Healing of erosions in rheumatoid arthritis

Sokka, Tuulikki; Hannonen, Pekka

doi:10.1136/ard.59.8.647

Cited by 36 publications

(18 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The regression was not complete, and the total amount of regression was therefore v14%. Similar findings by other authors confirm these results (33). Although this means that the existing scoring systems should be modified, to be able to include improvements, it is still a fact that regression of erosion is a rare phenomenon, and that the original theory of irreversibility, although not completely true, still is almost true for historical cohorts.…”

Section: Radiographic Evaluation As An Outcome Measure In Rasupporting

confidence: 89%

The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins

Graudal

2004

Scandinavian Journal of Rheumatology

View full text Add to dashboard Cite

Section: Radiographic Evaluation As An Outcome Measure In Rasupporting

confidence: 89%

The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins

Graudal

2004

Scandinavian Journal of Rheumatology

View full text Add to dashboard Cite

“…Exercises with experts blindly reading conventional radiographs assessing them for the evidence of repair of erosions consistently indicated that repair of individual lesions can indeed occur 16 17. Small radiographic case series from Rau and Herborn,18 McCarty and Carrera,19 Jalava and Reunanen20 and Sokka and Hannonen21 also suggested the principal possibility of the repair of individual bone erosions. As virtually all of these patients were either treated with gold salts or disease-modifying antirheumatic drug (DMARD) combinations the authors concluded that effective control of inflammation is a prerequisite for inducing repair.…”

Section: Discussionmentioning

confidence: 95%

Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion

Finzel

Rech

Schmidt

et al. 2011

Annals of the Rheumatic Diseases

109

View full text Add to dashboard Cite

ObjectivesTo investigate whether bone erosions in patients with rheumatoid arthritis (RA) show evidence of repair. Methods 127 erosions were identifi ed in metacarpophalangeal joints 2-4 of the right hands of 30 RA patients treated with tumour necrosis factor inhibitors (TNFi) and 21 sex, age and disease activitymatched patients treated with methotrexate. All erosions were assessed for their exact maximal width and depth by high-resolution µCT imaging at baseline and after 1 year. Results All erosions detected at baseline could be visualised at follow-up after 1 year. At baseline, the mean width of bone erosions in the TNFi group was 2.0 mm; their mean depth was 2.3 mm, which was not signifi cantly different from the methotrexate-treated group (width 2.4 mm; depth 2.4 mm). Mean depth of erosions signifi cantly decreased after 1 year of treatment with TNFi (−0.1 mm; p=0.016), whereas their width remained unchanged. In contrast, mean depth and width of erosive lesions increased in the methotrexate-treated group. The reduction in the depth of lesions was confi ned to erosions showing evidence of sclerosis at the base of the lesion. Moreover, deeper lesions in the TNFi group were particularly prone to repair (−0.4 mm; p=0.02) compared with more shallow lesions. Conclusions Bone erosions in RA patients treated with TNFi show evidence of limited repair in contrast to bone erosions in patients treated with methotrexate. Repair is associated with a decrease in the depth of lesions and sclerosis at the bases of the lesions. Repair thus emerges from the endosteal rather than periosteal bone compartment and probably involves the bone marrow.Bone erosion is a central pathophysiological process in rheumatoid arthritis (RA). Growth factors such as monocyte colony stimulating factor as well as cytokines such as receptor activator of nuclear factor kappa B ligand, tumour necrosis factor alpha (TNFα) and interleukin-1 expressed in the synovial tissue stimulate the differentiation of monocytes/ macrophages into osteoclasts, which initiate the resorption of the periarticular bone. 1 2 This resorption process leads to a loss of mineralised tissue along the joints, which can be visualised as bone erosion by conventional radiography. Apart from clinical measurements, the detection and quantifi cation of bone erosion is an important outcome parameter in both clinical studies and clinical practice. 3 4 Virtually all currently used drug therapies have been tested for their ability to retard the bone erosive process in RA, which is suggestive of effective disease control and preservation of the joint architecture.Bone erosion is closely linked to infl ammatory disease activity of RA. The better synovial infl ammation can be controlled by anti-infl ammatory drug therapy, the more likely retardation or arrest of bone erosion is achieved. Despite this link between infl ammation and bone erosions, some treatment regimens are particularly effective to retard structural damage. 5 Inhibition of tumour necrosis factor alpha inhibibors (...

show abstract

“…Two cases with filling-in and recortication after coming into remission with MTX and gold treatment, respectively, were demonstrated by Socca and Hannonen [38].…”

Section: History Of Publications On Healingmentioning

confidence: 93%

Healing of Radiologic Damage in Rheumatoid Arthritis

Rau

2007

CRR

View full text Add to dashboard Cite

Until recently the possibility of healing of erosive changes in RA has been neglected. When evaluating the radiographic course within clinical studies, a reduction of the radiographic score indicating improvement was not allowed since repair of erosions was considered to be impossible. During the last 3 decades several case reports and case series have been published demonstrating convincingly that healing of erosions of RA patients really occurs. In addition, a subcommittee on healing of the OMERACT imaging committee undertook to confirm the existence of repair by performing several studies: different experts had to evaluate erosions on radiographs of the same patients taken at two different time points demonstrating deterioration or improvement. Blinded to the sequence of the films they agreed which film was better or worse and which erosion was greater or smaller. Since 50% of the films showing improvement were taken at the second time point, that study confirmed that healing really exists. Owing to several special features healing could be diagnosed without knowing the sequence of the films in one study, not convincingly so in another study. Among different features indicating healing on radiographs the following can be distinguished with relative certainty: "re-cortication", meaning the re-appearance of a cortical plate that had been destroyed; "filling-in", meaning filling of an erosion with new bone; "restoration", meaning complete normalisation of the shape of the joint and the trabecular structure of the subchondral bone. The best agreement between observers concerns erosion size. Radiographic evaluation blinded to the sequence of the films in trials with biologics resulted in negative scores exceeding the measurement error of the scoring method in a certain percentage of patients, again supporting the existence of healing. As healing only occurs in an individual joint after the inflammatory process has been quiet in that joint for several months, healing could be utilized as an outcome measure in addition to the slowing or arrest of progression. This article gives an overview over the history and present knowledge of radiographic signs of erosion healing.

show abstract

Healing of erosions in rheumatoid arthritis

Cited by 36 publications

References 12 publications

The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins

The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins

Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion

Healing of Radiologic Damage in Rheumatoid Arthritis

Contact Info

Product

Resources

About