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Periarticular Osteopenia Mechanism — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingPeriarticular Osteopenia MechanismSCE Rheumatology

A 55-year-old woman has newly diagnosed seropositive rheumatoid arthritis with 4 months of active metacarpophalangeal and proximal interphalangeal joint synovitis. She has not received glucocorticoids. Hand radiographs show symmetric periarticular osteopenia without erosions. Which mechanism most directly accounts for this radiographic finding?

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Correct answer: D — Synovial cytokine-induced RANKL expression drives local osteoclast differentiation and resorption in juxta-articular bone

The correct answer is D. Periarticular osteopenia is an early local manifestation of rheumatoid synovitis. TNF, IL-1, IL-6 and IL-17 promote RANKL expression, particularly by synovial fibroblasts. RANKL acts on osteoclast precursors, increasing osteoclast differentiation and bone resorption in the juxta-articular compartment; impaired local bone formation may also contribute. Disuse can worsen bone loss but does not adequately explain its characteristic concentration around actively inflamed joints. Glucocorticoids predominantly promote generalised bone loss and have not been used here. Vitamin D deficiency with secondary hyperparathyroidism and age-related bone loss likewise produce systemic rather than inflammation-centred periarticular demineralisation.

Reference: Maeda K et al. Inflammation and Bone Metabolism in Rheumatoid Arthritis: Molecular Mechanisms of Joint Destruction and Pharmacological Treatments. International Journal of Molecular Sciences. 2022;23:2871. https://pubmed.ncbi.nlm.nih.gov/35270012/