Medication-related osteonecrosis of jaw and rheumatoid arthritis: Revisiting the concepts

Abstract

Medication-related osteonecrosis of the jaw (MRONJ) is one of the most challenging condition that clinicians come across owing to its varied degree of presentation defined in literature. In rheumatoid arthritis (RA), individuals are under the influence of varied medications which might impact the bone turnover. Hence, this narrative review has been undertaken to specifically discuss development of MRONJ in RA, to study the associated risk factors, to highlight the importance of oral health care and to revisit the concepts of medications related to the above said condition. PubMed and Cochrane database search was done in English language literature using the term “Medication-related osteonecrosis of jaw and rheumatoid arthritis” and “bisphosphonate induced osteonecrosis of jaw and rheumatoid arthritis”, which resulted in 45 articles. It was concluded that MRONJ is a multifactorial condition, seen concomitantly with various medical co morbidities like thromphophilia, hypertension, kidney disorders, osteoporotic conditions, arthritis, and various medications like steroids, bisphosphonates and other drugs affecting metabolism of bone. Literature has often tried to prove the association of RA in MRONJ causation, however there is no uniform agreement on the same. Though various risk factors have been delineated, but multiple evidences suggest that RA may prove to be a major risk factor. Present review supports the same and also highlights the growing evidence on the role of emerging new drugs in MRONJ development. Also utmost dental care, appropriate patient education, reduction of infective foci prior to initiation of medical therapy, patient compliance and regular follow up is required for reduction of number of patients presenting with MRONJ.

Keywords

• bisphosphonates
• immunosuppressants
• medication-related osteonecrosis of jaw
• methotrexate
• osteonecrosis of jaw