Which radiographic finding is more characteristic of rheumatoid arthritis?

• A. Asymmetric osteophyte formation
• B. Symmetric marginal erosions and periarticular osteopenia
• C. Subchondral sclerosis with joint space narrowing only
• D. Isolated soft tissue swelling without erosions

Answer: (B)

Radiographic rheumatoid arthritis shows a pattern of inflammation that hits joints more than once and tends to erode bone at the margins. The hallmark is symmetric involvement of multiple small joints, with erosions at the joint margins caused by the destructive pannus, and nearby areas of bone loss near the joints (periarticular osteopenia). This combination—erosions at the edges of joints plus reduced bone density around the joints and a symmetric distribution—is what distinguishes RA on X-rays.

In contrast, osteoarthritis typically features osteophyte formation, subchondral sclerosis, and joint space narrowing, usually in an asymmetric pattern. Isolated soft tissue swelling can occur early in arthritis but does not reflect the destructive bony changes seen in RA. Therefore, symmetric marginal erosions with periarticular osteopenia best identifies rheumatoid arthritis on radiographs.