Bone erosion

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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W8MD medical weight loss NYC and sleep center NYC

Bone erosion
X-ray of right fourth PIP joint with bone erosions by rheumatoid arthritis
Synonyms
Pronounce	N/A
Specialty	N/A
Symptoms	Joint pain, swelling, stiffness
Complications	Joint deformity, loss of function
Onset	Gradual
Duration	Chronic
Types	N/A
Causes	Rheumatoid arthritis, psoriatic arthritis, gout, osteomyelitis
Risks	Genetic predisposition, smoking, obesity
Diagnosis	X-ray, MRI, ultrasound
Differential diagnosis	Osteoarthritis, osteoporosis
Prevention	Early treatment of underlying conditions
Treatment	Disease-modifying antirheumatic drugs (DMARDs), biologics, corticosteroids, physical therapy
Medication	Methotrexate, adalimumab, prednisone
Prognosis	Variable, depends on underlying condition and treatment
Frequency	Common in patients with inflammatory arthritis
Deaths	N/A

Bone Erosion

X-ray of right fourth PIP joint with bone erosions by rheumatoid arthritis

Bone erosion refers to the loss of bone tissue, typically occurring in the context of inflammatory conditions such as rheumatoid arthritis (RA). It is characterized by the destruction of the bone surface, leading to structural damage and potential functional impairment.

Pathophysiology

Bone erosion is primarily driven by an imbalance between bone resorption and bone formation. In healthy bone, osteoclasts and osteoblasts work in harmony to remodel bone tissue. However, in pathological conditions, this balance is disrupted, often due to inflammatory processes. In rheumatoid arthritis, for example, the synovial membrane becomes inflamed, leading to the production of pro-inflammatory cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1). These cytokines stimulate osteoclastogenesis, the process by which osteoclasts are formed, leading to increased bone resorption and subsequent erosion.

Clinical Presentation

Patients with bone erosion may present with joint pain, swelling, and stiffness. Over time, the structural integrity of the affected bones can be compromised, leading to deformities and loss of function. In rheumatoid arthritis, common sites of bone erosion include the small joints of the hands and feet.

Diagnosis

Bone erosion is typically diagnosed using imaging techniques. X-ray is a common modality used to visualize bone erosions, as it can reveal changes in bone structure and density. More advanced imaging techniques, such as magnetic resonance imaging (MRI) and ultrasound, can provide more detailed information about the extent of erosion and associated soft tissue changes.

Management

The management of bone erosion involves addressing the underlying inflammatory condition. In rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate are commonly used to reduce inflammation and slow the progression of bone damage. Biologic agents targeting specific cytokines, such as TNF inhibitors, can also be effective in preventing further erosion.

Prevention

Preventing bone erosion involves early diagnosis and aggressive treatment of the underlying inflammatory condition. Regular monitoring with imaging studies can help assess the effectiveness of treatment and guide adjustments in therapy.

See also

• Rheumatoid arthritis
• Osteoclast
• Osteoblast
• Synovial membrane
• Tumor necrosis factor-alpha