Bone Erosion – Causes, Symptoms, Diagnosis, Treatment

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Bone erosion is a progressively peri-inflammatory destructive bone lesion that radiologically refers to a break in cortical bone with the destruction of the natural barrier between the extraskeletal tissue and the bone marrow compartment.

Bone erosion, a common side-effect of rheumatoid arthritis, can be prevented by using a combination of close patient monitoring and individualized therapeutic regimens that include agents to block cytokines, block osteoclasts, or target abnormal cellular reactions.

Bone erosion, a common side-effect of rheumatoid arthritis, can be prevented by using a combination of close patient monitoring and individualized therapeutic regimens that include agents to block cytokines, block osteoclasts, or target abnormal cellular reactions.

Bone erosion is the loss of bone from disease processes. Erosive arthritis is joint inflammation (arthritis) with bone destruction, and such conditions include rheumatoid arthritis.[rx] Bone erosion is the loss of bone in a certain area, rather than a change in bone density, which is found in osteoporosis. Surprisingly, bone erosion is not common in osteoarthritis, although there is a subtype of osteoarthritis (erosive osteoarthritis) that may result in bone erosion.[rx]

Bone erosions are typically described in articular and periarticular locations and can affect the subchondral bone plate or the cortical bone. This might happen in central subchondral locations of joints usually covered by articular cartilage, in the bare areas within the joints or outside of the joints at the entheses or other locations (e.g. tumor, metabolic).

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The following types of bone erosions are described 2:

  • subchondral or central bone erosions: typically seen in osteoarthritis
  • marginal erosions: a typical feature of rheumatoid arthritis, seen in the bare area of joints
  • erosions at the entheses: a typical feature of spondylarthritis

Causes of Bone Erosion

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.

Symptoms of Bone Erosion

  • Acute and chronic pain in the associate joint and muscle,
  • Restrict or loss of movement
  • Muscle cramping due to electrolyte imbalance
  • Anxiety, Depression, weakness may be present
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle
  • Changes in bladder or bowel function

Bony erosions are characterized by small bony lucencies or breaks in the subchondral or cortical bony surface often associated with alterations of the adjacent trabecular bone 3.

Ultrasound has a better capability than radiographs in the detection of bone erosions 2-4, which can be nicely depicted as a bony surface discontinuity or defect visible in two different planes 2,5.

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CT allows for a reliable evaluation of cortical bone and subchondral bone plate in multiple different planes at various locations and thus the detection of bony erosions.

Bone erosions are characterized by a loss of the dark signal of the subchondral bone plate or the cortical bone. They can be readily visualized on MRI, which is considered as a very sensitive technique for their detection 1 also in joints, which are hardly or not accessible by ultrasound. Especially high-resolution thin slice sequences show a high sensitivity, which is considered comparable or superior to CT.

Treatment of Bone Erosion

Some ways to strengthen your bones include

  • NSAIDs Prescription-strength drugs that reduce both pain and inflammation. Pain medicines and anti-inflammatory drugs help to relieve pain and stiffness, allowing for increased mobility and exercise. There are many common over-the-counter medicines called non-steroidal anti-inflammatory drugs (NSAIDs). They include mainly or first choice etodolac, then aceclofenac, etoricoxib, ibuprofen, and naproxen.
  • Calcium & vitamin D3 To improve bone health and healing fracture. As a general rule, men and women age 50 and older should consume 1,200 milligrams of calcium a day, and 600 international units of vitamin D a day.
  • Glucosamine & Diacerein, Chondroitin sulfate – can be used to tightening the loose tendon, cartilage, ligament, and cartilage, ligament regenerates cartilage or inhabits the further degeneration of cartilage, ligament.
  • Dietary supplement – to remove general weakness & improved health. A dietary supplement is a manufactured product intended to supplement one’s diet by taking a pill, capsule, tablet, powder, or liquid. A supplement can provide nutrients either extracted from food sources or that are synthetic in order to increase the quantity of their consumption. The class of nutrient compounds includes vitamins, minerals, fiber, fatty acids, and amino acids. Dietary supplements can also contain substances that have not been confirmed as being essential to life, but are marketed as having a beneficial biological effect, such as plant pigments or polyphenols. Animals can also be a source of supplement ingredients, such as collagen from chickens or fish for example. These are also sold individually and in combination, and may be combined with nutrient ingredients
  • Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc.
  • 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.
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