The final pathogenetic steps in focal bone erosions in rheumatoid arthritis
Steven R GoldringDepartment of
Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School
and New England Baptist Bone and Joint Institute, Harvard Institutes of
Medicine, Boston, USA
Correspondence to: Dr Golding, Department of Medicine, Beth Israel Deaconess Medical Center, 110 Francis Street, Boston, MA 02215, USA (sgoldrin@caregroup.harvard.edu)
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The presence of peri-articular osteoporosis and focal bone
erosions at the joint margins and within the subchondral bone adjacent to inflamed joints has been considered the radiographic hallmark of
rheumatoid arthritis (RA).1-4 In addition, in recent
years there has been an increased awareness that RA also produces
adverse effects on systemic bone remodelling at sites not directly
involved with joint inflammation. Numerous reports have documented that people with RA have reduced axial and appendicular bone mass and that
this bone loss is associated with an increased risk of
fracture.5-11 Thus, it is possible to identify three
distinct patterns of bone loss in RA. These include systemic
osteoporosis, juxta-articular osteopenia adjacent to inflamed joints
and focal marginal and subchondral bone erosions that are associated
directly with inflamed synovial tissues. Each of these disorders
represents an example of disturbed skeletal tissue remodelling in which
there is a net loss of bone, although
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