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Radiographic healing with sustained clinical remission in a patient with rheumatoid arthritis receiving methotrexate monotherapy.

The most important goal in the treatment of rheumatoid arthritis (RA) is to slow or even stop joint destruction. Investigators have often questioned whether radiographic improvement of joint damage actually occurs, but such improvement can provide direct evidence that the destructive process has been reversed. The recognition of reparative changes may become even more important with the availability and further development of more potent and faster-acting antirheumatic drugs. To date, reparative changes have been observed only with long-term monitoring of patients and when radiographs are obtained after profound clinical improvement or remission has been achieved. There may be a time lag of 6–12 months between the time clinical improvement has been achieved and the time improvement is evident radiographically. As a rule, patients have to be followed up for several years before radiographic repair can be recognized indisputably. The present case report with radiologic images demonstrates that remission and impressive repair of severely damaged joints may occur with conventional disease-modifying antirheumatic drug (DMARD) monotherapy (in this case, methotrexate [MTX]) as early as within 1 year of treatment initiation and that improvement may continue over several years.