title: Structural damage in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: traditional views, novel insights gained from TNF blockade, and concepts for the future.
abstract: Structural changes of bone and cartilage are a hallmark of inflammatory joint diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Despite certain similarities - in particular, inflammation as the driving force for structural changes - the three major inflammatory joint diseases show considerably different pathologies. Whereas RA primarily results in bone and cartilage resorption, PsA combines destructive elements with anabolic bone responses, and AS is the prototype of a hyper-responsive joint disease associated with substantial bone and cartilage apposition. In the present review we summarize the clinical picture and pathophysiologic processes of bone and cartilage damage in RA, PsA, and AS, we describe the key insights obtained from the introduction of TNF blockade, and we discuss the future challenges and frontiers of structural damage in arthritis.
authors.affiliation: Department of Internal Medicine 3, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany. Georg.schett@uk-erlangen.de
authors.forename: Georg
authors.initials: G
authors.lastname: Schett
authors.forename: Laura C
authors.initials: LC
authors.lastname: Coates
authors.forename: Zoe R
authors.initials: ZR
authors.lastname: Ash
authors.forename: Stefanie
authors.initials: S
authors.lastname: Finzel
authors.forename: Phillip G
authors.initials: PG
authors.lastname: Conaghan
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D001172:Arthritis, Rheumatoid / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D006801:Humans; D013167:Spondylitis, Ankylosing / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000502:physiology
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha