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Clin Rheumatol (2011) 30:591–592
DOI 10.1007/s10067-011-1700-y

LETTER TO THE EDITOR

Reparative radiological changes of a large joint
after adalimumab for rheumatoid arthritis
Shigeki Momohara & Eiichi Tanaka & Takuji Iwamoto &
Katsunori Ikari & Hisashi Yamanaka

Received: 23 January 2011 / Accepted: 24 January 2011 / Published online: 12 February 2011
# Clinical Rheumatology 2011

To the Editor:
Several reports have indicated that rheumatoid arthritis
(RA) patients with evidence of radiographic repair or
remodeling were in clinical remission [1, 2]. Inhye E. Ahn
et al. recently reported in Clinical Rheumatology on a
patient with RA who achieved bone erosion repair after
treatment with adalimumab (ADA) [3]. This finding is
particularly important, since bone destruction is a major
factor leading to functional disability. Moreover, Sergio
Ros-Expósito et al. also reported on a similar outcome in
an RA patient treated with ADA, in whom there was
radiographic evidence of significant improvement [4].
These cases suggest that treatment using biological agents
such as ADA may result in remodeling of radiological
damage. Such outcomes after ADA treatment may have a
great impact on the functional prognosis of RA patients.
However, a systematic study of joint repair and remodeling in RA patients in remission has not been undertaken,
and it is not even clear whether real repair occurs in large
joints. We report on a patient with RA who was treated

S. Momohara : E. Tanaka : T. Iwamoto : K. Ikari : H. Yamanaka
Institute of Rheumatology, Tokyo Women’s Medical University,
Tokyo, Japan
S. Momohara (*)
Department of Orthopaedic Surgery, Institute of Rheumatology,
Tokyo Women’s Medical University,
10-22 Kawada, Shinjuku,
Tokyo 162-0054, Japan
e-mail: smomohara@ior.twmu.ac.jp

with ADA, in whom there was radiological evidence of
reparative changes of a previously damaged hip joint.
A 46-year-old man, diagnosed with RA at 29 years of
age, was treated with methotrexate and other diseasemodifying antirheumatic drugs (DMARDs) through
2008. By that time, he had already undergone a left
total hip replacement and still had severe pain in the
right hip joint. Radiographic images of the right hip joint
in December 2005 (Fig. 1a) and August 2007 (Fig. 1b)
show complete loss of the joint space along with erosive
changes in the femoral head and acetabulum. No radiological improvement is evident for those 2 years of
treatment with non-biological DMARDs. Because his
disease activity remained high, he began ADA therapy in
January 2009, after it was approved for use in the
healthcare system. A standing radiographic image from
May 2010 clearly demonstrates improved congruency
between the right femoral head and acetabulum and
widening of the joint space (Fig. 1c).
Recent trials with biologics for RA, such as tumor
necrosis factor (TNF)-blocking agents like ADA, have
demonstrated improvements in radiographic scores, especially for drug-induced repair of erosions in small joints [3, 4].
There has been one study assessing the effect of TNFblocking therapies on weight-bearing joints in RA, and the
authors concluded that all hip and knee joints with preexisting damage of Larsen grade III/IV showed apparent
progression, even in patients with good response to the TNFblocking agents [5]. Therefore, the findings in our case are
cause for renewed interest in the radiographic detection of
repair in a large joint. We believe that this is a noteworthy
case because of the occurrence of both clinical remission and

592

Clin Rheumatol (2011) 30:591–592

Fig. 1 Radiographic images of the right hip joint in December 2005
(a) and August 2007 (b) show complete loss of the joint space along
with erosive changes in the femoral head and acetabulum, and no
radiological improvement is evident for those 2 years of treatment

with non-biological DMARDs. c After the patient began adalimumab
therapy in January 2009, a standing radiographic image in May 2010
clearly demonstrates improved congruency between the right femoral
head and acetabulum and widening of the joint space

radiographic remodeling of the hip joint space. Additional
studies determining the true nature of the changes that are
associated with the observed reparative radiological changes
in RA are needed.

References

Conflicts of interest SM received speaking fees and/or consulting
fee from Abbott Japan Co., Ltd.; Astellas Pharma Inc.; Bristol–
Myers Squibb; Chugai Pharmaceutical Co., Ltd.; Eisai Co., Ltd.;
Mitsubishi Tanabe Pharma Corporation; Pfizer Inc.; Santen Pharmaceutical Co., Ltd.; and Takeda Pharmaceutical Co. Ltd. KI
received speaking fees from Abbott Japan Co., Ltd.; Eisai Co.,
Ltd.; and Mitsubishi Tanabe Pharma Corporation. HY received
lecture fee and/or consulting fee from Abbott; Eisai Co., Ltd.;
Takeda Pharmaceutical Company Limited; Mitsubishi Tanabe
Pharma Corporation; Janssen Pharmaceutical K.K.; Hoffmann-La
Roche; Chugai Pharmaceutical Co., Ltd; and Pfizer Inc. ET and TI
have declared no conflicts of interest.

1. Ikari K, Momohara S (2005) Images in clinical medicine. Bone
changes in rheumatoid arthritis. N Engl J Med 353(15):e13
2. Rau R (2006) Is remission in rheumatoid arthritis associated with
radiographic healing? Clin Exp Rheumatol 24(6 Suppl 43):S-41–S-44
3. Ahn IE, Ju JH, Park SH, Kim HY (2010) Radiologic observation:
repair of focal bone erosions after humanized antitumor necrosis
factor antibody adalimumab therapy in a patient with rheumatoid
arthritis. Clin Rheumatol 29(2):211–213
4. Ros-Exposito S, Ruiz-Martin JM, Sanz-Frutos P, De La Fuente De
Dios D (2010) Bone erosion repair with adalimumab in rheumatoid
arthritis. Clin Rheumatol 29(11):1339–1340
5. Seki E, Matsushita I, Sugiyama E, Taki H, Shinoda K, Hounoki H
et al (2009) Radiographic progression in weight-bearing joints of
patients with rheumatoid arthritis after TNF-blocking therapies.
Clin Rheumatol 28(4):453–460


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