Erosive (Inflammatory) Osteoarthritis: Symptoms, Diagnosis, and Treatment

Erosive osteoarthritis is an inflammatory disease that impacts the joints in the fingers that allow the hand to flex towards the palm of the hand. These joints are known as interphalangeal joints. Since erosive osteoarthritis is a progressive condition that can limit movement in the hands, the sooner it’s diagnosed and the sooner it’s treated, the more likely some level of mobility can be maintained.

Usually, those who suffer from erosive osteoarthritis hands have another erosive condition but test negative for rheumatoid factor. Sometimes, erosive osteoarthritis symptoms can appear in the joints of the foot, hip, and shoulder, but it’s rare compared to the finger joints.

People who suffer from erosive osteoarthritis (EOA) often suffer from either Heberden or Bouchard nodes. Heberden nodes are bony enlargements at the middle joints of the fingers, while Bouchard’s nodes are swellings that develop closer to the fingertips.

Erosive osteoarthritis is common in post-menopausal women.

What Are the Symptoms of Erosive Osteoarthritis?

Erosive inflammatory osteoarthritis symptoms tend to begin suddenly. Many people report severe tenderness in the finger joints, along with stiffness, swelling, redness, and warmth. This is different than the gradual onset of symptoms that are usually seen in those who are suffering from typical osteoarthritis. X-rays of those who have EOA can show breaks in the bone surface in the center of a joint. An X-ray can also detect bony growths, cysts in the bone under cartilage, partial dislocations, and ankyloses, which is stiffness of a joint from bone fusion.

Although more women seem to be affected by the symptoms of erosive osteoarthritis, there is some debate over whether EOA is really its own disease or a progression of hand osteoarthritis.

How Is Erosive Osteoarthritis Diagnosed?

An erosive osteoarthritis diagnosis only happens after the doctor takes your full medical history, does a physical exam, and conducts laboratory tests. Sometimes, imaging is also involved. There is a brief outline of the diagnostic steps below:

• Medical history – To determine whether or not you have erosive osteoarthritis, the doctor will ask questions about your past and your family history. This will include zeroing in on any medical condition that is similar to EOA, such as rheumatoid arthritis. You will be asked to describe symptoms in detail.
• Physical exam – Your doctor will gently press on individual finger joints to examine for any swelling, tenderness, warmth, and redness. The range of motion and strength in your fingers will also be examined. In erosive osteoarthritis, the joints closest to the fingertips of the hand and the joints closest to the knuckles are usually involved. The physical exam usually includes checking other joints in the body, such as wrists and elbows. This is due to the fact that these areas of the body are often affected by rheumatoid arthritis as opposed to erosive osteoarthritis. In other words, it can help the doctor rule certain ailments out.
• Blood tests – Blood samples are generally used to rule out other diseases. They may include erythrocyte sedimentation rate (ERS), which can determine inflammatory activity in the body; C-reactive protein (CP), which is another type of inflammatory marker test; rheumatoid factor, and anti-cyclic citrullinated peptide antibody, an antibody present in most people who have rheumatoid arthritis (RA). If these tests are in the elevated category, it could be RA as opposed to erosive osteoarthritis.
• Imaging tests – X-rays can detect erosions in the hands. If someone has erosive osteoarthritis, the X-ray might show joint space narrowing; subchondral sclerosis, which is a thickening of the bone in joints; marginal osteophytes (bones spurs); joint deformity; or joint stiffness.

Ultrasound might help detect erosions early and provide valuable information on the presence of synovitis and inflammatory changes in other soft tissues.

Differential Diagnosis of Erosive Osteoarthritis

Research shows that erosions tend to have a “gull wing” or “sawtooth” deformity. Although a lot can be determined through an X-ray, clinical and laboratory findings are very important in diagnosing erosive osteoarthritis and ruling out RA as well as other conditions such as gout, chronic renal diseases, and endocrine diseases.

Non-erosive osteoarthritis includes degenerative changes. The difference between osteoarthritis and inflammatory erosive osteoarthritis is that EOA involves erosion. Rheumatoid arthritis affects the proximal joints, which sit behind the joints that are affected by erosive osteoarthritis.

People who suffer from rheumatoid arthritis can have wavy, gnarled-looking hands, but this is usually not the case with EOA. Unlike some forms of arthritis, EOA does not spread to large joints and doesn’t include fever, weight loss, or anemia. EOA should not be confused with psoriatic arthritis; an arthritic condition linked to psoriasis, which is a skin disease characterized by red, itchy, scaly patches.

Subclinical Atherosclerosis, Endothelial Dysfunction, and Erosive Osteoarthritis

Some medical research has indicated that an increased thickness of subclinical atherosclerosis has been found in some people who suffer from erosive osteoarthritis. Atherosclerosis basically means plaque build up in the arteries. The research shows atherosclerosis that could not be linked to usual cardiovascular risk factors.

Furthermore, there have been patients with EOA that have shown something referred to as endothelial dysfunction. The endothelium is a thin membrane lining the inside of the heart and blood vessels. Endothelial cells release a substance that controls vascular contractions and enzymes that play a role in preventing blood clotting, as well as helping with immune function.

Diabetes Increases Hand Pain in Erosive Osteoarthritis

Just a few years ago, a Norwegian study, which was published in the American College of Rheumatology, indicated that people with both osteoarthritis and erosive osteoarthritis experience widespread hand pain and that diabetes could be linked with pain in people with erosive osteoarthritis.

A previous study showed higher frequency of obesity, hypertension, and metabolic syndrome in people suffering from EOA. This study was the first to show an association between diabetes mellitus and hand osteoarthritis. Studies like this are significant because there is limited information about pain and disability impacting people who suffer from osteoarthritis or inflammatory erosive osteoarthritis. It has been suggested that diabetes mellitus and widespread pain in osteoarthritis sufferers should be the subject of more investigation.

Erosive Osteoarthritis Treatment

Treatment of erosive osteoarthritis can be tricky because there is no known cause. Currently, erosive osteoarthritis treatment is mainly physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, and pain relievers.

Research continues into new potential therapies. For example, a tumor necrosis factor inhibitor may be one way to treat erosive osteoarthritis, but more evidence needs to be obtained. The important point to keep in mind is that EOA can lead to hand deformity and limited hand function, so early treatment is best.

Tips for Erosive Osteoarthritis Patients

While there is no magic cure for inflammatory erosive osteoarthritis, you can take steps that will help manage it.

• Get a proper diagnosis – The condition can be easily misdiagnosed so make sure you get a complete workup to rule out other arthritic conditions, such as rheumatoid arthritis and psoriatic arthritis.
• Consider physiotherapy – Exercise can improve the strength and flexibility around the affected joints. If you feel pain when exercising, you should stop though. Many people with OA and EOA find gentle Yoga and Tai Chi helpful.
• Eat healthy – Foods that are high in sugar, saturated fats, and artificial additives can promote inflammation, so you should avoid such foods. Fresh fruits, vegetables, nuts, seeds, and lean meats are good options.
• Use heat and cold pads – Heat can help relieve stiffness, while cold pads are effective when you have pain or muscle spasms.
• Consider assistive devices – There are devices that can help you grab or grip items in the kitchen, making it easier to prepare meals.

There is no quick fix or quick diagnosis when it comes to inflammatory-erosive arthritis. If you are experiencing symptoms of pain, redness, swelling, and/or warmth in your finger joints, you should get a medical examination as soon as possible. Your doctor will rule out certain conditions and based on the conclusion of tests, you will receive advice on the best treatment options.

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• Osteopenia vs. osteoporosis: Understanding the difference