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Erosive osteoarthritis

Erosive osteoarthritis (EOA) is a form of osteoarthritis 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. Patients are rheumatoid factor negative.

Clinical presentation

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.

Radiographic features

Plain film

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

  • distal interphalangeal (DIP) joints
  • proximal interphalangeal (PIP) joints
  • firstcarpometacarpal (CPC) joint

Additional characteristic features include:

  • diffuse cartilage space loss
  • subchondral erosions (at least two central erosions affecting seperate 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
    • osteopaenia

Treatment and prognosis

Treatment is conservative, unless joint destruction and/or contractures require surgical arthrodesis, arthroplasty, or tendon repair.

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

Differential diagnosis

Imaging differential considerations include

See also

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