Title

Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment

UMMS Affiliation

Department of Medicine, Division of Rheumatology

Date

11-2012

Document Type

Article

Medical Subject Headings

Animals; Arthritis, Rheumatoid; Bone Resorption; Cell Differentiation; Cytokines; Humans; Osteoclasts

Disciplines

Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases

Abstract

Bone erosion is a central feature of rheumatoid arthritis and is associated with disease severity and poor functional outcome. Erosion of periarticular cortical bone, the typical feature observed on plain radiographs in patients with rheumatoid arthritis, results from excessive local bone resorption and inadequate bone formation. The main triggers of articular bone erosion are synovitis, including the production of proinflammatory cytokines and receptor activator of nuclear factor kappaB ligand (RANKL), as well as antibodies directed against citrullinated proteins. Indeed, both cytokines and autoantibodies stimulate the differentiation of bone-resorbing osteoclasts, thereby stimulating local bone resorption. Although current antirheumatic therapy inhibits both bone erosion and inflammation, repair of existing bone lesions, albeit physiologically feasible, occurs rarely. Lack of repair is due, at least in part, to active suppression of bone formation by proinflammatory cytokines. This Review summarizes the substantial progress that has been made in understanding the pathophysiology of bone erosions and discusses the improvements in the diagnosis, monitoring and treatment of such lesions.

Rights and Permissions

Citation: Nat Rev Rheumatol. 2012 Nov;8(11):656-64. doi: 10.1038/nrrheum.2012.153. Epub 2012 Sep 25. Link to article on publisher's site

Related Resources

Link to Article in PubMed

PubMed ID

23007741