inflammatory erosive osteoarthritis

Epidemiology

• 10% in patients with symptomatic hand osteoarthritis
• preferentially affects women

Pathology

• proliferative changes accompany joint erosion

Clinical manifestations

• episodic inflammation of the proximal interphalangeal joints (Bouchard's nodes) & distal interphalangeal joints (Heberden's nodes)
  • erythema, edema, tenderness, pain
  • joint deformities
• one or two joints are generally inflammed during an attack
• between attacks, findings are consistent with osteoarthritis
• squaring of the carpometacarpal joint may be noted
• generally does not affect wrist or elbows

Laboratory

• erythrocyte sedimentation rate generally not elevated
• serum C-reative protein generally not elevated
• rheumatoid factor is negative
• cyclic citrullinated peptide Ab is negative

Radiology

• X-ray of hands
  • erosive changes demonstrable radiographically
  • central erosions or cystic changes of proximal interphalangeal joints & distal interphalangeal joints
  • erosive changes in carpometacarpal joints may be noted
  • collapse of subchondral bone
  • numerous osteophytes
• 'gull-wing deformity' of distal interphalangeal joints
  • marginal sclerosis & osteophytes on the distal side of joints
  • centrally-eroded or collapsed & thinned proximal side of joint

More general terms

• osteoarthritis (OA)

Additional terms

• Bouchard's node
• Heberden's node