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Osteoarthritis (OA) is one of the most common diseases of the musculoskeletal system in the world. Some researchers call the small joints of the hands as being one of the most common sites of involvement in OA. Its most severe phenotype is considered to be inflammatory, or erosive, OA (EOA). Nevertheless, the radiographic pattern of this disease has not yet been sufficiently studied, and whether EOA is an independent form of OA, a regular later stage of the disease or an individual nosological entity, has not yet been resolved. Objective : to assess the location, frequency, and severity of radiographic symptoms and pain in patients with EOA and non-erosive OA (NEOA), to study the involvement of carpometacarpal (CMC), wrist, metacarpophalangeal (MCP) and radiocarpal (RC) joints in the pathological process in patients with EOA and NEOA of the hands. Subjects and methods . The investigation enrolled 64 women with hand OA who met the American College of Rheumatology (ACR) OA criteria. Hand joint images in the anteroposterior projection were first performed in all the patients. Each patient completed the AUSCAN questionnaire. The images were described according to the Kellgren and Lawrence classification. The mean age of the patients was 65.28+6.82 years; the age at onset of the disease was 48.81+7.73 years; its median OA duration was 15.0 [10.0; 19.5] years. According to the presence of erosions in the interphalangeal joints (IPJ) of the hand, the patients were divided into two groups: 1) EOA (n=23); 2) NEOA (n=37). Both groups were matched for age and disease duration (the mean age of patients with EOA was 68+6.15 years, the mean disease duration was 18.34+7.11 years; these in the NEOA group were 65.13+5.43 and 16.56+8.4 years, respectively). For age matching, 4 patients were excluded from Group 2. Results and discussion . Kellgren and Lawrence Stage II hand OA was detected most frequently (49%) and the most common radiographic symptoms of OA in the distal IPJ (DIPJ), proximal IPJ (PIPJ) and MCP joints were joint space narrowing (JSN) (100%, 100%, and 95%, respectively) and osteophytes (OPs) (88%, 70%, and 45% respectively). The least common conditions were subchondral osteosclerosis (SCOS) (5%), erosions (8%), and subluxations (3%) in the MCP joints, as well as subluxations in the PIPJ (6%). In the wrist, the most frequent sites of involvement was first CMCJ and scaphoid-trapezium-trapezoid joint (STTJ); their JSN was identified in 86 and 69% of patients, respectively; OPs were found respectively in 81 and 50% of cases. Changes in the RC joint (RCJ) were least common. EOA of the DIPJ and PIPJ was found in 15 (23%) patients with radiographic changes corresponding to Stages III—IV OA of the hand and in 8 (12%) patients with Stage II according to the Kellgren and Lawrence classification. The DIPJ in EOA versus NEOA showed significantly higher frequency of OPs (100 and 78%), SCOS (74 and 11%), cysts (61 and 24%), and subluxations (43 and 14%); the PIPJ — SCOS (43 and 5%), cysts (52 and 27%), and subluxations (17 and 0%; p

Introduction The present study aimed (a) to evaluate the clinical and radiographic characteristics of hand erosive osteoarthritis (EOA) in a group of consecutive patients, (b) to correlate the severity of radiographic involvement with clinical and laboratory findings and (c) to associate the levels of pain and functional impairment with some radiographic findings. Methods Patients with EOA were consecutively enrolled. Inclusion criteria required the American College of Rheumatology (ACR) criteria for hand osteoarthritis and the presence of at least one joint in “E” or “R” phase according to Verbruggen–Veys. For each patient, demographic and clinical data were collected including evaluation of pain and function with the Australian Canadian Osteoarthritis Hand Index (AUSCAN) scale and Health Assessment Questionnaire (HAQ). Laboratory parameters and plain radiography of both hands were also collected. Each radiograph was evaluated in accordance with the Verbruggen–Veys classification and scored with the Kallman score. Results During the study period 60 patients (M/F 13:47) with EAO were enrolled. More severe radiographic disease (“E” or “R”) was often found at II and III distal interphalangeal (IP) joints. In addition, Kallman score, presence of osteophytes, erosions and joint space narrowing correlated significantly with duration of symptoms, AUSCAN, pain and active joints. More severe radiographic involvement was associated with AUSCAN and with the presence of ankylosis only at proximal IP joints. Conclusion The present study showed that EOA is characterised by a significant correlation between radiographic involvement and some clinical characteristics of the disease. However, an impairment of joint function was mainly associated to radiological proximal IP joint involvement, but not with other symptoms such as pain.

No difference between both hands was observed for clinical and radiographical presentations in EHOA patients. A bilateral and symmetrical relationship was found between hand joints. EHOA have symmetrical distribution and specific association in structural lesions. This study aims to analyse the preferential topographical distribution of clinical and structural lesions between the dominant and non-dominant hands in erosive hand osteoarthritis (EHOA) patients. Both hands were assessed via radiography in EHOA patients. A comparative analysis of the clinical features and structural lesions between the dominant and non-dominant hands was performed. The structural lesions were assessed according to the anatomical radiographic score of Verbruggen-Veys (VV). Next, a principal component analysis was performed to describe and highlight the relationships observed between the joints. Sixty patients were included in this study: there were 57 women, and the mean age was 66.1 (± 7.6) years. For the distal interphalangeal (DIP) joints, nodes were observed more frequently on the dominant hand (4 vs 3; p = 0.005). No difference in structural lesions was observed between the two hands except for the 2nd proximal interphalangeal (PIP) (p = 0.045). A principal component analysis with varimax rotation described relationships between the 2nd PIP, 3rd PIP, 4th PIP, 4th DIP and 5th DIP joints in both hands. No significant differences between dominant and non-dominant hands were observed for clinical and structural lesions in our sample of EHOA patients. A bilateral and symmetrical injury was observed in most EHOA joints. Trial registration Clinical trial registration number: NCT01068405.

Background Erosive osteoarthritis (EOA) is a commonly invoked diagnosis representing an important variant of hand osteoarthritis (OA). There is increasing literature on the prevalence, risk factors, etiology, and management of EOA. Methods We systematically reviewed the literature to assess variability in the diagnostic definitions used to define EOA in these studies. Results We reviewed 336 articles and found 62 articles citing diagnostic definitions for EOA. Radiographic appearance was the most commonly used criterion, but there was little agreement on the details or extent of the radiographic changes. Overall, 56 of the 62 studies included clinical features in the diagnostic definitions, yet these features varied considerably. Exclusion criteria were mentioned in 43 of the studies. Conclusion Based on the widely disparate definitions of EOA, we urge caution in interpretation of this literature, and propose that further understanding of EOA will require consensus on its definition.

OBJECTIVE: We aimed to determine if hand joints develop an accelerated form of osteoarthritis and characterize individuals who develop accelerated hand osteoarthritis (AHOA). METHODS: We evaluated 3519 participants in the Osteoarthritis Initiative with complete data for baseline and 48-month radiographic hand osteoarthritis. One reader scored posteroanterior radiographs of the dominant hand using a modified Kellgren-Lawrence (KL) scale and another reader scored the presence of central or marginal erosions. A third reader read images flagged for signs of diseases other than osteoarthritis. We defined AHOA as ≥1 joints that progressed from a KL grade of 0 or 1 at baseline to KL 3 or 4 at 48 months. RESULTS: The definition of AHOA was met by 1% over 4 years: 37 hands had 1 joint affected and 1 hand had 2 joints affected. At baseline, adults who developed AHOA were more likely to have hand pain (37% vs 22%), radiographic hand osteoarthritis (71% vs 36%), as well as central (22% vs 7%) and marginal erosions (11 vs 2%) in other joints compared to those without AHOA. Adults with AHOA were more likely to develop new erosions over 48 months (central 35%; marginal 5%) than those without AHOA (central 5%; marginal 1%). The most common locations of accelerated osteoarthritis were the second metacarpophalangeal and first carpometacarpal joint. CONCLUSION: Accelerated osteoarthritis can occur in the hand, especially among digits commonly used for pinching and fine motor skills.

Chapter 45 discusses imaging of erosive osteoarthritis (EOA), a severe phenotype of osteoarthritis (OA) characterized by erosions and superimposed synovitis, most typically seen in women in the interphalangeal (IP) joints of the hand. Radiography is the primary imaging modality used in the diagnosis of EOA. EOA is distinguished from non-EOA based on the presence of erosions on radiography. US and MRI can be useful in detecting erosions, joint effusion, and active synovitis that may precede radiographic changes. The most common differential diagnosis of EOA is psoriatic arthritis (PsA), which exhibits additional characteristic imaging features such as bony proliferations and periostitis.

Background The aims of this study were to analyse the serum concentrations of clusterin (CLU) in patients with hand osteoarthritis (OA) and in healthy controls, to compare CLU levels between patients with erosive and non-erosive disease, and to examine the association of CLU levels with clinical and laboratory parameters. Methods A total of 135 patients with hand OA (81 with erosive and 54 with non-erosive disease) and 53 healthy individuals were included in this study. All patients underwent clinical and hand joint ultrasound examination. The Australian/Canadian (AUSCAN) hand osteoarthritis index, algofunctional index and a visual analogue scale (VAS) for the measurement of pain were assessed. Serum levels of CLU were measured by an enzyme-linked immunosorbent assay (ELISA). Results Serum levels of CLU were significantly lower in patients with hand OA than in control subjects (p

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Background Erosive osteoarthritis (EOA) is a form of severe involvement of osteoarthrosis in the hands, characterized by inflammation of the synovium of the proximal interphalangeal (PIF) and distal joints (DIF); the last ones are the most affected in a symmetrical manner. Inhibition of interleukin 6 (IL-6) in joints with osteoarthrosis helps to improve the production of the cartilaginous matrix and microfractures of articular cartilage. Objectives To know if the application of TCZ is useful for the control of the clinical manifestations of EOA of the hands. Methods Twenty-four patients with EOA were studied, 18 females and 6 males with ages ranging from 42 to 72 years, with an evolution time of 4 to 30 years. The application of TCZ was intravenous (8 mg/kg of body weight per month). Articular pain in the PIF and distal joints was evaluated by the visual analogue scale (VAS) (0 to 10) and joint pain (0 to 50), morning stiffness (0 to 10), and functional limitation (0–90) by the AUSCAN index. Results The VAS showed improvement of 30% (0% to 100%). The AUSCAN index showed improved pain (16.2), morning stiffness (0.6) and functional limitation (17.5). Decreased ESR, CRP, and IL-6 levels less than 1.56 to 59.1 pg/ml. Conclusions IV Tocilizumab is useful for the control of the clinical manifestations of OAE of the hands. More precise studies are needed to evaluate the improvement of the cartilaginous matrix in EOA by TCZ. Disclosure of Interest None declared

Eine symptomatische Fingergelenkspolyarthrose (HOA) tritt bei 5–20 % der Bevolkerung ≥ 40 Jahre auf. Die Diagnosestellung erfolgt primar anhand der klinischen Symptomatik mit Schmerzen, knocherne Verdickungen der Fingergelenke und geringer Morgensteifigkeit. Laboruntersuchungen und Rontgenaufnahmen der Hande konnen in der Differenzialdiagnostik anderer entzundlicher Gelenkerkrankungen, insbesondere der rheumatoiden Arthritis und Psoriasis-Arthritis notwendig werden. Nicht-pharmakologische Therapieoptionen umfassen Patientenschulung zur Kraftigung der Muskulatur und Mobilisation als auch physio- und ergoherapeutische Behandlungsverfahren. Bei leichten bis masigen Schmerzen konnen topische nicht-steroidale Antirheumatika (NSAR) oder Capsaicin effektiv sein. Zur systemischen Therapie kommen in erster Linie Paracetamol, NSAR und Coxibe in Frage. Innovative Therapieoptionen werden derzeit in klinischen Studien erforscht.

We evaluated the efficacy and safety of intramuscular clodronate (CLO) for the treatment of active erosive osteoarthritis of the hand (EOA). Forty outpatients treated with anti-inflammatory (NSAIDs) or analgesic drugs since at least 6 months, for at least 3 days a week, were randomly divided into two groups. Group A: 24 patients treated for 6 months with intramuscular (i.m.) CLO added to usual NSAIDs or analgesic drugs. The attack dose was 200 mg/day i.m. for 10 days followed by a maintenance dose of CLO i.m. 200 mg/day for 6 days after 3 and 6 months. Group B: 16 patients who continued the usual treatment with anti-inflammatory or analgesic drugs. Patients in both groups reported in a diary, day by day, the consumption of symptomatic drugs. In group A, the consumption of anti-inflammatory or analgesic drugs (p 0.0001), pain (p 0.0001), number of tender joints (p = 0.0097), number of swollen joints (p = 0.0251), Dreiser score (p = 0.0119), and patient's and physician's global assessment of disease activity significantly decreased (both p 0.001). At 6 months, serum COMP also significantly decreased (p 0.0029). Strength of right (p = 0.0465) and left hand (+38%, p = ns) significantly increased. In group B, there was no significant change in all parameters considered. Intramuscular CLO in EOA of the hand is effective and safe on pain with a significant reduction in the consumption of anti-inflammatory or analgesic drugs, increasing the functionality of the hands. Serum COMP reduction suggests that CLO could play a role as a disease-modifying drug (EudraCT number 2013-000832-85).

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.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.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.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.

Summary Objective Erosive osteoarthritis of the hand (EHOA) is thought to be an aggressive variant of hand osteoarthritis (HOA) characterised by prominent local inflammation and radiographic aspects of bone erosions in interphalangeal (IP) joints. However, rare studies have until now investigated the value of biomarkers in these patients. Thus, we determined Coll2-1, a marker of type II collagen denaturation, its nitrated form (Coll2-1NO2) and myeloperoxidase (MPO) levels in serum of patients with EHOA vs non-EHOA and subsequently evaluated their relationships with disease indices of severity and activity. Methods Coll2-1, Coll2-1NO2 and MPO were measured using specific immunoassays in 82 patients, 57 with EHOA, all females, median age 59 (41–74yrs) and 20 with non-EHOA, all females, median age 55 (43–73yrs), fulfilling the American College of Rheumatology (ACR) criteria for hand OA. EHOA was characterized by the presence of at least one central bone erosion on radiograph in the IP joints. Patients were also evaluated for disease duration, number of affected (swollen and painful or tender) joints, radiographic score (RS) by Kallman scale and high sensitivity C-reactive protein (hsCRP). Results Serum levels of MPO were higher in EHOA (230.0±152.1ng/ml) than in non-EHOA (160.2±111.5ng/ml, P =0.037). Coll2-1NO2 levels trended towards an elevation in EHOA compared non-EHOA (0.40±0.86 vs 0.22±0.14nmol/l, P =0.06), while Coll2-1 levels were not different. Correlations were found for disease duration and both MPO ( R 2 =0.48, P =0.001) and Coll2-1NO2 ( R 2 =0.73, P =0.01) after the splitting of the population in subgroups according to a cut off value above the 50th percentile. A correlation was found between hsCRP and MPO ( R 2 =0.57, P =0.01). Conclusions This study clearly demonstrates an elevation of some serum biomarkers in EHOA, in comparison with non-EHOA. In particular, MPO, hsCRP and the ratio Coll2-1NO2/Coll2-1 discriminated the two subsets of hand osteoarthritis (HOA), and a trend was also observed for Coll2-1NO2. These data suggest that these biomarkers could be helpful for the diagnosis of EHOA.

Resume L’arthrose des mains (AM) erosive (AME), dite aussi arthrose erosive des doigts ou arthrose digitale erosive, est une entite clinique encore en quete d’une definition satisfaisante. Selon les recentes recommandations de l’Eular, l’AME doit etre consideree comme un sous-groupe de l’arthrose de la main ciblant les articulations interphalangiennes et caracterise par une apparition brusque avec douleur intense et associe a une deficience fonctionnelle, des symptomes et signes inflammatoires (rigidite, gonflement des tissus mous, erytheme, paresthesies, legere augmentation de la proteine C-reactive) et une evolution plus defavorable que celle de l’arthrose non erosive de la main. Il est aussi specifie que l’AME est defini radiographiquement par l’erosion sous-chondrale, la destruction corticale et la reaction reparatrice secondaire, qui peut inclure l’ankylose osseuse. Toutefois, puisque les moyens d’imagerie plus sensibles, tels que l’IRM, retrouvent des erosions plus frequemment que la radiographie standard, un consensus est necessaire pour definir l’AME. Dans la plupart des cas, les traitements classiques sont decevants, raison pour laquelle des nouveaux moyens therapeutique sont en evaluation, incluant des medicaments biologiques anti-cytokines qui, dans les essais preliminaires non controles, semblent interessants.

We evaluated the efficacy of clodronate for treating active erosive osteoarthritis of the hand and to compare it with hydroxychloroquine. Group A consisted of 24 patients treated for 24 months with clodronate 300 mg i.v. for 7 days, followed by clodronate i.m. 100 mg for 14 days every 3 months. Group B comprised 14 patients treated with hydroxychloroquine 400 mg daily for 30 days, followed by 200 mg daily for the next 11 months. In group A, 21/24 patients completed the trial and obtained significant pain reduction (p

Rationale and Objectives To investigate the diagnostic value of high-resolution dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for assessment of synovitis in erosive osteoarthritis (EOA) of the hand and compare the results with those acquired in its potential mimic, the psoriatic arthritis (PsA). Materials and Methods Twenty-six patients (17 PsA, 9 EOA) were examined at 3 T. The time course of synovial contrast uptake was measured by ROI analysis using a three-dimensional encoded spoiled gradient-echo sequence. Characteristic parameters of synovial uptake curves (time to peak [TTP], peak value, mean transit time [MTT], area under the curve [AUC], and maximum upslope) of PsA and EOA patients were compared using gamma variate analysis and calculation of the late relative enhancement 15 minutes after contrast administration. Results Enhancement curves of PsA and EOA patients paralleled each other at comparable levels in the early phase after contrast injection without statistical difference in the following calculated characteristic curve parameters: TTP, peak value, MTT, AUC, and maximum upslope. However, significant difference was found in the late relative enhancement 15 minutes after contrast injection (P = .0275) with higher values in EOA patients. Conclusion DCE-MRI provides assessment of synovitis in both patients with EOA and PsA. Interestingly, synovial enhancement characteristics were comparable for the most part in these two disorders. However, late enhancement might help in differentiation which is essential for guiding therapy.

Received: October 28, 2009 Accepted: December 18, 2009 Correspondence: Hasan Ulusoy, M.D. Firat Universitesi Tip Fakultesi, Fiziksel Tip ve Rehabilitasyon Anabilim Dali, Romatoloji Bilim Dali, 23119 Elazig, Turkey. Tel: +90 424 247 89 28 e-mail: ulusoyh@mynet.com ©2011 Turkish League Against Rheumatism. All rights reserved. Eroziv osteoartrit (EOA) elin interfalangeal eklemlerini etkileyen ilerleyici bir hastaliktir. Ayni zamanda osteoartritin inflamatuvar bir formu olarak da bilinir. Agri, sislik, kizariklik, isi artisi ve el eklemlerinde fonksiyon kaybi Heberden ve Bouchard nodulleri olan veya olmayan hastalarin cogunda bulunur. Konvansiyonel radyografilerde birlikte yeni kemik proliferasyonu ve erozyonlar gorulur ve erozyonlara bagli olarak, etkilenen eklemlerde “marti kanadi” ve “testere disi” deformiteleri olarak bilinen karakteristik goruntuler olusur. Eroziv osteoartrit ile diger sik gorulen eroziv interfalangeal artropatileri birbirinden ayiran hicbir laboratuvar bulgusu olmadigindan, radyolojik ozellikler hala klinik bulgulari ile birlikte tanisal degere sahiptir. Bu nedenle radyolojik bulgularin iyi tespit edilmesi yanlis tani olasiligini azaltabilir. Bu yazida belirgin ve kafa karistirici nitelikte bir inflamasyonun eslik ettigi tedaviye direncli bir EOA olgusu bildirildi.

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

Osteoarthritis (OA), a disease that mainly targets cartilage, also affects ligaments, the subchondral bone and synovium, and, according to recent definitions, it is a disease of the joint as an organ.1 Its most characteristic radiographic features are joint space narrowing, bone sclerosis and osteophytes;2 bone erosions, and in particular subchondral bone erosions, have also been found in some patients.3 Bone erosions that classically affect the interphalangeal (IP) joints identify a disease subset called erosive osteoarthritis (OA).4 The particular localisation of erosive OA is considered so characteristic of the disease that the term has been used, since it was first described by Peter et al ,5 almost interchangeably with erosive hand OA. A growing body of evidence, however, suggests that it is time to re-evaluate the definition, since the term erosive OA can be appropriately applied to other OA localisations including at the thumb base (TB)6 and facet joints.7 These different disease subsets share not only the same classic radiographic features, such as subchondral bone erosions, but also the severity …

Osteoarthritis of the spine can predominate on the zygapophyseal joints or on the discovertebral space. In this last localization, it can be characterized by superficial erosions or a cystic lesion into the vertebral body with densification of the vertebral end-plates and small osteophytes. We present the case of an 83 years-old woman with an erosive osteoarthritis at 3 levels of the lumbar spine associated with a large cystic node of L5, revealed by a low energy fall. The absence of fever, a history of tuberculosis, inflammation at the laboratory tests and the aspect of the CT scan allowed the avoidance of sophisticated or invasive explorations. Evolution was good with medical treatment, making unnecessary immobilization into a brace.

ObjectiveThe educational objectives of this continuing medical education activity are for the reader to exercise, self-assess, and improve skills in diagnostic radiology with regard to the interpretation of radiographs, CT, and MRI of the hand and to improve understanding of the appropriate use of CT and MRI in evaluating lesions of the hand.ConclusionThe conditions illustrated in this article include erosive osteoarthritis, sarcoidosis, metastatic calcification, and synovial sarcoma. This article is qualified by the American Board of Radiology (ABR) in meeting the criteria for self-assessment toward the purpose of fulfilling requirements in the ABR Maintenance of Certification.

Erosive osteoarthritis (OA) is a subcategory of OA in which destructive changes occur in the joints, probably as a result of a combination of inflammatory inciters and phenomena. The major changes occur in the distal and proximal interphalangeal joints, root joints of the thumb, and less commonly other hand and centripetal joints. A familial tendency suggests hereditary predisposition, and women more likely to be afflicted than men. Diagnosis has been enhanced by newer imaging techniques such as sonography and scintigraphy. Treatment remains chiefly palliative, although there are hints that alleviation of inflammation may be more salutary than simple analgesia.

Erosive osteoarthritis is a disorder that predominantly affects the hands of postmenopausal or middle aged women. Ages usually range from 30 to 83 years. Although the etiology of erosive osteoarthritis is not known, a lack of estrogen hormones has been implicated in the pathogenesis. We report a patient with onset of symptoms at age 16 and a diagnosis at age 21. She has aggressive inflammatory involvement of the distal interphalangeal joints and characteristic radiographic changes with central erosions. She is not postmenopausal nor does she have any conditions that are believed to be possible associations with erosive osteoarthritis. To the best of our knowledge, this is the youngest reported patient with erosive osteoarthritis in the literature.

We read with interest the article ‘In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis’ by Kortekaas et al .1 The authors found that interphalangeal joints of erosive osteoarthritis (EOA) patients, with erosions being defined by conventional radiography (CR), demonstrated more sonographic inflammatory changes in adjacent non-CR-eroded joints compared with patients without EOA. This may give the impression that a joint showing erosions on hand CR points towards a more severe generalised inflammatory phenotype and we would like to clarify this. We are unsure what the significance and robustness of these observations are, given the increasing pathophysiological understanding of hand osteoarthritis that has …

We present here a case of erosive polyarthropathy in an incomplete skeleton from a middle-Saxon period (c. AD 650-900) cemetery site in Sedgeford, Norfolk, England. After a differential diagnosis that includes erosive osteoarthritis and psoriatic arthritis, we believe rheumatoid arthritis (RA) to be the most probable cause. This example may therefore add to the evidence for an early date for the appearance of RA in Europe.

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 2-1NO(2) and Col2-3/4C(short). 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.

Objectives: The exact prevalence of erosive osteoarthritis (EOA) is still unknown. Aim of our study was therefore to evaluate the prevalence of osteoarthritis (OA) and EOA of the hand in a representative population from Venetian area. Methods: All people aged > 40 years of a small town in Venetian area has been considered. A complete clinical evaluation has been performed in all subjects. For those patients with clinical signs or symptoms of OA, radiographic evaluation of the hands has been carried out. Results: The entire population aged >40 years living in Silea entered the study. Signs or symptoms of OA were present in 200 out 640 subjects (31.2%), whereas EOA was diagnosed in 17 (8.5%) all female, mean age 57.5±10.1 years (range 41-74) mean disease duration 5.1±3.8 years (range 1-15). The most frequently involved joint was the second DIP of the right hand. Conclusion: The prevalence of EOA in the Venetian area seems to be around 8.5%.

A patient with typical erosive osteoarthritis of the hands was treated with galactosaminoglucuronoglycan sulfate 1200 mg/day for 18 months and was evaluated for pain, joint motion, and roentgenographic evidence of disease. At the 18-month follow-up, we observed a significant clinical amelioration and reduction of analgesic requirements. There was no evidence of further erosion after 20 months, and some reparative changes were seen in previously noted erosions. We conclude that worsening of erosive osteoarthritis of the hands may be avoidable.

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.

Bevacizumab (BVC) is currently used in recurrent ovarian cancer and as part of the initial treatment for ovarian cancer. The most serious toxicities associated with BVC include gastrointestinal perforations, delayed wound healing, and hemorrhage. Arthritis had never been addressed in patients who received BVC treatment. This is the first case report of arthritis emergence linked to BVC administration. A 59-year-old female with recurrent ovarian cancer received multiple hormonal and cytotoxic regimens for 5 years and then developed erosive osteoarthritis of the hands secondary to BVC and paclitaxel. This effect was confirmed by a significant improvement in her symptoms and signs, after treatment was discontinued.

Osteoarthritis and osteoporosis are two major health problems affecting postmenopausal women. Epidemiological observations seem to demonstrate a possible inverse relationship between osteoarthritis and osteoporosis. Erosive osteoarthritis (EOA) of the hand is a destructive form of primary osteoarthritis. This study evaluated bone mineral density and bone metabolism changes in erosive and nonerosive hand osteoarthritis women.Fifty-five women (mean age, 59 years; body mass index, 23 +/- 1.4 kg/m) who had been postmenopausal for an average of 9 years and who presented with hand osteoarthritis according to American College of Rheumatology criteria were enrolled in the study; 15 women showed clinical and radiological evidence of hand EOA. Twenty women matched for age, age at menopause, and body mass index formed the control group. Bone mineral density (g/cm) was measured at the hip and lumbar spine using dual-energy x-ray absorptiometry. Serum and urinary calcium and phosphate, serum 25-hydroxyvitamin D, parathyroid hormone, osteocalcin, and urinary breakdown products of bone matrix (CrossLaps) were analyzed.Women with hand EOA had a statistically significant lower T- and Z-score L2-L4 value than non-hand EOA women and controls (P0.01). Moreover, postmenopausal women with hand EOA had higher significant percentage of osteoporosis at lumbar spine when compared with non-hand EOA postmenopausal women and controls. Any statistically significant difference in osteocalcin and CrossLaps serum levels was noted among women with hand EOA, hand osteoarthritis, and controls.Our data suggest that postmenopausal women with clinical and radiological EOA are at risk for development of osteoporosis.

Publisher Summary Interphalangeal (IP) finger joint osteoarthritis (OA) becomes symptomatic during inflammatory episodes associated with the onset of erosive or inflammatory OA. The pathogenic mechanisms that initiate the destructive phases in the IP finger joints of these patients are not known, although catabolic cytokine pathways most plausibly are involved. Polysulfated polysaccharides have been shown to interfere with these cytokines and their down‐stream events. This observation may reveal the way chondroitin sulfates (CSs) hold up the onset of the destructive phases of erosive OA of the finger joints and this explains the symptom‐modifying properties of these drugs. When interfering with the onset of inflammatory or erosive OA, chondroitin sulfates prevent the formation of nodosities in the finger joints of the patients. These properties allow classifying these agents among the disease-modifying osteoarthritis drugs (DMOAD) with symptom‐modifying osteoarthritis drug (SMOAD) effects. Osteoarthritis becomes more generalized and progressive in women in their early 50s. Distal and proximal interphalangeal joints and the first carpometacarpal joints become more frequently involved.

To investigate the value of serum C reactive protein (CRP) as a marker of erosive osteoarthritis (EOA) of the hand.Ninety eight patients, 67 with EOA and 31 with non-EOA of the hand, were included in the study and analysed for radiographic score (RS), number of erosions, and joint count (JC) at clinical observation and at bone scintigraphy. CRP was assayed in a serum sample by a highly sensitive immunonephelometric method.The median (interquartile range) CRP level was 4.7 (2.4-6.9) mg/l in the EOA and 2.1 (0.5-4.9) mg/l in the non-EOA group (p = 0.001). In all patients, CRP correlated with RS (r(s) = 0.43, p0.001), and mainly with JC at clinical observation (r(s) = 0.72, p0.001) and at bone scintigraphy (r(s) = 0.47, p0.001). The correlation of CRP with RS and JC was confirmed at clinical observation and at bone scintigraphy in the EOA subgroup, but only with JC at clinical observation in the non-EOA subgroup.CRP levels are higher in EOA than in non-EOA patients. These levels probably reflect the disease activity of EOA, as suggested by correlations between CRP and JC at clinical observation and at bone scintigraphy.

Background Erosive osteoarthritis of hand (EOA) is believed to be a subset of generalised OA characterised by frequent inflammatory episodes and an aggressive clinical course. Objectives Since rare studies are available on the risk factors of EOA, we investigated its immunogenetic predisposition. Methods In 47 patients with EOA (42 F, mean age 62.8 ± 8 years), HLA typing for A, B, C, DRB1 loci was performed. In the same patients we also evaluated the number of active joints (NAJ), the number of X-ray erosions (NEJ), the radiographic score (RS, Kallman), along with ESR and CRP. Results The HLA antigens most frequently found in the 47 patients with EOA were A2 (16 = 34%), B5 (13 = 27.7%), Cw4 (13 = 27.7%), and DRB1011 (11 = 23.4%) and DRB103 (8 = 17%). Interestingly, the frequency of these two latter antigens were higher in EOA than in non-EOA patients (DRB1011 = 10%; DRB103 no found). NAJ (p Conclusion EOA seems characterised by a high frequency, higher than in non-EOA, of some HLA antigens, in particular DRB103 and DRB1011, thus suggesting an immunogenetic predisposition in these patients. HLA antigens do not seem to be associated with the disease severity of EOA. However, more information may derive from an adequately long follow-up of these patients.

Adipocytokines including adiponectin and resistin are suggested to be associated with obesity-related complications.1 In general, higher systemic concentrations of resistin and adiponectin compared with paired synovial fluid counterparts were demonstrated in patients with osteoarthritis of the knee.2–4 In contrast, resistin and adiponectin levels were found to be increased at local sites of inflammation in patients with rheumatoid arthritis.3–5 It is suggested that adiponectin in particular actively participates in the process of immune response, inflammation and matrix degradation in destructive arthritides.6 7 Erosive osteoarthritis represents a subtype of generalised osteoarthritis primarily affecting the small joints of the hands, with prominent local inflammation …

In human skeletons from archaeological sites, osteoarthritis is by far the most common disease found, but no case of erosive osteoarthritis has been described and we present here what we believe to be the first such case.

Background Increasing clinical and scientific interest has recently been raised on hand osteoarthritis (HOA); a peculiar subgroup of patients experiment more severe symptoms and characteristic structural damage in the joints (central erosion type lesions - CE). No agreed criteria have been established about the number of erosive joints necessary for the definition of erosive disease. So far reports have been published utilizing both the one erosive joint and the two erosive joints criteria (1-2) Objectives To evaluate clinical and radiographic features of HOA patients divided into three groups: a)-without CE joint (CEJ), b)-with one CEJ, c)-with at least two CEJ. Methods 419 patients with HOA were enrolled; on the basis of the presence of central erosion in IP joints they were divided into the three groups. Demographic (gender, age, age of disease onset), clinical (BMI) and radiographic features [Kellgren & Lawrence (K&L) and Kallman’s scores obtained from radiographs of both hands] from all patients were recorded. In addition we evaluated the presence of marginal erosions (ME). Results While significant differences were found between group b and group c in all evaluated items [Age, mean ± sd (95%CI) =67.3±6.7 (66.9-67,7) vs 68.9±8.0 (68.7-69.1); Age at disease onset, mean ± sd (95%CI) =56.0±9.9 (55.4-56.6) vs 53.7±9.4 (53.4-54.0); Disease duration, mean ± sd (95%CI) =7.9±6.5 (7.5-8.4) vs 11.3±8.7 (11.0-11.5); Total Kallman, mean ± sd (95%CI) =83.2±17.3 (76.5-89.8) vs 98.7±2.4 (95.8-101.6); KL ME, %(n) =19.5 (198/1016) vs 33.9 (1667/4912), p Conclusions Since patients without CEJ and patients with only one CEJ had similar values of two relevant features (age at disease onset, K&L score) we suggest that the definition of erosive disease should be confined to patients with at least two CEJ. References Kwok WY, Kloppenburg M, Rosendaal FR, van Meurs JB, Hofman A, Bierma-Zeinstra SM. Erosive hand osteoarthritis: its prevalence and clinical impact in the general population and symptomatic hand osteoarthritis. Ann Rheum Dis 2011;70:1238-42. Epub 2011 Apr 6 Punzi L, Ramonda R, Sfriso P. Erosive osteoarthritis. Best Pract Res Clin Rheumatol 2004;18:739-58. Disclosure of Interest None Declared

Erosive osteoarthritis (EOA) characteristically involves the hands of middle-aged women. The diagnosis is essentially radiological and depends upon the presence of articular surface erosions. This study investigates whether this radiological feature is a marker of a specific clinical entity. From a series of 500 consecutive patients attending a rheumatology clinic with symptomatic limb joint osteoarthritis, 24 were identified by radiological criteria to have EOA. These were age-sex matched with 24 patients from the same series who presented with osteoarthritis of the hand. Those with EOA had nearly twice as many radiographically abnormal joints in the hands as the controls (274: 144). This was almost entirely due to an increase in distal (134: 68) and proximal (79: 24) interphalangeal joint involvement, 71% of which were erosive. Erosions were found apart from the hands in both elbows of one patient with EOA. Otherwise only minor differences were present between the two groups in terms of distribution and incidence of osteoarthritic changes. There were no distinguishing serological or other clinical differences. This study has demonstrated that erosions in EOA are associated with more severe hand disease but are not apparently a marker of a separate disease entity. EOA appears to be an aggressive acute form of hand osteoarthritis and may represent the hand equivalent of similar forms of osteoarthritis in the shoulder, hip and knee.