Round #5
Correct Diagnosis: Erosive osteoarthritis
Discussion:
Erosive osteoarthritis is a severe and debilitating form of degenerative joint disease occurring primarily in postmenopausal women. It is seen most commonly in the hands, with a predilection for the DIP and PIP joints. Because it can present as an acute to subacute onset symmetric inflammatory arthritis with morning stiffness, it is often initially mistaken for rheumatoid or psoriatic arthritis. However, the absence of systemic symptoms, skin rash, or seropositivity coupled with the marked degenerative changes seen clinically and radiographically help confirm the diagnosis.
X-rays of the hands usually reveal severe degenerative changes with osteophytosis and subchondral sclerosis at the DIP and PIP joints of the fingers, and the CMC and IP joints of the thumb. Central erosions due to destruction of articular cartilage are seen with relative sparing of the joint margins. Deformity at the distal joints with sparing of the MCPs can lead to mediolateral subluxation and contractures.
Treatment is conservative, unless joint destruction and/or contractures require surgical arthrodesis, arthroplasty, or tendon repair. Both oral and intra-articular corticosteroids have been used with some success in this condition. The prognosis is good; in most patients the inflammatory arthritis remits after several years, leaving more classic residual osteoarthritic deformities.
References:
- Belhorn LR, Hess EV. Erosive Osteoarthritis. Semin Arth Rheum 22 (5):298-306, 1993.
- Cobby M., Cushnaghan J., Creamer P., Dieppe P., Watt I. Erosive Osteoarthritis: is it a separate disease entity? Clin Radiol 42(4): 258-63, 1990.
ACR 2007 Highlights
Pathophysiology 2007