Erosive arthritis (differential)

Erosive arthritis has a broad differential:

  • erosive osteoarthritis
    • clinically an acute inflammatory attacks (swelling, erythema, pain) in postmenopausal woman
    • typically includes the distal interphalangeal joints, proximal interphalangeal joints, 1st carpometacarpal joint 6, but not the metacarpophalangeal (MCP) joints and large joints
    • classic central erosions; possible ankylosis
  • rheumatoid arthritis
    • sometimes RF positive
    • usually bilateral symmetric involvement of metacarpophalangeal joints, proximal interphalangeal joints, and carpal bones; involves the hands before the feet
    • periarticular osteopenia and later osteoporosis (both unlike psoriatic arthritis), uniform joint space, marginal erosions, subchondral cyst formation, and subluxations; no bone formation unlike psoriatic arthritis and reactive arthritis
  • psoriatic arthritis
    • commonly involves the hands and there is an interphalangeal predominant distribution in psoriatic arthritis vs. metacarpophalangeal joint predominance in rheumatoid arthritis (RA)
    • starts with erosions in the margins and eventually involves the whole joint. classic: “pencil in cup” and bone proliferation (unlike RA); osteoporosis is not a feature in psoriatic arthritis
  • reactive arthritis (Reiter syndrome)
    • predilection for the lower limb
    • symmetrical involvement of the proximal interphalangeal joints, metacarpophalangeal joints, and carpal bones.
    • osteopenia and then osteoporosis, uniform joint space loss, subchondral cyst formation, subluxations, marginal erosions but no bone formation
  • ankylosing spondylitis
  • gout
    • tophi, most commonly involving the 1st metatarsophalangeal joint, known as podagra
  • HADD
  • amyloidosis
  • multicentric reticulo-histiocytosis
  • infectious arthritis
  • scleroderma
  • pressure erosion (PVNS and synovial osteochondromatosis)
  • articular defects simulating erosions in CPPD, osteonecrosis, osteochondritis dissecans, and osteochondral fractures

Article information

rID: 26939
Section: Gamuts
Synonyms or Alternate Spellings:
  • Erosive arthritis - causes
  • Causes of erosive arthritis
  • Differential diagnosis of erosive arthritides
  • Erosive arthropathy: differential diagnosis
  • Erosive arthropathy: causes

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Cases and figures

  • Case 1: erosive osteoarthritis - probable
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  • RA
    Case 2: rheumatoid arthritis
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  • Case 3: scleroderma
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