Patient description: The patient is a 53-year-old man complaining of frequent headaches, generalized bone pain and difficulty chewing that started 6 years ago and is getting worse. Examination shows bilateral swellings around the molars. The swellings have increased since his last examination. Several extraoral lesions of the head and face are detected. The swellings are non-tender and attached to the underlying bone. Further evaluation shows increased uptake of radioactive substance as well as an increase in urinary pyridinoline. The serum alkaline phosphatase is 300 IU/L (the normal range is 44- 147 IU/L). The patient's sister had the same problems. She was diagnosed with Paget's disease of bone when she was 52 years old. The diagnosis of Paget's Disease of Bone is confirmed and Bisphosphonate will be started as first-line therapy.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Arthritis, Rheumatoid Had a diagnosis of rheumatoid arthritis using American College of Rheumatology of at least 6 months duration A female subject of childbearing potential who is sexually active must agree to use adequate contraception, and must be neither pregnant nor lactating from Screening throughout the duration of the study Had a physical examination at Screening that revealed no clinically significant abnormalities (other than rheumatoid arthritis) in the investigator's opinion Had clinical laboratory test results at Screening that were normal or, if abnormal, were not clinically significant in the investigator's opinion Had a 12-lead electrocardiogram at Screening that was normal or, if abnormal, was not clinically significant in the investigator's opinion Had a chest x-ray within 6 months prior to or during the Pretreatment Period that, in the investigator's opinion, showed no signs of active tuberculosis and was free of clinically significant findings Had a negative purified protein derivative skin test for tuberculosis (less than or equal to 5 mm in duration) during the Screening Period Had been receiving oral or parenteral methotrexate for at least 6 months prior to Baseline and must have been on a stable dose (12.5 to 25 mg per week, inclusive) of methotrexate for at least 4 weeks prior to Baseline. The subject must have been on a dose of folic acid at greater than or equal to 1 mg/day Had at least 6 swollen and 9 tender joints using the 66/68 joint count scale at Screening and Baseline At Screening, the subject must have had a C-reactive protein of at least 1.2 mg/dL or an erythrocyte sedimentation rate of at least 28 mm/hr  Had been diagnosed with any type of arthritis at age 16 or younger Had a history of a clinically significant illness, medical condition, or laboratory abnormality within 3 months prior to Baseline that, in the investigator's opinion, would preclude the subject's participation in the study Had a known history of human immunodeficiency virus infection Had a known history of hepatitis B or C Had uncontrolled hypertension Had moderate or severe liver disease at Screening, as defined by at least 1 of the following conditions Aspartate transaminase or alanine transaminase greater than 1.2 times the upper limit of normal Total bilirubin greater than 1.2 times upper limit of normal (excluding subjects diagnosed with Gilbert's disease) Alkaline phosphatase greater than 1.5 times upper limit of normal Had elevated serum creatinine level for age and gender at Screening