“We know that there are long-term functional consequences of erosions, but we have no evidence as of yet that healing of the erosion will alter that,” she said.
Other Considerations
It also is important to take cartilage loss into account. “I think that there are some very important implications of subchrondal bone erosion for cartilage loss,” Dr. Gravallese said. “Cartilage is attached to subchrondral so if subchrondral bone is eroded, you can lose cartilage secondarily. It is important to consider that cartilage loss may be affected by bone erosion.”
Plus, she said, if a lack of healing indicates that there’s persistent inflammation—something suggested though not proven by her lab’s work—then erosion could be an important surrogate marker or bioassay for persistent inflammation.
Also, she wondered, what the clinical impact of residual, low-grade inflammation in RA patients is on the cardiovascular system and the axial and appendicular skeleton—“in other words, How much inflammation do we really need to resolve before we no longer need to worry about these downstream effects?”
“I don’t have the answers to these questions,” she said, “but these are the kinds of things that we’ve been thinking about.”
Thomas Collins is a freelance medical journalist based in Florida.
References
- Bøyesen P, Haavardsholm EA, Ostergaard M, van der Heijde D, Sesseng S, Kvien TK. MRI in early rheumatoid arthritis: Synovitis and bone marrow oedema are independent predictors of subsequent radiographic progression. Ann Rheum Dis. 2011;70:428-433.
- Cohen SB, Dore RK, Lane NE, et al. Denosumab treatment effects on structural damage, bone mineral density, and bone turnover in rheumatoid arthritis: A twelve-month, multicenter, randomized, double-blind, placebo-controlled, phase II clinical trial. Arthritis Rheum. 2008;58:1299-1309.
- Sherlock JP, Joyce-Shaikh B, Turner SP, et al. IL-23 induces spondyloarthropathy by acting on ROR-γt+ CD3+CD4-CD8- entheseal resident T cells. Nat Med. 2012;18:1069-1076.
