Bone Erosion and Rheumatoid Arthritis: What to Know

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Rheumatoid arthritis (RA) is a chronic inflammatory disorder that occurs when the body's immune system targets its own healthy cells. This condition commonly affects joints throughout the body, breaking down soft tissues, such as ligaments and cartilage. However, RA can also cause bone erosion.

This article discusses bone erosion that occurs with RA, including causes, symptoms, and management of your condition.

X-ray RA in hands

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What Is Bone Erosion From RA?

Bone erosion is a gradual loss of bone that occurs from inflammation caused by rheumatoid arthritis. Bone erosion can show up as early as the first couple of months after diagnosis. About 60% of people with RA have bone erosion after one year.

RA causes inflammation of connective tissue in joints called the synovial membrane. The membrane grows larger and causes breakdown of cartilage (padding between bones in the joint) and bone erosion. Overactivity of cells called osteoclasts is responsible for bone erosion in RA.

When bone erosion is present, typically, your condition is more severe and you'll have more difficulties with daily function.

Signs and Symptoms of Bone Erosion

Rheumatoid arthritis causes significant joint damage, leading to the following symptoms:

  • Pain
  • Swelling
  • Warm skin
  • Stiffness
  • Nodules (painless lumps under the skin)
  • Contractures (permanent loss of movement)
  • Joint instability (feeling like joints are "giving out")
  • Joint deformities from bones moving out of place

How Are Symptoms Assessed?

There aren't any "unique" symptoms for bone erosion. Imaging is often used to assess joint damage with RA, including bone erosion.

Magnetic resonance imaging (MRI) is used to detect fluid buildup in the bone marrow, which is an early sign of bone erosion. X-rays are commonly used to determine the joints that are affected by bone erosion, and determine how quickly your bones are breaking down.

How Is Bone Erosion Managed?

Unfortunately, there's no way to prevent bone erosion from occurring with rheumatoid arthritis. Treatment for bone erosion begins with targeting your overactive immune system, which is causing joint inflammation.

Certain RA medications have been shown to stop bone erosion and help repair some of the damage that has occurred. However, bone erosion from RA cannot be fully reversed.

Medications

Disease-modifying antirheumatic drugs (DMARDs) are commonly used to treat rheumatoid arthritis. However, not all DMARDs are effective for treating bone erosion. Traditional DMARDs target your overactive immune system as a whole to decrease inflammation but aren't very effective for repairing bone erosion.

Biologic DMARDs are made from proteins in human genes. These medications target specific cells in your immune system and have been shown to help partially repair bone erosion.

Tips for Joint Protection

Joint protection principles can help make life easier with bone erosion from RA. Consider seeing a physical or occupational therapist for individualized interventions.

Tips for joint protection include:

  • Rest: Whenever possible, avoid activities that make your joint pain worse. If you can't avoid them, schedule frequent rest breaks.
  • Use adaptive equipment: Look for items that make everyday tasks easier. For example, use tools with built-up handles to decrease pressure on your hands and finger joints.
  • Transfer weight to larger joints: Carry bags in the bend of your elbow or over your shoulder, instead of gripping them by the handles.
  • Change positions frequently: Staying in one position for too long can increase stiffness that occurs with RA. Take a quick stretch break several times per hour to increase blood flow to your joints.
  • Maintain good posture: Poor posture puts unnecessary pressure on your joints.
  • Know your limits: Don't push through the pain. This can cause even further damage to your joints.
  • Try a brace or splint: Several types of braces and splints are available to help immobilize painful joints with RA. For specific recommendations, consult a physical or occupational therapist.
  • Use an assistive device: If bone erosion is affecting joints in your legs, using an assistive device, such as a cane or walker, can help reduce stress on these joints when you walk.

Summary

Rheumatoid arthritis (RA) is an autoimmune condition that often causes bone erosion. Excess inflammation builds up in affected joints, leading to pain, stiffness, swelling, loss of motion, and difficulty with mobility.

Bone erosion is not preventable, but treatment can help slow the progression of damage to your joints. Treatment includes medications that target your immune system and joint protection strategies to help reduce symptoms.

A Word From Verywell

Bone erosion is a serious side effect of rheumatoid arthritis that can lead to significant disability. Early detection and treatment are important for managing your symptoms. Follow your healthcare provider's instructions and make a practice of incorporating joint protection practices into your daily life. For additional support and tips, consider joining a support group.

Frequently Asked Questions

  • Is bone erosion reversible?

    Bone erosion caused by rheumatoid arthritis is not fully reversible. However, certain medications can help stop the progression of bone loss and partially repair bone loss that has already occurred.

  • What is bone erosion?

    Bone erosion is the breakdown of bone that occurs from excess inflammation in your joints. This is a common symptom of rheumatoid arthritis.

  • Can rheumatoid arthritis cause bone loss?

    Bone loss (bone erosion) affects about 60% of people with rheumatoid arthritis within one year of diagnosis.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Panagopoulos PK, Lambrou GI. Bone erosions in rheumatoid arthritis: recent developments in pathogenesis and therapeutic implications. J Musculoskelet Neuronal Interact. 2018;18(3):304-319.

  2. Rheumatoid Arthritis Support Network. RA symptoms: How do you diagnose rheumatoid arthritis?

  3. Rheumatoid Arthritis Support Network. RA imaging tests: What tests are done for rheumatoid arthritis?

  4. Arthritis Foundation. DMARDs.

  5. University Hospitals. Joint protection for arthritis.

By Aubrey Bailey, PT, DPT, CHT
Aubrey Bailey is a physical therapist and professor of anatomy and physiology with over a decade of experience providing in-person and online education for medical personnel and the general public, specializing in the areas of orthopedic injury, neurologic diseases, developmental disorders, and healthy living.