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Introduction: Erosive osteoarthritis (EOA) is a rarer form of osteoarthritis (OA) and more aggressive, damaging cartilage and bone and leading to joint deformities. A nitrogen-free bisphosphonate, clodronate, may have a positive impact on treating EOA. Anti-inflammatory, osteoclast-inhibiting, chondrogenesis, bone resorption inhibition, and pain control make clodronate a promising EOA treatment. Aims and objectives: This study aims to evaluate the efficacy of intramuscular administration of clodronate infusion in the treatment of EOA. Method: A systematic review was performed to evaluate the therapeutic efficacy of clodronate in the treatment of EOA. To find relevant material about the efficacy of injectable clodronate in the treatment of EOA, a systematic search was undertaken on PubMed and Google Scholar with Boolean operators and specific keywords, including "clodronate, erosive osteoarthritis, and osteoarthritis.". Result: The studies on clodronate for EOA reveal promising clinical analgesic properties, increased hand strength, and radiological outcomes that eventually lead to pain relief and improved physical and mental health. Some studies found clodronate to be effective in preventing bone marrow lesions and reducing cartilage degradation. The studies show a generally low risk of bias across key domains. Selection bias is well-controlled, with only a few exceptions. Performance bias is effectively managed in all studies. Detection bias is mostly low-risk, with a few exceptions. Attrition bias is well-addressed, though a couple of studies raise concerns. Other biases vary. Recruitment bias, baseline imbalance, and loss of clusters are rare. Incorrect analysis is seldom seen. Overall, the studies demonstrate high methodological rigor, instilling confidence in their findings' validity and reliability. Conclusion: The study has concluded that clodronate can effectively alleviate pain, reduce the release of pro-inflammatory mediators, and prevent articular degradation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate serum levels of visfatin, resistin and adiponectin in patients with erosive (E) and non-erosive (NE) osteoarthritis (OA) of the hand (HOA) compared to normal controls (NC). Methods: 94 outpatients with E HOA and NE HOA and 21 NC were enrolled. The radiological assessment of both hands was performed according to the Kellgren-Lawrence and Kallman score. Patients were divided into two subsets (lone HOA or generalized OA) based on clinically OA involvement of knee and hip. Serum visfatin, resistin and adiponectin levels were determined by ELISA assay. Results: Visfatin was significantly higher in E HOA patients in comparison to NC and NE HOA group. Resistin showed a significant increase in both E HOA and NE HOA groups versus NC, in particular in generalized OA. No significant differences among groups were found in adiponectin. The Kallman score was more severe in the two subsets of E HOA patients compared to NE HOA. Conclusions: This study showed increased levels of resistin in erosive and non-erosive HOA, and higher visfatin levels in E HOA in comparison to NE HOA. These data suggest the adipokines possible role in the pathogenesis of HOA and their potential usefulness as biomarkers of the disease. [ABSTRACT FROM AUTHOR]

Hand osteoarthritis (OA) is a common disease frequently affecting middle-aged women. Prevalence estimates for OA vary widely depending on the age and sex of the population studied, the assessment tools used, and the specific joint sites analyzed OA is characterized by the degradation of articular cartilage, subchondral bone changes and osteophyte formation at the joint margins leading to joint failure. The pathogenesis of the disease and its evolution are multifactorial involving biomechanical, metabolic, hormonal, and genetic factors. Moreover, the role of inflammation has recently been advanced as pivotal in OA onset and progression. In particular, an uncommon variant of hand OA, erosive hand OA, is characterized by inflammatory and degenerative interphalangeal proximal and distal joints. The diagnosis of different types of hand OA is centered on clinical and laboratory investigations which can distinguish the peculiar aspects of these forms. Joint and bone assessments in hand OA are widely studied but there is no agreement with regard to established parameters to make a definitive diagnosis. This report focuses on the laboratory and clinimetric assessments that can be used to distinguish hand OA subtypes and addresses the debatable association with low bone mineral density in osteoporosis. [ABSTRACT FROM AUTHOR]

Erosive osteoarthritis (EOA) is defined as hand osteoarthritis (OA) with interphalangeal joint erosions on plain radiographs. We sought to find ultrasound (US) and magnetic resonance imaging (MRI) features that could distinguish EOA from nodal hand OA (NOA). Symptomatic consecutive patients with hand OA as defined by the American College of Rheumatology criteria (13 EOA patients as defined by erosion in ≥1 interphalangeal joint and seven nodal OA patients) and five normal individuals were examined by plain radiography, US, and MRI. Patients and controls underwent evaluation of metacarpophalangeal and interphalangeal joints by US, and all fingers from second to fifth digit by MRI. A total of 240 joints in symptomatic patients were examined by both imaging modalities. Synovitis, osteophytes, cartilage loss, and erosions were frequently detected in the joints of patients with EOA and NOA. Six of seven patients with NOA had joint erosions that were seen on MRI or US scan but seen on plain radiographs. The overall concordance between MRI and US findings was substantial for osteophytes ( κ = 0.79) and excellent for cysts ( κ = 0.85), erosions ( κ = 0.84), synovitis ( κ = 0.82), and tenosynovitis ( κ = 0.83) in both groups. Inflammatory changes, such as effusions and synovitis, and structural changes, such as erosions, were frequently detected by US and MRI in EOA and nodal OA. These findings may support the hypothesis that EOA could not be a separate entity but may represent the severe end of the spectrum of hand OA. [ABSTRACT FROM AUTHOR]

Objective: To study the value of 3 T dynamic contrast-enhanced (DCE)-MRI for assessment of synovitis of the interphalangeal joints in patients with erosive osteoarthritis (EOA) for treatment response monitoring. Materials and methods: The interphalangeal joints of fingers two to five were examined at 3 T MRI in nine patients with EOA. Two musculoskeletal radiologists recorded erosions, bone marrow oedema (BME), synovitis and osteophytes. Interobserver reliability was calculated using κ statistics. In six patients, DCE-MRI time intensity curves of synovitis in two affected joints were analysed. The maximum upslope, absolute and relative enhancement of synovitis were compared with MRI after 12 months of anti-tumour necrosis factor treatment. Intraobserver reproducibility was calculated using intra-class correlation coefficient. Results: Interobserver reliability was 'good' for detection of erosions (κ = 0.70), BME (κ = 0.77) and synovitis (κ = 0.77), but 'poor' for osteophytes (κ = 0.12). Post-treatment DCE-MRI showed decreasing maximum upslope ( p = 0.002) and absolute ( p = 0.002) and relative ( p = 0.01) enhancement compared to the initial scan. Intraobserver reproducibility of DCE-MRI was 'almost perfect' or 'strong' for all parameters. Conclusions: 3 T DCE-MRI demonstrates changes in time intensity curves of synovitis in EOA of the interphalangeal joints in a longitudinal study, indicating this technique is promising for monitoring therapy response. [ABSTRACT FROM AUTHOR]

Abstract: This review focuses on biomarkers in erosive hand osteoarthritis (EHOA), a subset of hand osteoarthritis (HOA), that primarily affects interphalangeal joints and is characterized by abrupt onset, severe pain and functional impairment, as well as signs of inflammation, in particular stiffness, swelling, erythema, paraesthesiae, and worse outcome. Inflammatory features and radiographic erosions are the main diagnostic hallmarks of this particular disease subset. As in other fields of OA, EHOA biomarkers can be classified as dry and soluble. Soluble biomarkers which are found in serum, synovial fluid and urine can be specific indicators of joint inflammation and degradation. With regard to inflammatory markers, C-reactive protein and myeloperoxidase have been found to be increased in EHOA, with respect to non-erosive HOA. All these markers have, moreover, been found to be correlated with disease activity. Another interesting marker linked to inflammation is hyaluronic acid, considered to be a marker of synovitis, which is frequently found in EHOA. The most useful cartilage markers in both erosive and non-erosive HOA, seems to be collagen (Coll) 2-1, Coll 2-1NO2 and Col2-3/4Cshort. Immunogenetic markers were also determined and an association between EHOA and a single nucleotide polymorphism on the gene encoding interleukin-1β was found in HLA and there was an increased frequency of HLA-B44 and HLA-DRB1*07 in EHOA. [Copyright &y& Elsevier]

Abstract: Erosive (E) osteoarthritis of the hand (HOA) is a subset of HOA, targeting interphalangeal joints and characterised by an abrupt onset, marked pain and functional impairment, inflammatory symptoms and signs, including stiffness, soft tissue swelling, erythema, paraesthesiae, mildly elevated C-reactive protein, and a worse outcome than non-EHOA. This subset is defined radiographically by subchondral erosion, cortical destruction and subsequent reparative change, which may include bony ankylosis. Although the presence of both clinical and radiographic aspects are very suggestive for the diagnosis in most cases, doubts have been recently raised from some studies which, by means of sensitive imaging techniques such as MRI and sonography, had found erosive changes in most patients with HOA, including those without erosions at conventional radiography, so suggesting the need of a consensus on the definition of EHOA. Since the classic treatments are in most cases disappointing, new therapies have been recently proposed in EHOA, including the anti-cytokines biologic agents. The first results seem interesting, although they require confirmation, since derived from uncontrolled studies. [Copyright &y& Elsevier]

Erosive osteoarthritis (EOA) is a progressive disease affecting the interphalangeal joints of the hand. It is also known as an inflammatory form of osteoarthritis. Pain, swelling, redness, warmth and limited function of the hand joints are commonly found in most patients with or without Heberden and Bouchard's nodes. Conventional radiographs of the hands show a combination of bony proliferation and erosions, which give characteristic patterns of the affected joints, known as "gull-wing" and "saw-tooth" deformities. Since there are no distinguishing laboratory findings between EOA and other common erosive interphalangeal arthropathies, radiographic features still have diagnostic value along with clinical presentation. Thus, recognition of the radiological manifestations may lessen the likelihood of misdiagnoses. A treatment-resistant case of EOA with marked and confusing inflammation is described in this report. [ABSTRACT FROM AUTHOR]

Erosive osteoarthritis, a less common subtype of osteoarthritis, is often described as a more severe form. This combination of cartilage degeneration with pathologic features suggestive of inflammatory synovial changes generally manifests in women around the time of menopause and hormonal levels as well as genetics are thought to play a role in its onset. The hands are most often involved with the sudden onset of palpable pain and swelling of the distal interphalangeal joints and proximal interphalangeal joints most frequently, but other joints have been reported. Phalangeal deformities appearing as wavy or subluxed as well as Heberden and Bouchard nodes can be seen clinically. Laboratory tests for systemic inflammation are usually normal but small studies looking at markers of bone resorption have shown increased levels in these patients. Radiographs reveal central joint erosions implying an inflammatory process which has been described in synovial specimens. Treatment options that have been tried include those utilized for general osteoarthritis as well as those for rheumatoid arthritis. Since prolonged disability in hand function can occur, further studies looking at its pathogenesis and targeted treatment options are needed. [ABSTRACT FROM AUTHOR]

The objective of this study is to assess the reliability of clinical examination in patients with erosive osteoarthritis (EOA). Eighteen patients with EOA underwent clinical examination for joint tenderness, bony swelling, and inflammation by two independent, blinded assessors. All patients were also examined by ultrasound (US) by an independent radiologist. The inter-observer agreement was moderate for bony swelling and joint tenderness and fair for joint inflammation ( κ = 0.513, 0.448, and 0.402, respectively). US detected significantly more inflamed joints than clinical examination. The sensitivity and specificity of clinical examination for joint inflammation were 0.12 and 0.95, respectively. Clinical joint counts for bony swelling, tenderness, and inflammation all correlated with functional status, assessed by the functional index for hand osteoarthritis (FIHOA), whereas US joint counts for joint inflammation did not correlate with the FIHOA. No correlation was found between any clinical or US joint count and visual analog scale for pain. US detects more joints with inflammation than clinical examination in patients with EOA. US can supplement the clinical examination of patients with EOA, as US-detected subclinical joint inflammation might accelerate joint damage and thus functional impairment. [ABSTRACT FROM AUTHOR]

Our pilot study aimed to investigate the efficacy and tolerability of intra-articular (i.a.) injections of infliximab as a therapy for erosive osteoarthritis of the hands. Ten women with bilateral involvement of the hands and typical erosive osteoarthritis radiographic findings were enrolled and followed for 12 months. All the patients were refractory to conventional drugs. Treatment consisted in monthly i.a. injections of 0.2 ml of infliximab (0.1 mg/ml) in each affected proximal and distal interphalangeal joint of the most involved hand, identified on the basis of clinical and radiological examinations. The other hand was treated with physiological saline (control). The patients did not know which hand was receiving infliximab. Clinical response was evaluated at enrollment, after 6 and 12 months. Posteroanterior radiographs of both hands were obtained at baseline and 12 months later. At 6 months all the patients experienced relief from spontaneous pain and pain on lateral pressure in the hand treated with infliximab and these findings became statistically significant after 1 year. No important modifications were recognized in the hand treated with physiological saline. The anatomical lesion progression system radiological score indicated a reduction, even if not statistically significant, in the hand treated with infliximab and a tendency to slow worsening in the hand treated with physiological saline at 12-month follow-up. No local or systemic adverse reactions were recorded. Our study shows the symptomatic effect and a possible disease modifying action of i.a. infliximab in erosive osteoarthritis of the hands. [ABSTRACT FROM AUTHOR]

Objective: To establish by ultrasonography (US) the frequency of calcaneal entheses involvement in erosive osteoarthritis (EOA), nodal osteoarthritis (NOA), RA and PsA, and to compare these results in order to aid clinicians in the differential diagnosis among these diseases. A comparison between US results and radiography was also made.Methods: The heels of 56 consecutive outpatients with EOA, 209 with NOA, 158 with RA and 125 with PsA were studied by US and radiography. A control group of 50 subjects was examined by US.Results: US showed no significant difference in inferior calcaneal enthesophytosis among the four diseases. The frequency of posterioinferior enthesophytosis was lower in RA (34%) in comparison with the other diseases (57% in EOA, 47% in NOA, 49% in PsA). Achilles enthesitis was found in 8% of PsA and in 2% of RA. Retrocalcaneal bursitis was found in 18% of RA and in 6% of PsA. Posterior erosions were present in 12% of RA and 5% of PsA. Inferior erosions were present in 6% of RA and in 1% of PsA. Plantar fasciitis was found in 26% of RA, in 37% of PsA, and in 15% of NOA and 12% of EOA. Subcalcaneal panniculitis was observed in 10% of RA and in 1% of PsA. In the control group, only posterioinferior and inferior enthesophytosis (22% and 18% respectively) were found. Kappa statistics show excellent agreement between US and radiography in detecting posterioinferior (kappa = 0.89) and inferior enthesophytosis (kappa = 0.83), and entheseal erosions (kappa = 0.86).Conclusions: The calcaneal lesions that could be found in EOA are similar to those observed in NOA. The frequency of calcaneal enthesophytosis is similar in EOA, NOA, and PsA, but inflammatory lesions of calcaneal entheses and of the adjacent bursae are more frequent in RA and in PsA. In terms of heel involvement, EOA seems to be similar to NOA. US shows an excellent concordance with radiography in detecting entheseal cortical bone abnormalities. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the hands is very common, particularly in elderly people. Little is known though, is the subset of erosive osteoarthritis (EOA), which predicts a poorer prognosis and causes much more discomfort. Even less known is the fact that this subset can evolve into spontaneous ankylosis. We describe eight women (average age 62.6, range 54-74 years) with EOA and spontaneous ankylosis of the proximal interphalangeal (PIP) and/or distal interphalangeal (DIP) joints. In total, 21 PIP joints (0-7 per patient) were found with EOA and nine PIP joints (0-3 per patient) with ankylosis. In one patient, ankylosis of the PIP was already seen at the first presentation. In the other cases, it took an average of 77.4 months (range 34-119) for EOA to develop into ankylosis of the PIP. For DIP joints, the numbers were 17 joints (1-4 per patient) with EOA and three joints (0-1 per patient) with ankylosis, respectively. In one patient, ankylosis of the DIP was already seen at the first presentation. Ankylosis was found significantly more often on the left hand ( n = 10) compared to the right hand ( n = 2; p < 0.0005), while all the patients were right handed. No difference in handedness was found for the occurrence of EOA. Although rare, PIP or DIP joint with EOA can-over the course of several painful years-develop into a spontaneous pain-free ankylosis. Ankylosis was more commonly found in the left hand than in the right hand, probably due right handedness. [ABSTRACT FROM AUTHOR]

Abstract: Erosive osteoarthritis is considered an unusual disease, mostly developing among women. The typical locations are the interphalangeal joints of the hands. However, on a few occasions it has also been found in hips, shoulders and feet. We describe two patients (one woman and one man) who have this disease in their feet. [Copyright &y& Elsevier]