Rheumatoid arthritis (RA) is characterized by a chronic inflammation of the joints, which leads to the destruction of articular cartilage and bone. The degree of joint damage assessed by radiographic imaging represents a key outcome in RA. There are several methods for scoring the joint damage associated with RA. The most widely used are the Sharp and Larsen systems, as well as more recent modifications of each method. Radiographic imaging has several advantages compared with other outcome measures in RA, specifically: X-rays reflect the history of joint pathology, provide a permanent record for serial evaluation, and can be randomized and blinded for objective scoring. Several modifications of these methods have been proposed and employed in the investigation of disease progression. A review of the radiographic progression of RA is presented, as well as a simplified scoring system useful for the evaluation of joint damage in RA in a clinical setting.

T lymphocytes play a critical role in the inflammatory process of rheumatoid arthritis (RA). Studies in a new animal model of RA, created by implanting human inflamed synovium into SCID mice, have confirmed that the production of matrix-degrading enzymes and pro-inflammatory cytokines is ultimately under T-cell control. T-cell dysfunction in RA patients also alters T-cell dynamics, resulting in profound abnormalities in T-cell pool composition. The cause and consequences of altered T-cell dynamics in RA are not yet understood, but factors determining T-cell homeostasis include the generation of new T cells, loss of T cells during immune responses and self-renewal of T cells within the system. Understanding the mechanisms that govern the formation of the T-cell pool in RA emphasizes the dynamic and quantitative aspects of lymphocyte behaviour in RA and has profound therapeutic implications when devising strategies to counteract T-cell dysfunction.

To summarize the evidence on treatment withdrawal rates reported in observational studies and randomized controlled trials (RCTs) of methotrexate (MTX), parenteral gold (GST), sulphasalazine (SSZ) and hydroxychloroquine (HCQ) among patients with rheumatoid arthritis (RA).

Magnetic resonance imaging (MRI) has important applications in musculoskeletal medicine. It allows the visualization of bone and soft tissues in three dimensions using a multiplanar technique and is uniquely suited to imaging the rheumatoid joint. Bony erosions are seen well using MRI in early rheumatoid arthritis and are frequently detected before they appear on plain radiographs. Bone marrow oedema is another important MRI feature associated with inflammatory joint disease and may be a forerunner of erosion. Synovial membrane inflammation and hypertrophy are detected after contrast enhancement and also by the use of dynamic MRI techniques, which provide a non-invasive method to accurately measure the inflammatory process. This information can be analysed and collated using MRI scoring systems and ultimately may be used to improve diagnostic accuracy, predict prognosis and monitor therapy in these patients. This review examines the case for the use of MRI in early inflammatory arthritis, outlining its strengths and potential weaknesses as an imaging modality in this context and indicating its potential role in clinical practice.

Juvenile idiopathic arthritis (JIA) results in significant morbidity that includes an adverse impact on oral health that is generally not well recognized. This review describes current literature which demonstrates poor oral health in children with JIA. The impact of JIA on oral health is probably multifactorial and these factors are discussed. This review emphasizes the role of paediatric dentistry in the multidisciplinary management of JIA and highlights the need for further research.

To review the role of intravenous immunoglobulin (IVIg) in antiphospholipid syndrome (APS).