EDITORIAL - The history of erosions in RA: are erosions history?

[Guest guest]

Arthritis & Rheumatism

Volume 62, Issue 2, Pages 312-315

Published Online: 28 Jan 2010

Editorials

The history of erosions in rheumatoid arthritis: Are erosions history?

Dennis McGonagle

Chapel Allerton Hospital, Leeds, UK

Small joint periarticular erosions have occupied center stage in the

understanding of the pathogenesis of rheumatoid arthritis (RA) for

well over 50 years ([1]). Such erosions have diagnostic and prognostic

significance and have served as a valuable outcome measure in the

evaluation of therapeutic responses to drugs for disease ([2]). The RA

erosion paradigm extends well beyond these immediately clinically

relevant issues. An understanding of the proinflammatory milieu at the

cartilage-pannus junction, the putative site where erosion formation

was thought to be initiated, was considered to represent a key event

toward the development of biologic therapies in RA ([3]). Ongoing

efforts seek to link the immunopathogenetic basis for erosion

formation to emergent genome-wide association studies to further

elucidate the basis for joint disease in RA.

The importance of erosions in the immunopathogenesis of RA is almost

dwarfed by the importance that their early detection has assumed.

Erosions represent 1 of the 3 diagnostic criteria for RA when combined

with clinical and serologic parameters ([2]). With the advent of more

sophisticated imaging techniques, most notably, magnetic resonance

imaging (MRI) and ultrasound (US), rheumatologists are increasingly

interested in detecting these seemingly diagnostic and prognostic

features in early RA to facilitate a definitive diagnosis and to

initiate the most appropriate therapy, at the earliest possible

opportunity. Why this is the case and why it merits reconsideration

based on work reported by Stach et al in this issue of Arthritis &

Rheumatism ([4]) and based on other recent data are the subjects of

this perspective.

*************************************************************

Read the full editorial here:

http://www3.interscience.wiley.com/cgi-bin/fulltext/123266748/HTMLSTART

Not an MD