EROSIVE
OSTEOARTHRITIS
A clinical form of osteoarthritis of genetic predisposition that, in
the hand, primarily affects the DIP joint, some PIP joints, and the first carpometacarpal
joints, with extensive synovitis and cyst formation.
Bony enlargement of the DIP joints (Heberden's nodes) and bony overgrowth
of the PIP joints (Bouchard's nodules) are present, often without significant soft tissue
swelling. The MCP joints and wrists are usually spared in erosive osteoarthritis. On
x-ray, erosions appear subchondral rather than marginal (as is usually seen in RA). The
thumb base (carpometacarpal joint) frequently is involved, with a squared-off appearance.
Unlike in RA, the ESR and CBC are usually normal, regardless of disease severity.
Treatment can include range-of-motion exercises in warm water, intermittent splinting to
prevent deformity, use of analgesics or NSAIDs, and occasional intra-articular injections
of depot corticosteroids for acutely symptomatic joints to relieve pain and prevent
limited motion.
Certain diseases are often categorized as subsets of primary osteoarthritis. These
disorders include primary generalized osteoarthritis (PGOA), erosive inflammatory
osteoarthritis, and chondromalacia patellae.
Discovery of Erosive osteoarthritis
Kellgren and Moore described PGOA in 1952. The disease is characterized by familial and
often premature development of Heberden and Bouchard nodes, as well as the precocious
degeneration of the articular cartilage of multiple other joints, including the first
carpometacarpal joints, knee joints, hip joints, and spine articulations. The radiographic
appearance of PGOA is indistinguishable from that of nonfamilial primary osteoarthritis,
although the disease typically progresses relatively rapidly and appears severe on images.
Description of Erosive osteoarthritis
Erosive (ie, inflammatory) osteoarthritis is a form of primary osteoarthritis marked by
a greater degree of inflammation, with erosive abnormalities and, in some cases, bony
ankylosis. The disease most commonly occurs in postmenopausal women, and it may be
hereditary. Laboratory findings are generally uninformative. Erosive osteoarthritis is
typically bilateral and symmetric, and it occurs in the interphalangeal, particularly
distal interphalangeal, joints of the hands (see Image 24). Rarely, patients may have
erosive osteoarthritis at the base of the first metacarpal or even in the feet
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