What Is Erosive Osteoarthritis?

A Subset of Generalized Osteoarthritis

Mature woman holding hand

Erosive osteoarthritis is considered a subtype of osteoarthritis and it is usually seen in the joints of the hand and fingers. It often strikes women around the time of menopause, which leads to the suspicion that hormones and genetics play a role in its progression.

Erosive osteoarthritis is sometimes referred to as inflammatory osteoarthritis, which seems like a contradictory term to many people who believe osteoarthritis is not associated with inflammation.

Symptoms of Erosive Osteoarthritis

Initially, symptoms of erosive osteoarthritis may be confused with rheumatoid arthritis or psoriatic arthritis. Erosive osteoarthritis is primarily characterized by erosions of cartilage in the hands. Middle-aged or post-menopausal women are most commonly affected. Women are more affected by erosive osteoarthritis than males, 12 to 1. Studies have shown evidence of erosions in other joints too, but the severe, aggressive type of hand disease associated with erosive osteoarthritis defines the disease.

Erosive osteoarthritis can begin suddenly with pain, tenderness, and swelling present. This strikes both hands in the same joints at the same time. The joints are often stiff int he morning for as long as an hour after awakening. The episodes of joint swelling and inflammation come and go, although they may be frequent.

The joint closest to the fingertips (distal interphalangeal joints) of the hand are most frequently involved.

The joint closest to the knuckles (proximal interphalangeal joints) are the next most commonly involved joints with erosive osteoarthritis. The knuckles and larger joints are occasionally involved. The feet are also a site for erosive osteoarthritis, and this may be the cause of toe and foot pain.

Hand deformities can occur as the disease progresses.

These can include partial dislocation (subluxations), flexion contractures and ankylosis (stiffness and fusing of the joint). This impairs the function of the hand.

Diagnosis of Erosive Osteoarthritis

A medical history and physical examination will be performed. As for diagnostic testing, there may be a mild elevation of the sedimentation rate, but generally, blood tests for inflammation are negative. X-rays reveal typical erosions, and a "gull-wing" deformity is associated with erosive osteoarthritis. A saw tooth erosion can also be seen and when it is it often leads to the joint becoming stiff or fused (ankylosis).

The diagnostic criteria are not established, but it often will be made if these signs are seen. First, the symptoms meet the usual criteria for osteoarthritis of the hands. Ther have to be erosions of ate least two interphalangeal joints and one of those must be the distal joint. Negative rheumatoid factor and anti-cyclic citrullinated peptide antibody. No history of psoriatic arthritis or gout and chondrocalcinosis of the hands. Supporting signs are a normal ESR and normal wide range C-reactive protein and the presence of central subchondral erosions.

Treatment of Erosive Osteoarthritis

The cause of erosive osteoarthritis is unknown, but hormones, metabolic disorders, and autoimmunity are suspect.

A better understanding of the cause may produce better treatment options, but for now, treatment of erosive osteoarthritis focuses on physical therapy, nonsteroidal anti-inflammatory drugs, and prednisone.

Hand deformity and impaired hand function are definite concerns with erosive osteoarthritis. Treatment plans should be periodically reviewed to minimize damage from the condition. Early treatment is best and, unlike rheumatoid arthritis, the inflammation can eventually subside. The joint may be left enlarged, but it doesn't progress to rheumatoid arthritis.


Erosive Osteoarthritis. Leonardo Punzi MD, Ph.D. Best Practice & Clinical Rheumatology. Vol.18. Issue 5. October 2004.

Erosive Osteoarthritis: Is it a separate disease entity? M. Cobby et. al. Clinical Radiology. Vol. 42. Issue 4. October 1990.

Erosive Osteoarthritis. Linda R. Belhorn, et.al. Seminars in Arthritis and Rheumatism. Vol. 22. Issue 5. April 1993.

Allen Anadarajah. "Erosive Osteoarthritis." Discovery Medicine, May 20, 2010.

Banks, SE. "Erosive osteoarthritis: a current review of a clinical challenge." Clin Rheumatol. 2010 Jul;29(7):697-706. doi: 10.1007/s10067-009-1369-7.

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