Return to normal of x-ray changes in rheumatoid arthritis; case report.

Our principal object is to present this case from the radiological aspect because of the progressive retrogression and total disappearance of the organic articular lesions. This observation we believe to be unique. We have not come across any mention of the return to normal of the radiological features, either alone or concomitantly with the clinical cure of arthritis. We know that pathological articular lesions once produced have a tendency to progress in spite of treatment or suspension of clinical evolution. The improvement in radiological changes, once obtained, is not proportional to the clinical improvement, being very much slower and showing an extinction of activity of the destructive lesions rather than a reparative process. However, with the improvement in the general condition of the patient, or his articular functions, radiological lesions develop much more slowly or even become stationary, as a consequence of the clinical inertia of the disease. Morrison and Kuhns (1936) were the first to take up the study of the evolution of the alterations observed by x rays in 73 cases of chronic arthritis, 55 of which were rheumatoid arthritis. There was a history of some months duration in 6 cases, there were 5 cases of one year's duration, and 21 cases of over five years. Among these patients, the radiological observations covered a period of from four to ten years from the first to the last observation. In 49 cases, the radiological findings became worse; 4 cases showed no appreciable alteration; and in only 2 cases were there improvements in the radiological findings-a decrease of the bony deformity and disappearance of the destructive articular changes. Clinically, 22 cases deteriorated, 7 were stationary, and 26 improved. From these statistics one may come to the conclusion that there is no parallelism in the evolution of the radiological and clinical pictures. There was a high proportion of cases showing clinical improvement together with radiological deterioration. Morrison and Kuhns concluded that real improvement in the radiological findings is rarely seen. The case report which follows should be considered in the light of their findings.