Rheumatoid Arthritis

Erosion Repair More Common in Early RA Than Previously Thought

Avatar photoHannah Dellabella
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Periarticular bone erosions are a diagnostic feature of RA and are detected using radiographic imaging.1,6 They result from progressive periarticular osteoporosis resulting from an imbalance between bone resorption and inadequate bone formation at the joint margins.7 On imaging, they appear as breaks in the cortical bone accompanied by loss of subchondral trabecular bone and bone marrow edema.1,6 Although bone erosions occur in healthy people or patients with other joint diseases, they are more severe in patients with RA.6 Bone erosions arise early in the course of RA (within a few weeks to a few months of onset in some patients).1,7 They most often affect metacarpophalangeal joints and predict more severe disease.1,7 Approximately 63% of patients with RA have erosions at diagnosis.1 Seropositivity and smoking increase the risk for bone erosions.1 Evidence suggests DMARDs and the nuclear factor-kB ligand inhibitor denosumab can prevent progression of bone erosions, but no treatment appears to repair erosions.1,2,7
Researchers cited case reports of biologics, such as antitumor necrosis factor therapy in combination with methotrexate, that create an expectation for repair of erosions.

Among patients with early rheumatoid arthritis (RA) who are being treated with conventional methods, the repair of erosions may be more common than previously thought, according to results published in The Journal of Rheumatology.

The study included conventionally treated participants with early RA who had radiographs of hands and feet on enrollment and at 1, 2, 5, and 8 years of follow-up (n=395). The researchers used the Sharp/van der Heijde method to chronologically score the radiographs for erosions. They defined an erosion with repair as 1 that has become partially or totally filled, with or without sclerosis.

At 1 year, 16% (n=64) of participants had erosions with repair, with 29% (n=113) at 2 years, 36% (n=142) at 5 years, and 51% (n=200) at 8 years.

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After 1 year of follow-up, 13% of participants with at least 1 new erosion showed repair compared with 3% of participants with no new erosions (P =.001). At 2 years, these percentages were 22% and 6%, respectively; at 5 years, they were 28% and 8%; and at 8 years, they were 39% and 11% (all P =.001).

The researchers found that the sum of all repaired erosions significantly correlated with the sum of all erosions and with the sum of all erosion scores. They also found that the presence of rheumatoid factor and anticyclic citrullinated peptide antibodies were significantly associated with both new erosions and repair of erosions.

“Further studies are needed to clarify the potential value of recording repair in clinical practice,” the researchers wrote.

Reference

Forslind K, Eberhardt K, Svensson B. Repair of erosions in patients with rheumatoid arthritis [published online February 1, 2019]. J Rheumatol. doi:10.3899/jrheum.180557

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