Rheumatoid arthritis (RA) inevitably involves the synovium and articular structures of joints where the disease is characterized by synovitis, which may lead to bony erosions, articular cartilage loss, and eventual damage to supporting structures, such as tendons and ligaments. Radiographic measures of bony destruction are closely associated with work disability in patients with RA.[1,2] Because the natural course of RA is chronic and usually unremitting, with few patients achieving long-term remission prior to joint destruction, early aggressive therapy has been advocated to prevent joint destruction and accompanying morbidity. The success of disease-modifying antirheumatic drugs (DMARDs) and more recently biological response-modifying drugs in halting or even reversing the bony destruction process has stimulated increased interest in radiographic assessment.[3-6] Clinical and biochemical aspects of RA are important in evaluating patients for diagnosis and disease activity, but bony destruction and change can progress even with apparent clinical remission.[7] Imaging, therefore, remains a critical aspect in the evaluation of patients with RA.
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