Rheumatoid arthritis (RA) is a chronic inflammatory disease that affects about 1.3 million Americans, according to the American College of Rheumatology.
RA is an autoimmune disorder in which the immune system mistakenly attacks the body’s own tissues and cells. The disease differs from other immune conditions in that it affects primarily the lining of joints.
This progressive disease not only causes joint inflammation, but can lead to damage and deformity of joints. The damage is a result of erosion of the bones.
Bone erosion is a key feature of RA. The risk increases with disease severity and is characterized by the loss of bone in certain parts of the body.
Even though there’s no cure for RA, it’s possible to manage and slow the progression of bone erosion. Here’s what you need to know about bone erosion, including prevention and management tips.
RA causes chronic inflammation, which leads to gradual bone erosion. Classic RA symptoms include swollen joints, joint stiffness, and joint pain. Some people also have fatigue and loss of appetite.
RA often affects the smaller joints like your hands, feet, and fingers, so bone erosion can occur in these joints. It can also affect other joints of your body such as your knees, elbows, hips, and shoulders.
Bone erosion and RA are linked because chronic inflammation stimulates osteoclasts, which are cells that break down bone tissue. This leads to a process known as bone resorption.
Typically, bone resorption is part of the normal regulation of minerals required to balance maintenance, repair and remodeling of bones. The process, however, becomes unbalanced in people with RA, resulting in the rapid breakdown of mineralized tissue.
Bone erosion can also occur when there’s a significant number of inflammatory cytokines in the body. Cells release these small proteins to stimulate the immune system to fight diseases.
Sometimes, though, the body releases an excessive amount of cytokines. This can lead to inflammation and swelling, and ultimately joint, bone, and tissue damage.
Bone erosion can develop early and become progressively worse. In some people, bone erosion can start within weeks of an RA diagnosis. About 10 percent of people who receive a diagnosis of RA have erosion after 8 weeks. After 1 year, up to 60 percent of people experience erosions.
Since progressive bone erosion can cause disability, slowing down or healing the erosion can help improve the quality of your life. However, once erosion occurs, it’s rarely reversible.
It’s not impossible, though. There have been some reports linking the use of disease-modifying antirheumatic drugs (DMARDs) with the ability to decrease the advancement of bone erosion.
Any chance of repairing or healing bone erosion starts with controlling inflammation. DMARDs are often the first-line treatment for RA. Although pain medications can treat symptoms like pain and stiffness, DMARDs target specific cells of the immune system that are responsible for promoting inflammation.
This can help RA enter remission and slow disease progression. These medications can also stop bone erosion and help repair any existing erosion, although medication may not fully repair bones.
Traditional DMARDs consist of oral and injectable medications like methotrexate.
When these medications are unable to control inflammation, your doctor may recommend switching to a biologic such as:
- certolizumab (Cimzia)
- etanercept (Enbrel)
- adalimumab (Humira)
- abatacept (Orencia)
- infliximab (Remicade)
- golimumab (Simponi)
Biologics are a different type of DMARD. In addition to targeting specific immune system cells that cause inflammation, they block chemicals like cytokines that signal or promote inflammation.
Once inflammation is under control, bone erosion can also slow down and begin to heal. Controlling inflammation is also important because less inflammation reduces the stimulation of osteoclasts. This too can slow bone erosion.
Your doctor may also recommend therapy to suppress osteoclasts. This includes antiresorptive drugs that treat bone loss and other bone problems, such as bisphosphonates and denosumab (Xgeva, Prolia).
Bone erosion is a key feature of RA and you may not be able to fully prevent it. However, treating inflammation early is one of the best ways to protect your joints. Talk to your doctor about symptoms like joint pain and stiffness, redness, chronic fatigue, weight loss, or a low-grade fever.
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Some ways to strengthen your bones include:
- Consider taking calcium and vitamin D supplements. Adults typically need about 1,000 milligrams (mg) of calcium per day, and 600 international units (IU) of vitamin D each day, according to the Mayo Clinic. Before starting any new supplements, talk to your doctor.
- Get regular exercise. Regular physical activity can strengthen your muscles and promote strong bones. Start out slow and incorporate a mixture of cardio exercises and strength-training activities. Low-impact exercises like walking, yoga, and swimming are good places to start.
- Quit smoking. Tobacco use can weaken your bones, as does drinking too much alcohol. Look into ways to quit smoking, and reduce your alcohol intake. In general, women should have no more than one drink a day, and men should limit their intake to two drinks a day.
- Adjust your medication. Long-term use of some medications that treat inflammation, such as prednisone and methotrexate, may also damage your bones. Talk to your doctor about reducing your dosage or switching to a different medication once inflammation is managed effectively.
Bone erosion is a typical occurrence in people living with RA. Decreasing inflammation can help you feel better and prevent progression. Starting treatment early can increase the quality of your life and lower your risk of disability.