This new agent represents a new approach to the treatment of erosive inflammatory arthritis. On the surface, using a drug with no effect on articular inflammation may not sound viable. However, it is compelling to contemplate combination regimens with denosumab that may result in control of articular signs and symptoms with concomitant suppression of erosions with little risk of additional toxic side effects. It is interesting to note that joint space narrowing was not suppressed by denosumab, suggesting that the mechanisms of cartilage destruction and erosions are distinct in RA. The efficacy of denosumab to treat post-menopausal osteoporosis is a potential added benefit.