erosive osteoarthritis

Erosive (inflammatory) osteoarthritis is a form of hand osteoarthritis (OA) where, as the name implies, there is an additional erosive/inflammatory component.

Epidemiology

There is marked female predilection (F:M ~12:1), typically presenting in the postmenopausal patient.

Clinical presentation

Clinically the presentation mimics inflammatory arthropathies such as psoriatic arthritis (PsA) or rheumatoid arthritis (RA). Patients complain of a relatively acute or subacute onset of morning stiffness in the fingers of both hands. Systemic symptoms, however, are absent.

Pathology

Erosive osteoarthritis exhibits a combination of degenerative cartilage changes as well as a rheumatoid arthritis-like proliferative synovitis . Erosive osteoarthritis is a subset of non-erosive OA, rather than a disease in its own right .

Markers

Radiographic features

Plain radiograph

Erosive osteoarthritis has a predilection for the hands. The dominant features are those of osteoarthritis, particularly in terms of distribution:

  • distal interphalangeal (DIP) joints
  • proximal interphalangeal (PIP) joints
  • first carpometacarpal (CMC) joint

Additional characteristic features include:

  • diffuse cartilage loss, with joint space narrowing
  • subchondral erosions (at least two central erosions affecting separate interphalangeal joints); typical central location of the erosions produces the classic "gull-wing" appearance
  • joint ankylosis
  • absence of
    • marginal erosions
    • fusiform soft-tissue swelling
    • osteopenia

Treatment and prognosis

Treatment is conservative unless the disease advances to joint destruction and/or contractures, which may require surgical arthrodesis, arthroplasty, or tendon repair.

The prognosis is good with remission after several years being seen in most patients. The degenerative changes of course remain and are then merely those of osteoarthritis.

Differential diagnosis

Imaging differential considerations include: