Erosive osteoarthritis

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

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 (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.

Erosive osteoarthritis exhibits a combination of degenerative cartilage changes as well as a rheumatoid arthritis-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 interphalangeal joints); typical central location of the erosions produces the classic "gull wing" appearance
  • joint ankylosis
  • absence of 2
    • marginal erosions
    • fusiform soft-tissue swelling
    • osteopenia

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.

Imaging differential considerations include:

Arthritides
Share article

Article information

rID: 10756
Synonyms or Alternate Spellings:
  • Inflammatory osteoarthritis
  • EOA
  • Erosive osteoarthritis (EOA)
  • Erosive OA
  • Inflammatory OA
  • Erosive osteoarthosis
  • Inflammatory osteoarthrosis

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    DV
    Case 2
    Drag here to reorder.
  • Drag
     Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Drag
    Case 5
    Drag here to reorder.
  • Drag
    Case 6
    Drag here to reorder.
  • Drag
    Case 7
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.