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Review

Inflammatory lesions in the bone marrow of rheumatoid arthritis patients: a morphological perspective

Serena Bugatti*, Antonio Manzo, Roberto Caporali and Carlomaurizio Montecucco

Author affiliations

Division and Laboratory of Rheumatology, University of Pavia School of Medicine, IRCCS Policlinico San Matteo Foundation; Piazzale Golgi, 2, 27100 Pavia, Italy

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Citation and License

Arthritis Research & Therapy 2012, 14:229  doi:10.1186/ar4115

Published: 27 December 2012

Abstract

The synovial tissue stands at the epicenter of joint pathology in rheumatoid arthritis (RA). As a primary target of the disease, studies on the synovium have provided invaluable insights into the mechanisms involved in disease pathogenesis. Recent work has, however, revealed the importance of a previously unseen anatomic compartment in direct contact with the joint space, namely the subchondral bone marrow. Bone marrow edema (BME) visible on magnetic resonance imaging (MRI) is clinically meaningful in both early and late RA as it associates with future development of bone erosions and poor functional outcomes. Although the histopathologic correlates of MRI-based BME in early RA remain obscure, studies in advanced disease are consistent in describing lymphocytic inflammatory infiltrates within the subchondral marrow cavity of affected joints. In this review, we discuss the nature of bone marrow lesions in patients with RA, analyze their relationship with synovitis, and explore their potential contribution to the pathological processes of the disease.