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Erosive Osteoarthritis

1966; Radiological Society of North America; Volume: 86; Issue: 4 Linguagem: Inglês

10.1148/86.4.640

1527-1315

Kenneth L. Kidd, J. B. Peter,

Osteoarthritis Treatment and Mechanisms

The purpose of this presentation is to document radiographic changes in postmenopausal women in whom clinical, radiological, and laboratory findings are at variance with the classic descriptions of rheumatoid arthritis, degenerative arthritis, and primary generalized osteoarthritis. These patients have erosive changes as well as osteophytic degenerative arthritis of the interphalangeal joints. The term “erosive osteoarthritis” emphasizes the juxta-articular erosions which may simulate those of rheumatoid arthritis in patients who do not have classical or definite rheumatoid arthritis by any of the usual criteria. Our studies emphasize the erosive nature of the joint changes and correlate these with descriptions of the synovial histopathology of this disease. Erosive Osteoarthritis In erosive osteoarthritis a rather abrupt onset of arthritic symptoms occurs typically in middle-aged, postmenopausal women with concomitant development of Heberden's nodes. The disease then spreads in a less acute form to the proximal interphalangeal joints. Sometimes the arthritic process may be initiated in a proximal interphalangeal joint or may involve the first carpometacarpal joint. Other joints, including the intercarpal, metacarpophalangeal, and radioulnar, are not involved. Symptoms may last from a few months to several years and vary with the intensity of the inflammatory process. This variation parallels that of the bone erosions observed when the disease reaches its burned-out stage. In Table I are listed the major clinical and laboratory features of rheumatoid arthritis (1, 2, 6), degenerative arthritis (3, 7, 8), and primary generalized osteoarthritis (4, 5), which may at times be difficult to distinguish from erosive osteoarthritis. Particularly helpful in the clinical differentiation are the distribution of joints involved, the age of onset, sex incidence, negative test for rheumatoid factors, normal sedimentation rates, and the generally self-limited character of the disease. The relatively localized involvement in erosive osteoarthritis contrasts with that of primary generalized osteoarthritis. The erosions and lack of cervical osteoarthritis tend to distinguish these patients from those with interphalangeal osteoarthritis (9). None of our patients has ever had psoriasis. In contrast to patients with rheumatoid arthritis those with erosive osteoarthritis do not have morning stiffness, weight loss, or systemic manifestations such as fever. They do not have subcutaneous nodules. The erythrocyte sedimentation rate is normal or minimally elevated and latex agglutination tests for rheumatoid factors are characteristically negative. The course of the disease, while variable, is self-limiting and does not progress to other areas of the body, nor is it dramatically altered by any mode of therapy short of surgery. Roentgen differentiation of erosive osteoarthritis is outlined in Table II.