How Rheumatoid Arthritis Leads to Bone Erosion

Medically Reviewed By William C. Lloyd III, MD, FACS
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In rheumatoid arthritis (RA), the body’s immune system mistakenly attacks healthy joint tissue. The chronic inflammation of joint structures like the synovia—membranes that line and help lubricate some of the body’s joints—eventually destroys this protective tissue. Not only does this cause the characteristic pain of rheumatoid arthritis, but it can lead to permanent bone injury. Early diagnosis and treatment can reduce bone erosion in rheumatoid arthritis.

Understanding How Bone Erosion Occurs in Rheumatoid Arthritis

Some of the body’s joints, such as the elbow, wrist and hip are designed to bend, glide or rotate. These joints are ‘synovial joints.’ Every synovial joint contains several internal structures to protect, cushion and lubricate the joint so it moves easily without friction. These structures include a fibrous capsule, cartilage pads, and a fluid-filled cavity enclosed by the synovial membrane.

Rheumatoid arthritis causes the synovial membranes to become inflamed. This is synovitis. Chronic synovitis can destroy this membrane, causing fluid loss from the joint and allowing other joint structures to rub against each other without adequate lubrication. In turn, this persistent rubbing can destroy the joint’s capsule and cartilage, leading to bone grinding against bone. Eventually, the ends of each bone in the joint can erode, leading to irreversible joint damage.

Diagnosing Rheumatoid Arthritis and Synovitis

Common X-rays provide important information for diagnosing RA. Doctors and rheumatologists use X-ray images to look for synovitis, bone damage, and narrowing of the cavity in inflamed joints.

Early in the course of rheumatoid arthritis, X-ray images of affected joints may appear normal. Many doctors repeat X-ray exams periodically to track the course of synovitis or bone damage in RA. Because joint damage may not be present at first, X-rays alone do not provide enough information to diagnose RA.

Your doctor also will use blood tests to check for systemic inflammation (inflammation throughout the body) or certain antibodies produced by the immune system in RA. In some cases of RA, doctors use other imaging tests like computed tomography (CT scan) to look for the characteristic RA inflammation in various organs and joints.

How RA Treatment Stops Bone Erosion

One key goal of rheumatoid arthritis treatment is to reduce inflammation inside the joint capsule and throughout the body. Taming this inflammation stops or slows damage to the synovia and keeps other joint structures intact.

Doctors generally take an aggressive approach to treatment in the early stages of RA to prevent permanent joint damage. Your doctor may prescribe medicines that directly reduce inflammation. You also may take drugs that control symptoms like pain and stiffness. Once inflammation has been brought under control (disease remission), your doctor will continue to monitor your RA symptoms and create a maintenance plan to keep your rheumatoid arthritis under tight control.

Preventing Bone Erosion in RA

In addition to RA medication, you can help avoid bone erosion in RA by pursuing an active lifestyle. To keep your joints healthy, rheumatologists advise to:

  • Adhere closely to your medication plan to keep inflammation low inside your joints.

  • Engage in strength training to improve the strength of muscles that support your joints.

  • Engage in stretching activities to maintain joint flexibility.

  • Maintain a healthy body weight to reduce joint strain.

  • Participate in aerobic activities like walking or low-impact classes like water aerobics for overall health, weight loss, and general joint health.

  • Perform range-of-motion exercises to keep joints limber.

Doctors have many treatments available to reduce joint damage and prevent bone erosion in rheumatoid arthritis. With early diagnosis and aggressive intervention, RA can be managed well so you can live a long, active life free from bone erosion.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 May 8
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  2. Rheumatoid Arthritis. U.S. Arthritis Foundation.
  3. Rheumatoid Arthritis. American College of Rheumatology.