Bone Changes in Rheumatoid Arthritis
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《新英格兰医药杂志》
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
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