Erosive (inflammatory) 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.
Clinically the presentation mimics inflammatory arthropathies such as psoriatic arthritis or rheumatoid arthritis (RA). Patients complain of a relatively acute or subacute onset of morning stiffness in the fingers of both hands. However, systemic symptoms are absent.
Erosive OA has a combination of degenerative cartilage changes as well as an RA-like proliferative synovitis 7.
- rheumatoid factor: negative
- antinuclear antibody (ANA): negative
- ESR/CRP: negative or slightly elevated 6
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 patients. 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 a wider differential list refer to: differential diagnosis of erosive arthritis
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