From the Guidelines
Skeletal findings in rheumatoid arthritis (RA) are characterized by periarticular osteopenia, uniform joint space narrowing, and osseous erosions, as identified by radiography, the recommended initial imaging method 1. The hallmarks of RA on radiography, as outlined in the American College of Radiology's appropriateness criteria 1, include:
- Periarticular osteopenia
- Uniform joint space narrowing
- Osseous erosions These findings are crucial in identifying possible erosions and providing an overview of the disease distribution in the extremities. Key characteristics of RA skeletal findings include:
- Periarticular osteopenia as an early radiographic sign
- Joint space narrowing, particularly in the hands, wrists, and feet
- Marginal erosions at the joint margins
- Characteristic deformities such as ulnar deviation, swan-neck deformities, boutonnière deformities, and subluxations in advanced disease
- Symmetrical involvement of multiple joints, distinguishing RA from other arthritides.
From the Research
Skeletal Findings in RA
- Rheumatoid arthritis (RA) is associated with local and systemic inflammation that induces many changes in skeletal health, including periarticular bone loss and juxta-articular bone erosions 2
- Joint ankylosis, generalized bone loss, osteoporosis, and fractures may develop secondary to inflammation in RA patients 2
- The disease can lead to an increased risk for fragility fractures, which further impair functional ability, quality of life, and life expectancy 3
- Patients with active RA have elevated bone resorption and local bone loss, and are at increased risk for generalized bone loss, vertebral and non-vertebral fractures 3
Treatment and Skeletal Health
- Combination therapy with methotrexate, sulfasalazine, and hydroxychloroquine is more effective than either methotrexate alone or a combination of sulfasalazine and hydroxychloroquine in patients with RA 4
- Methotrexate and sulfasalazine combination therapy is more effective than either drug alone in patients with RA with a suboptimal response to sulfasalazine 5
- Disease-modifying antirheumatic drugs (DMARDs) can affect bone health in RA patients, and the effects of these drugs on bone health should be considered in treatment decisions 2, 6
- Optimal fracture prevention in RA patients is based on optimal diagnostics and the use of adequate non-medical and medical treatment options, including bisphosphonates and newer drugs 3