Erosive osteoarthritis (EOA) is a form of osteoarthritis (OA) where, as the name implies, there is an additional erosive/inflammatory component.
On imaging, it is usually characterised by proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints erosive and productive bony changes with central erosions producing the classic "gull or seagull wing" appearance. Distribution of OA, with first carpometacarpal (CMC) joint involvement, leads to the diagnosis.
There is marked female predilection (F:M ~12:1), typically presenting in the postmenopausal patient. Patients are rheumatoid factor negative.
Clinically the presentation mimics inflammatory arthropathies such as psoriatic arthritis or rheumatoid arthritis. Patients complain of a relatively acute or subacute onset of morning stiffness in the fingers of both hands.
Systemic symptoms are however absent.
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 IP joints); typical central location of the erosions produces the classic "gull wing" appearance
- joint ankylosis
absence of 2
- marginal erosions
- fusiform soft-tissue swelling
Treatment and prognosis
Treatment is conservative unless 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 patient. The degenerative changes of course remain and are then merely those of osteoarthritis.
Imaging differential considerations include:
- non-erosive osteoarthritis: same distribution and degenerative changes, but without erosions
- rheumatoid arthritis: different joint distribution, proximal joints in RA
- usually do not involve the first carpometacarpal joint, scaphoid-trapezoid, and scaphoid-trapezium joints, which are typical for OA
- for more wider differential refer to: differential diagnosis of erosive arthritis
- seronegative spondyloarthritides
- Jaccoud arthropathy
- juvenile idiopathic arthritis
- lyme arthritis
- rheumatoid arthritis
- systemic lupus erythematosus
- erosive osteoarthritis
- osteoarthritis (mnemonic)
- primary cystic arthrosis of the hip
- rapidly destructive osteoarthritis of the hip
- secondary synovial osteochondromatosis
- miscellaneous disorders
- related articles
- 1. Martel W, Stuck KJ, Dworin AM et-al. Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. AJR Am J Roentgenol. 1980;134 (1): 125-35. AJR Am J Roentgenol (abstract) - Pubmed citation
- 2. Chew FS. Radiology of the hands: review and self-assessment module. AJR Am J Roentgenol. 2005;184 (6): S157-68. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Belhorn LR, Hess EV. Erosive osteoarthritis. Semin. Arthritis Rheum. 1993;22 (5): 298-306. Pubmed citation
- 4. Bryant LR, des Rosier KF, Carpenter MT. Hydroxychloroquine in the treatment of erosive osteoarthritis. J. Rheumatol. 1995;22 (8): 1527-31. Pubmed citation
- 5. Smith D, Braunstein EM, Brandt KD et-al. A radiographic comparison of erosive osteoarthritis and idiopathic nodal osteoarthritis. J. Rheumatol. 1992;19 (6): 896-904. Pubmed citation