EDITORIAL - Periarticular bone changes in RA: pathophysiological implications and clinical utility

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ls of the Rheumatic Diseases 2009;68:297-299; doi:10.1136/ard.2008.099408

EDITORIAL

R Goldring

Departments of Orthopedics and Rheumatology, Hospital for Special

Surgery, Weill Medical College of Cornell University, New York, USA

Periarticular bone changes in rheumatoid arthritis: pathophysiological

implications and clinical utility

In recent decades there has been a dramatic change in the treatment

approaches for management of rheumatoid arthritis (RA). The

introduction of methotrexate and the subsequent development of the

biological agents that target tumour necrosis factor (TNF) and/or

immune cell activation pathways have dramatically improved patient

outcomes. Nevertheless, as additional information becomes available

from prospective studies of patients receiving these therapies, there

is evidence that a significant number of individuals continue to

experience progressive joint damage and functional impairment.1–6

Based on these observations, there is a need to develop validated

assessment tools for identifying patients who are at risk for a poor

prognosis and to target this population for more aggressive and/or

specific therapies to prevent eventual joint damage. In this and a

recent issue of the ls of Rheumatic Diseases, two independent

groups of investigators have utilised the techniques of bone mineral

density (BMD) and radiographic analysis to assess bone loss in

patients with early RA and to validate the changes in BMD as a

predictor of subsequent radiographic evidence of focal marginal joint

erosions.7 8

Both of the studies have exploited the evidence that the RA

inflammatory process produces adverse effects on both local articular

as well as systemic bone remodelling.9–13 The skeletal changes can be

segregated into distinct patterns on the basis of anatomic site and

distribution. These include focal marginal joint erosions (the

radiographic hallmark of RA), subchondral bone erosions, periarticular

osteoporosis and systemic osteoporosis. These skeletal changes are

associated with net bone loss and in all instances are reflective of

an imbalance in the activities of the cells that mediate bone

resorption and formation.

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Read the entire editorial here:

http://ard.bmj.com/cgi/content/full/68/3/297

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