RA is a highly heterogeneous condition with a variable clinical course resulting in major differences in joint damage and disability.
Cytokines have a major role in causing joint damage.
Cytokines play a major role in promoting joint damage and their association with radiographic progression has been investigated in several early RA cohort studies.
In rheumatoid arthritis (RA), early diagnosis and early therapeutic intervention improve clinical outcomes and reduce the accrual of joint damage and major irreversible long-term disability.
Given these observations and the lack of association between Sharp scores, CRP, swollen-joint count, tender-joint count, and high MDHAQ pain scores, we believe that the associations between patient global assessment/MDHAQ function and MDHAQ pain may be attributed to non-RA-related factors, and that the likelihood that inflammation and joint damage are major contributors to pain is low.
Studies have strongly associated major joint injuries including cruciate ligament damage and meniscal tears with the onset of osteoarthritis [ 31].
Our data suggest that inflammation and structural joint damage are not major causes of pain, because CRP, swollen-joint count, tender-joint count, and Sharp scores were not significantly associated with increased pain severity at baseline or 1 year.
This statement stems from the evidence that patients with RA followed up by rheumatologists, in comparison with other doctors, are diagnosed earlier, receive DMARD treatment more frequently and have better outcomes in all major characteristics of RA, in particular joint damage and physical function.
In the present article, we summarize the mechanistic concepts of structural damage in these three major joint diseases, we review the achievements of TNF blockers – in particular, their contribution to under standing structural damage – and we discuss unanswered questions and future frontiers in the management of bone and cartilage damage in RA, PsA, and AS.
Joint inflammation has been proposed as the main driver of physical disability in the early stage of PsA; while joint damage is considered the major determinant at later stage.
