A 74-year-old woman presented to her primary care physician complaining of worsening hand pain and stiffness. She had tried various nonsteroidal anti-inflammatory drugs, but her pain increased over time. The physician noticed hypertrophy, erythema, and tenderness of the interphalangeal joints on physical examination and ordered hand radiographs for further characterization. Frontal radiographs (A) revealed symmetric proximal and distal interphalangeal joint space narrowing, subchondral sclerosis, marginal osteophytes, and erosions. The erosions demonstrated the characteristic “gull-wing” appearance (B) of erosive osteoarthritis. She also had degenerative changes of the first carpometacarpal joints (A).
Erosive osteoarthritis (EOA) is the inflammatory version of osteoarthritis found predominantly in postmenopausal women. The erosions mimic changes found in rheumatoid arthritis (RA); however, patients’ clinical findings and radiologic distribution of erosions differ from RA. The typical distribution of EOA involves the proximal and distal interphalangeal joints and first carpometacarpal joints of the hands, similar to osteoarthritis. Although less likely, EOA may also involve the hip, knee or facets of the cervical spine.1 RA characteristically involves the metacarpophalangeal joints as well as the carpometacarpal, intercarpal, and radiocarpal joints of the wrist.1
Abrupt onset of pain, swelling, redness, warmth, and limited hand function are common in most patients with EOA. EOA is usually a self-limiting disease with residual deformity after the acute arthritic stage has passed; however, some cases occasionally progress to long-term clinical manifestations such as RA.2
Ivy H, Brooks D. JAOCR at the Viewbox: Erosive Osteoarthritis. J Am Osteopath Coll Radiol. 2018;7(3):34.