What Is Erosive Osteoarthritis?

 Osteoarthritis is a condition in which wear and tear on the joints causes a loss of cartilage. Cartilage is the strong but flexible tissue that cushions the ends of the bones in your joints.

Osteoarthritis can lead to:

  • pain
  • swelling
  • joint stiffness
  • loss of flexibility and function

Erosive osteoarthritis is a type of inflammatory osteoarthritis. It can develop in the hinge joints of the fingers and less frequently in the toes. Clinically, these are known as the interphalangeal joints.

Research suggests that less than 3 percent of people develop erosive osteoarthritis. About 10 percent of people with symptomatic osteoarthritis have this inflammatory joint condition.

Erosive osteoarthritis can cause:

  • a hardening of the bone near the cartilage, known as subchondral sclerosis
  • a narrowing of the space in between bones
  • the destruction of some bone material (erosions)

Erosive osteoarthritis can be challenging to diagnose with X-rays and other imaging tests. An analysis of dozens of studies found that there is some disagreement among doctors about what joint changes indicate erosive osteoarthritis.

One generally accepted sign of the condition is its sudden appearance. Stiffness and soreness associated with conventional osteoarthritis tends to build gradually. But symptoms of erosive osteoarthritis usually come on without warning.

Those symptoms primarily affect the fingers and usually include:

  • sudden-onset pain
  • swelling
  • warmth
  • redness
  • reduced function of the hand (it becomes harder to grip objects, for example)

Joint function changes usually occurTrusted Source in the fingers’ proximal joints (in the middle of the fingers), rather than the distal joints (nearer the fingertips).

Health experts disagree about whether erosive osteoarthritis should be considered an aggressive form of osteoarthritis or a distinct type of arthritis.

Typical osteoarthritis can be traced to wear on the joints over time or to an injury that doesn’t heal properly. Erosive osteoarthritis doesn’t share those obvious origins. Researchers believe hormones may be involved because women are affected more often than men. Another possibility is an autoimmune condition.

Erosive osteoarthritis most often affects women around the age of 50. Researchers believe that the loss of estrogen may play a role, particularly since typical osteoarthritis of the hands and knees is much more common in women after menopauseTrusted Source.

A family history of erosive osteoarthritis also raises your risk of developing the condition.

The presence of typical osteoarthritis may also increase risk. The estimated prevalence of erosive osteoarthritis in the general population is 2.8 percent. However, the rate climbs to 10.2 percent among people with symptomatic hand osteoarthritis. For perspective, the CDC reportsTrusted Source that nearly 50 percent of people 65 and older have been diagnosed with some type of arthritis.

Women get diagnosed with arthritis more commonly than men.

Erosive osteoarthritis symptoms, such as painful and swollen fingers, can be similar to those of rheumatoid arthritis (RA). Psoriatic arthritis can also begin in the fingers. As a result, erosive osteoarthritis is sometimes misdiagnosed at first.

One important distinction is that erosive osteoarthritis usually doesn’t involve the wrist or the joints where the fingers meet the palm — two common areas affected by rheumatoid arthritis.

A diagnosis starts with a thorough review of symptoms and personal and family medical histories. Imaging tests are also essential in getting a proper diagnosis. One telltale distinction is subcondral erosions in the fingers caused by the destruction of cartilage and bone in the joints.

Another sign of erosive osteoarthritis that distinguishes it from standard osteoarthritis is the presence of central bone erosion.

There is currently no cure for erosive osteoarthritis. It’s also a progressive condition that can’t be reversed. The goal of treatment is to manage the severity of symptoms and maintain joint function.

Many erosive osteoarthritis treatments are the same as standard osteoarthritis treatments. However, the severity of your symptoms will determine the best approach for you.

NSAIDs and analgesics

Over-the-counter and prescription-strength pain relievers are usually the first-line treatments for erosive osteoarthritis.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can help reduce the inflammation associated with the condition.

Analgesics, including acetaminophen (Tylenol), can be very effective pain relievers that are especially helpful for people who cannot take NSAIDs.

For a small subset of people with severe symptoms, these oral medications may not be sufficient. In this case, doctors may consider off-label use of medications routinely used to treat rheumatoid arthritis, primarily methotrexate.

Off-Label Use

The Food and Drug Administration (FDA) has not approved the use of any medications to treat erosive osteoarthritis, including methotrexate. You should speak with a doctor before using it.

Steroid injections

Steroid injections are meant to reduce inflammation and pain, but they can only be used a few times a year in an individual joint. Typically, they are more effective in temporarily easing symptoms in larger joints, such as the knee or shoulder, rather than the smaller joints of the hand.

Biologics: An Area of Future Study

Biologics are medications made from living microorganisms. A type of biologic called etanercept was found to help reduce pain after 1 year and improve bone health in a small group of individuals with erosive osteoarthritis. However, researchers acknowledged that a larger, longer-term study was needed to confirm their findings.

Occupational therapy

When finger and hand function become impaired, basic tasks like buttoning a shirt or eating utensils can become challenging. An occupational therapist can teach you modified ways to perform everyday tasks on your own or with the help of special tools and devices.

As part of occupational therapy, people with erosive osteoarthritis should also exercise to strengthen affected joints and improve their function.

Heat therapy

The use of hot compresses or hot water soaks is a mainstay of arthritis treatment. Heat helps open up blood vessels to deliver more oxygen and nutrients to the tissue of your joints, easing stiffness and relieving pain. Heat therapy can be an effective complement to oral medications and other treatments.

Some degree of joint pain, swelling, and stiffness are characteristic of most types of arthritis. But there are some distinctions that may help you and your doctor determine just what condition is causing your symptoms.

Vs. traditional osteoarthritis

Erosive osteoarthritis tends to produce more pain, swelling, and functional disability in an affected joint than traditional osteoarthritis. It also involves the erosion or destruction of bone. Typical osteoarthritis usually involves the loss of cartilage and commonly affects the base of the thumb joint, which is spared in erosive osteoarthritis.

Vs. rheumatoid arthritis

Rheumatoid arthritis often begins in the hands, but usually involves other joints, such as the wrists and elbows. Erosive osteoarthritis is usually isolated in the fingers, though it sometimes affects the toes.

The majority of people with RA also test positive for certain biomarkers, including anti-cyclic citrullinated peptide (anti-CCP) antibodies, while people with erosive osteoarthritis test negative for those antibodies.

Vs. psoriatic arthritis

Distinguishing between these two types of arthritis can be difficult in some cases if there are no signs of psoriasis — a scaly rash that forms on this skin. People with psoriatic arthritis may rarely develop painful arthritis symptoms before any changes to the skin are observed. Once psoriasis is diagnosed, it may be easier for your doctor to rule out erosive osteoarthritis as the cause.

Living with erosive osteoarthritis may mean using a variety of therapies to manage your symptoms and retain the use of your hands. Though there is no cure, there has been a growing acceptance in the medical community that erosive osteoarthritis warrants greater research to better understand its origins and identify treatments.

By being proactive and dedicated to your treatment plan, you may be able to keep a pleasant quality of life, despite the presence of a painful and frustrating condition.

Erosive osteoarthritis presents with many of the same symptoms as traditional osteoarthritis, though the pain, swelling and other earmarks of the disease are usually limited to the fingers.

If you have arthritic symptoms, see your doctor or a rheumatologist. The earlier you are diagnosed and map out a treatment plan, the sooner you may be able to slow down the progression of erosive osteoarthritis and manage symptoms.

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