Images in Clinical Medicine

Bone Changes in Rheumatoid Arthritis

Katsunori Ikari, M.D., Ph.D., and Shigeki Momohara, M.D., Ph.D.

N Engl J Med 2005; 353:e13October 13, 2005

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Article

A 38-year-old woman with a five-year history of rheumatoid arthritis had complete remission after 17 months of weekly monotherapy with 4 mg of methotrexate. Radiographs of both hands and feet were taken to assess the effectiveness of the treatment. In contrast to the radiograph that had been taken one year before the initiation of treatment (Panel A), healing of the erosions at the metatarsal head and at the base of the proximal phalanx in the fifth metatarsophalangeal joint of the right foot were observed (Panel B). The patient's symptoms in her hands, wrists, and feet (including joint pain, tenderness, swelling, and redness) had begun to improve during the first six months after the initiation of therapy. Her only remaining symptom was a limitation in the range of motion of both wrists.

Typically, the goal of treatment of rheumatoid arthritis is a reduction in the pace of the destructive process. Rarely, as was noted in this case, healing of arthritic changes in bone may occur, especially in patients treated with methotrexate or, recently, with an anti–tumor necrosis factor antibody.

Katsunori Ikari, M.D., Ph.D.
Shigeki Momohara, M.D., Ph.D.
Tokyo Women's Medical University, Tokyo 162-0054, Japan

Citing Articles (4)

Citing Articles

1. 1

   Teruyuki Nakatani, Toru Maekawa, Shinsuke Ishii. (2011) A case of juvenile idiopathic arthritis exhibiting repair of systemic bone erosion in response to continuation of MTX therapy after achievement of clinical remission. Modern Rheumatology 21:5, 514-517
   CrossRef

2. 2

   Shigeki Momohara, Eiichi Tanaka, Takuji Iwamoto, Katsunori Ikari, Hisashi Yamanaka. (2011) Reparative radiological changes of a large joint after adalimumab for rheumatoid arthritis. Clinical Rheumatology 30:4, 591-592
   CrossRef

3. 3

   Yu Sakuma, Katsunori Ikari, Takuji Iwamoto, Asami Tokita, Shigeki Momohara. (2010) Reparative radiological changes of the hip joint in rheumatoid arthritis: Do these findings indicate the true repair of the joint?. Joint Bone Spine 77:3, 278-279
   CrossRef

4. 4

   John D. MacKenzie, David. Karasick. 2009. Imaging of Rheumatoid Arthritis. , 340-364.
   CrossRef