERON'S ANSWER:

There is a lot of autoimmunity going on--Spondyloarthropathy+MS+Sjo fracture risk). Spondyloarthropathy can be associated with gastrointestinal (GI) inflammation and nutrient absorption problems can result which means an additional risk for osteopenia. Sjs and celiac also can be associated with malabsorption.

It sounds like you are beginning to get the information you will need to establish where your bones are now and then what you can do to prevent further bone loss and perhaps even improve your bone quality to prevent further fractures. So I would focus on what you can do to prevent progression of the process.

Usually bone density (DEXA), Vitamin D, Calcium, Phosphorus, and routine type labs are the place to start.  I would talk to your current doctors and see how experienced they are in assessing and managing osteoporosis, and how aggressive they tend to be. As with all medicines and treatments, there are risks/benefits to be weighed and each person may make a different choice for themselves.  If they don't work alot in this area-ask for a referral to someone in your area does. Usually, Endocrinologists are the most specifically trained in bone metabolism-however they may not connect the inflammation/autoimmune or GI piece.

That you are physically active is very important in bone health. Calcium, Vitamin D, and hormones are also important. The main medications that are used are bisphosphonates (currently not clear how long patients should be treated)-they block bone breakdown, and a new agent denusomab (RANK ligand blocker) which may also block pathways of inflammation. It is being studied in RA-but it is in early stages so we don't know if it would help both autoimmune/inflammatory disease and osteoporosis.

Dr.C.