Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment

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