Radiographic remodeling of the shoulder joint in a patient with rheumatoid arthritis after 4 years of treatment with etanercept

Excerpt

The treatment strategy for rheumatoid arthritis (RA) has changed dramatically over the past decade with the introduction of biologic agents. One of the most intriguing effects of biologic agents is structural modification. It has been recognized that radiographic healing occurs even in patients with longstanding RA when clinical remission has been achieved [1‐4]. Recent clinical trials have reported radiographic improvement of the affected joint (reappearance of the cortical plate or filling in of erosions) that was more often apparent with a combination of methotrexate (MTX) and biologic agents than with conventional disease-modifying antirheumatic drugs [5‐9]. However, evidence of this phenomenon has been limited to small joints of the hand or foot, as evaluated by the van der Heijde- or Genant-modified Sharp scores [10, 11]. However, functional improvement generally depends on the condition of the large joints and is an important goal of treatment for RA. At present, reports on the structural modifying effect of biologic agents on large joints are rare, and the effect of these agents on the shoulder joint has not been documented in the literature. …