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Table 1 Traditional model for rheumatoid arthritis (RA) based mainly on radiographic findings and modern concepts emerging from magnetic resonance imaging in RA

From: What magnetic resonance imaging has told us about the pathogenesis of rheumatoid arthritis – the first 50 years

  Traditional paradigms for RA Modern imaging paradigms
Erosions A relatively late feature Present in the majority at clinical presentation
Synovitis and damage Synovitis not necessarily linked to damage – uncoupling Linear link between synovitis with damage
Erosion mechanism Immunologically mediated or autonomously by synovial fibroblasts Major biomechanical contribution – such factors may mechanically uncouple synovitis from damage.
Cutting edge of erosions Synovial fibroblasts and osteoclasts destroy tissue from outside in. Recognition that magnetic resonance imaging bone oedema represents a diffuse osteitis – at least some of erosive process occurs within the bone.
Synovitis locations Considered as diffuse Regional variations within and between joints
Pathophysiological perspective Erosion formation and cartilage pannus junction key to understanding RA Erosion and pannus are inevitable and predictable consequences of chronic synovitis, RA being the most common cause.