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Clin Calcium. 2013 Mar;23(3):409-17. doi: CliCa1303409417.

[Assessment of joint structure in patients with rheumatoid arthritis].

[Article in Japanese]

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The First Department of Internal Medicine, University of Occupational and Environmental Health, Japan.


Recent progress in the treatment of rheumatoid arthritis (RA) with TNF-inhibitors has brought a paradigm shift, in which clinical and structural remission is now a target to be approached. However, joint damage already develops in a majority of patients before appropriate treatments are provided. Joint damage results from the destruction of bone and cartilage, which can be visualized via radiography as joint erosion (JE) and joint space narrowing (JSN) , respectively. JSN is a surrogate marker for loss of cartilage and it also reflects damage to tissues causing joint dislocation, a phenomenon that is less prevalent among patients with early RA. JE has been perceived to be the most critical indicator of permanent disability in RA. The combination of TNF-inhibitor and MTX reduces the risk of joint damage, measured by radiographic modified total Sharp score (mTSS) . Biologics targeting cytokines and lymphocytes not only expand the array of treatments for RA but also provide important insights into pathogenesis of this disease.

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