Understanding Erosive Osteoarthritis

A subtype of hand osteoarthritis that is more severe

Mature woman holding hand
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Erosive osteoarthritis is considered an uncommon and unique type of hand osteoarthritis (OA). It's unique because there is joint inflammation involved, which leads to characteristic x-ray findings, as well as more severe joint pain and stiffness. 

By gaining knowledge about this disease, you can hopefully understand why it's more disabling than typical hand OA.

Symptoms and Signs of Erosive Osteoarthritis

Erosive osteoarthritis usually starts with the sudden onset of severe tenderness in multiple finger joints along with variable degrees of redness, stiffness, warmth, and swelling.

The abrupt onset of symptoms seen in erosive osteoarthritis is in contrast to the gradual onset seen in typical hand osteoarthritis.

X-rays of the hands of someone with erosive osteoarthritis reveal central erosions, which are breaks in the bone surface in the center of the joint (on the x-ray, you see "bare areas" or areas where there should be bone but there is not).

In erosive osteoarthritis, other x-ray changes that may be seen include:

  • Osteophytes (bony growths)
  • Subchondral cysts (cysts in the bone underneath the cartilage)
  • Subluxations (partial dislocations)
  • Ankyloses (stiffness of a joint from bone fusion)

Women Are Affected More Than Men

The overall prevalence of erosive osteoarthritis is approximately 3 percent of the general population, and women are affected more than men. 

Even so, these percentages are debated by experts, in part because some studies that have examined the progression of typical hand osteoarthritis report that a high number of people (up to 40 percent) actually exhibit "erosive changes."

This suggests that a lot of people with "hand osteoarthritis" may actually have "erosive hand osteoarthritis." This has fueled the debate over whether erosive osteoarthritis is really its own disease or a phase of hand osteoarthritis progression.

Diagnosis of Erosive Osteoarthritis

The diagnosis of erosive osteoarthritis is still a tricky process, as there is currently no set in stone criteria.

Even so, doctors use a combination of medical clues and x-rays to ultimately make the diagnosis.

Medical History 

In order to diagnose erosive osteoarthritis, a doctor will first perform a medical history and physical examination. In terms of a medical history, your doctor will ask questions about your past or family history of arthritis, especially rheumatoid arthritis (the medical condition that probably most closely resembles erosive osteoarthritis).

He will also inquire about whether or not you have whole-body symptoms like a low-grade fever, fatigue, or weight loss. These should not be present in erosive osteoarthritis but may occur with rheumatoid arthritis or other types of inflammatory arthritis (for example, psoriatic arthritis).

Physical Examination

When examining your hands, your doctor may gently press on an individual finger joint to access for swelling, tenderness, warmth, and redness. He will also examine your fingers' range of motion and strength.

Remember, in erosive osteoarthritis, there is an inflammatory process going on (as evidenced by central erosions on x-ray), so joint aching, stiffness, and limited joint function is more severe than in typical hand OA.

Your doctor will also examine other joints in your body, besides your hands, like your wrists and elbows, which are commonly affected in rheumatoid arthritis but not in erosive osteoarthritis.

Another clue to doctors that a person may have erosive osteoarthritis is the specific finger joints involved. In erosive osteoarthritis, the joints closest to the fingertips (called the distal interphalangeal joints) of the hand are most frequently involved, followed by the joints closest to the knuckles (called the proximal interphalangeal joints).

The knuckles of the hand (called the metacarpal-phalangeal joints) are usually not affected, and the thumb joint is also usually spared in erosive osteoarthritis.

Blood Tests

Your doctor will likely order blood tests, more to rule out other diseases than to rule in erosive osteoarthritis.

These blood tests commonly include: 

  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CP)
  • Rheumatoid factor
  • Anti-cyclic citrullinated peptide antibody

These tests may be positive (or elevated) in rheumatoid arthritis but should be within the normal range in erosive osteoarthritis.

Imaging Tests

X-ray evidence of central erosions on the hands adds a lot of value when making the diagnosis of erosive osteoarthritis. This is in contrast to marginal erosions (bare areas on the sides) seen in rheumatoid or psoriatic arthritis. 

Treatment of Erosive Osteoarthritis

The exact cause of erosive osteoarthritis is unknown, so treatment is still challenging. For now, treatment of erosive osteoarthritis focuses mainly on physical therapy and nonsteroidal anti-inflammatory drugs. As research evolves, newer therapies are emerging, although the evidence behind them is still very early. For instance, adalimumab (a tumor necrosis factor inhibitor) may be an effective treatment for erosive osteoarthritis. 

Lastly, due to the concerns of hand deformity and impaired hand function with erosive osteoarthritis, early treatment is best. Even so, it's good to note that, unlike rheumatoid arthritis, the inflammation of erosive osteoarthritis can eventually subside.

A Word From Verywell

The big picture here is that while the precise diagnosis and classification of erosive osteoarthritis is still debated among experts, the severity (as compared to typical hand osteoarthritis) and specific x-ray findings (central erosions) are hallmark features. 

If you or a loved one has erosive osteoarthritis, be sure to seek out care from a doctor who specializes in joints (called a rheumatologist). With a good treatment plan that includes medications and physical therapy, you can optimize your joint health. 

Sources:

Anandarajah A. (2010). Discovery Medicine: Erosive Osteoarthritis. 

Doherty M, Abhishek A. Clinical manifestations, and diagnosis of osteoarthritis. Hunter D, ed. UpToDate. Waltham, MA: UpToDate Inc.

Gazeley DJ, Yeturi S, Patel PJ, Rosenthal AK. Erosive osteoarthritis: A systematic analysis of definitions used in the literature. Semin Arthritis Rheum. 2017 Feb;46(4):395-403.

Kwok WY, Kloppenburg M, Rosendaal FR, van Meurs JB, Hofman A, Bierma-Zeinstra SM. Erosive hand osteoarthritis: its prevalence and clinical impact in the general population and symptomatic hand osteoarthritis. Ann Rheum Dis. 2011 Jul;70(7):1238-42.

Verbruggen G, Wittoek R, Vander Cruyssen B, Elewaut D. Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double-blind, randomized trial on structure modification. Ann Rheum Dis. 2012 Jun 1;71(6):891-98.

 

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