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Draghi F, Ferrozzi G, Ballerini D, Bortolotto C. Psoriatic arthritis: Ultrasound peculiarities with particular emphasis on enthesitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:556-560. [PMID: 35238049 DOI: 10.1002/jcu.23170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
The prevalence of psoriatic arthritis among patients with psoriasis has a marked variability with ethnic and geographic variations. Inflammatory changes associated with psoriatic arthritis include bone erosion, tenosynovitis, and synovial hypertrophy, but enthesitis is considered the hallmark. Both X-ray and magnetic resonance imaging (MRI) are usefull in the diagnosis of psoriatic arthritis, but ultrasonography is the best imaging modality to assess entheses. Ultrasound findings of enthesitis include a loss of the regular fibrillar architecture, hypoechoic thickening, hypervascularization of tendons, ligaments, and joint capsules at their bony attachment, bony changes (including irregularities and erosions). Ultrasound has also proved the ability to detect inflammatory subclinical findings and to be useful in the follow-up of therapies.
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Affiliation(s)
- Ferdinando Draghi
- Diagnostic Imaging Department, IRCCS Maugeri Montescano, Montescano (PV), Italy
- Diagnostic Imaging Department, Centro Medico Clastmed, Codevilla, Italy
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
| | - Daniela Ballerini
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Addimanda O, Cavallari C, Pignotti E, Pulsatelli L, Mancarella L, Ramonda R, Fioravanti A, Meliconi R. Radiographic involvement of metacarpophalangeal and radiocarpal joints in hand osteoarthritis. Clin Rheumatol 2017; 36:1077-1082. [PMID: 28161769 DOI: 10.1007/s10067-017-3565-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
To evaluate, by means of a longitudinal study, radiographic involvement of metacarpophalangeal and radio-carpal joints in hand osteoarthritis, its relationship with erosive disease and its progression, 368 patients with hand osteoarthritis were enrolled. All patients underwent hand X-rays. On the basis of the presence of central erosions in interphalangeal joints, patients were divided into three groups: 0-no central erosions, 1-one joint with central erosion, and 2-two or more joints with central erosions. A longitudinal study on 44 patients and nine normal controls, whose X-rays were available after 3.9 years, was performed. The radiological involvement of metacarpophalangeal and radio-carpal joints was evaluated using Kellgren-Lawrence and OARSI scores. Low number of joints showed Kellgren-Lawrence values ≥2 group 0, 42/1290 (3.3%); group 1, 10/410 (2.4%); and group 2, 36/1980 (1.8%). Low score values were obtained for all radiographic items. Only metacarpophalangeal joint space narrowing score showed significant increase from groups 0 to 2. Subsequent adjustment for age, gender, and BMI did not confirm the statistical significance. Marginal erosions were rarely found (6.7% of joints). Metacarpophalangeal and radio-carpal radiographic per patient scores significantly worsened at follow-up, but no significant increase in joints with Kellgren-Lawrence score ≥2 was found. In normal controls, no significant radiographic worsening was found. Only a minority of metacarpophalangeal joints shows a Kellgren-Lawrence value ≥2. Metacarpophalangeal and to lesser extent radiocarpal joints had significant worsening at follow-up. Metacarpophalangeal joint involvement in hand osteoarthritis is mild but progressive. Radiocarpal involvement is negligible.
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Affiliation(s)
- Olga Addimanda
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy. .,Dept of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Carlotta Cavallari
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy
| | | | - Lia Pulsatelli
- Immunorheumatology and Tissue regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy
| | | | - Antonella Fioravanti
- Rheumatology Unit, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Riccardo Meliconi
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy.,Dept of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, Italy
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Kwok WY, Kloppenburg M, Marshall M, Nicholls E, Rosendaal FR, Peat G. The prevalence of erosive osteoarthritis in carpometacarpal joints and its clinical burden in symptomatic community-dwelling adults. Osteoarthritis Cartilage 2014; 22:756-63. [PMID: 24680934 PMCID: PMC4071416 DOI: 10.1016/j.joca.2014.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 02/19/2014] [Accepted: 03/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the prevalence of erosive disease in first carpometacarpal joints (CMCJs) and investigate its clinical impact compared with radiographic thumb base (TB) osteoarthritis (OA). PATIENT AND METHODS Standardized assessments with hand radiographs were performed in participants of two population-based cohort studies in North Staffordshire with hand symptoms lasting ≥1 day in the past month. Erosive disease was defined as the presence of eroded or remodeled phase in ≥1 interphalangeal joint (IPJ) or first CMCJ following the Verbruggen-Veys classification. Hand pain and function were assessed with Australian/Canadian Hand Osteoarthritis Index (AUSCAN). Prevalence was estimated by dividing the number of persons with erosive lesions by population size. Linear and logistic regression analyses were used to contrast clinical determinants between persons with erosions and with radiographic TB OA. Results were presented as mean differences and odds ratios (ORs) with 95% confidence intervals (95% CI), adjusted for age, sex and radiographic severity. RESULTS 1,076 participants were studied (60% women, mean age 64.7 years (SD 8.3); 24 persons had erosive disease in the TB. The prevalence of erosive disease in first CMCJs was 2.2% (95% CI 1.4, 3.3). Only 0.5% (95% CI 0.2, 1.2) had erosive disease affecting IPJs and first CMCJs combined. More persons with erosive disease of first CMCJs reported pain in their TB than persons with radiographic TB OA, AUSCAN pain and function scores were similar. CONCLUSION Erosive disease of first CMCJs was present in 2.2% of subjects with hand pain and was often not accompanied by erosions in IPJs. Erosive disease was associated with TB pain, but not with the level of pain, when compared with radiographic TB OA.
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Affiliation(s)
- W Y Kwok
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Marshall
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
| | - E Nicholls
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - G Peat
- Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire, United Kingdom
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Rothschild BM. Distinguishing erosive osteoarthritis and calcium pyrophosphate deposition disease. World J Orthop 2013; 4:29-31. [PMID: 23610748 PMCID: PMC3631948 DOI: 10.5312/wjo.v4.i2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/01/2013] [Accepted: 01/30/2013] [Indexed: 02/06/2023] Open
Abstract
Erosive osteoarthritis is a term utilized to describe a specific inflammatory condition of the interphalangeal and first carpal metacarpal joints of the hands. The term has become a part of medical philosophical semantics and paradigms, but the issue is actually more complicated. Even the term osteoarthritis (non-erosive) has been controversial, with some suggesting osteoarthrosis to be more appropriate in view of the perspective that it is a non-inflammatory process undeserving of the “itis” suffix. The term “erosion” has also been a source of confusion in osteoarthritis, as it has been used to describe cartilage, not bone lesions. Inflammation in individuals with osteoarthritis actually appears to be related to complicating phenomena, such as calcium pyrophosphate and hydroxyapatite crystal deposition producing arthritis. Erosive osteoarthritis is the contentious term. It is used to describe a specific form of joint damage to specific joints. The damage has been termed erosions and the distribution of the damage is to the interphalangeal joints of the hand and first carpal metacarpal joint. Inflammation is recognized by joint redness and warmth, while X-rays reveal alteration of the articular surfaces, producing a smudged appearance. This ill-defined, joint damage has a crumbling appearance and is quite distinct from the sharply defined erosions of rheumatoid arthritis and spondyloarthropathy. The appearance is identical to those found with calcium pyrophosphate deposition disease, both in character and their unique responsiveness to hydroxychloroquine treatment. Low doses of the latter often resolve symptoms within weeks, in contrast to higher doses and the months required for response in other forms of inflammatory arthritis. Reconsidering erosive osteoarthritis as a form of calcium pyrophosphate deposition disease guides physicians to more effective therapeutic intervention.
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Abstract
Hand osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several hand OA subsets--such as nodal interphalangeal OA, thumb base OA and erosive OA--can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Forney MC, Winalski CS, Schils JP. Magnetic resonance imaging of inflammatory arthropathies of peripheral joints. Top Magn Reson Imaging 2011; 22:45-59. [PMID: 22648080 DOI: 10.1097/rmr.0b013e31825c008d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As the treatment of inflammatory arthropathies has advanced with new therapies that can slow or even halt the development of disabling disease, early and accurate diagnosis has become imperative. Magnetic resonance (MR) imaging has proved to be very sensitive in the detection of erosions, but more importantly, it can demonstrate pre-erosive changes. Detection of synovitis and edema-like bone marrow lesions for initial diagnosis and as an indicator of disease progression can provide crucial information leading to therapeutic interventions before permanent joint damage occurs. Understanding the characteristic intra-articular and extra-articular MR imaging findings of the inflammatory arthritides allows the radiologist to provide appropriate consultations in the care of these patients. The MR appearances of both intra-articular and extra-articular findings of inflammatory arthritis are presented. Despite the advances in imaging, however, many of the MR findings remain nonspecific, and radiologists must avoid overdiagnosis by synthesizing all of the clinical information available into their interpretations.
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Affiliation(s)
- Michael C Forney
- Section of Musculoskeletal Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
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Wittoek R, Jans L, Lambrecht V, Carron P, Verstraete K, Verbruggen G. Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI. Ann Rheum Dis 2011; 70:278-83. [PMID: 21081530 DOI: 10.1136/ard.2010.134932] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To study the reliability and construct validity of ultrasound in interphalangeal finger joints affected by erosive osteoarthritis (EOA) and non-EOA with MRI as the reference method. METHODS 252 joints were examined by ultrasound, conventional radiography and clinical examination. Ultrasound was performed using a high-frequency linear transducer (12 × 18 MHz). On the same day, magnetic resonance images of 112 joints were obtained on a 3.0 T magnetic resonance unit. The ultrasound and MRI images were re-read independently by other readers unaware of the diagnosis, clinical and other imaging findings. Interobserver reliability was calculated by the percentage of exact agreement obtained and κ statistics. With MRI as the reference method, the sensitivity and specificity of ultrasound in detecting structural (bone erosions and osteophytes) and soft tissue (effusion and grey-scale synovitis) changes in EOA were calculated. RESULTS Ultrasound and MRI were found to be more sensitive in detecting erosions than conventional radiography in EOA. A high agreement between ultrasound and MRI in the assessment of bone erosions (77.7%), osteophytes (75.9%) and synovitis (86.5%) was present. A high percentage of inflammatory changes was found in EOA, and in smaller amount in non-EOA, both confirmed by MRI. Good interobserver reliability of ultrasound was obtained for all variables (all median κ > 0.8). CONCLUSION Grey-scale ultrasound proved to be a reliable and valid imaging technique to assess erosions and soft tissue changes, compared with MRI as a reference method in EOA.
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Affiliation(s)
- Ruth Wittoek
- Department of Rheumatology, University Hospital Ghent, Gent, Belgium.
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Abstract
Osteoarthritis occurs with the highest prevalence in the distal interphalangeal joint of the hand and has been divided into an erosive and a nonerosive form. The pathogenesis of the early stages of osteoarthritis is poorly understood, but considerable emphasis has been placed on the role of cartilage and subchondral bone as well as soft tissue structures such as collateral ligaments and tendons. Radiographic evaluation represents the most standardized method to quantify disease progression, with different systems having been developed for defining and grading radiographic features. This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint.
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Erosive osteoarthritis: a current review of a clinical challenge. Clin Rheumatol 2010; 29:697-706. [PMID: 20108014 DOI: 10.1007/s10067-009-1369-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/23/2009] [Indexed: 10/19/2022]
Abstract
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.
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10
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Abstract
Owing to the potential to image not only bone but also cartilage, bone marrow, and the surrounding internal soft tissue structures, MRI is particularly useful for the assessment of degenerative arthritides. Cartilage-sensitive MRI techniques have been shown to have a significant correlation with arthroscopic grading scores. MRI is also helpful in differentiating osteoarthritis from avascular necrosis, labral pathology, and pigmented villonodular synovitis. This chapter describes advanced imaging techniques, including driven equilibrium Fourier transform (DEFT) and steady-state free precision (SSFP) imaging, direct MRI arthrography, and 3D-T1rho-relaxation mapping.
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Affiliation(s)
- Jian Zhao
- Department of Radiology, University of California-San Francisco, 185 Berry Street, San Francisco, CA 94107, USA.
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Grainger AJ, Farrant JM, O'Connor PJ, Tan AL, Tanner S, Emery P, McGonagle D. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skeletal Radiol 2007; 36:737-45. [PMID: 17497149 DOI: 10.1007/s00256-007-0287-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 12/21/2006] [Accepted: 01/31/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Erosive osteoarthritis is usually considered as an inflammatory subset of osteoarthritis (OA). However, an inflammatory component is now recognised in all subsets of OA, so this subgroup of erosive or inflammatory OA is more difficult to conceptualise. The aim of this study was to compare routine CR and MRI to investigate erosion numbers and morphology to determine whether hand OA in general is a more erosive disease than previously recognised. DESIGN AND METHODS Fifteen patients with clinical (OA) of the small joints of the hand underwent MRI of one of the affected proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. Conventional radiographs (CR) of the hand were also obtained. The MR images were reviewed by two observers for the presence of central and marginal erosions. The site and morphology of any erosions was recorded. CR images of the same hand joint were scored independently for central and marginal erosions by the same observers. RESULTS There was 100% agreement between the observers for scoring erosions on CR. Agreement for the MRI scores was also excellent (kappa = 0.84). MRI detected 37 erosions, of which only 9 were seen on CR. The increase in sensitivity using MRI was much greater for marginal erosions (1 detected on CR, 19 on MRI) than for central erosions (8 on CR, 18 on MRI). Using MRI 80% of joints examined showed 1 or more erosions compared with 40% using CR. If only marginal erosions were considered 80% of joints were still considered erosive by MRI criteria, but only 1 showed evidence of erosion on CR. Morphologically central erosions appeared to represent areas of subchondral collapse and pressure atrophy. In contrast, marginal erosions resembled those seen in inflammatory arthritides. CONCLUSION Erosions, and particularly marginal erosions typical of those seen in inflammatory arthritis, are a more common feature of small joint OA than conventional radiographs have previously indicated.
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Affiliation(s)
- A J Grainger
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK.
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Abstract
Osteoarthritis is the most widespread form of arthritis in the United States. Classically, osteoarthritis has been grouped into primary and secondary types. Primary or idiopathic osteoarthritis is believed to be a sequela of altered biomechanical stresses across joints in susceptible individuals. Secondary osteoarthritis is a consequence of underlying cartilage damage, such as from preceding inflammatory arthritis, metabolic abnormality, or injury. The radiographic hallmark of osteoarthritis is asymmetric loss of cartilage space. Osteophytosis bony eburnation, subchondral cysts, and eventual subluxation follow. Osteoporosis and erosions are not usual features of this disease.
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Abstract
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.
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Affiliation(s)
- G E Ehrlich
- University of Pennsylvania School of Medicine; One Independence Place #1101, 241 South Sixth Street, Philadelphia, PA 19106-3731, USA.
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Rovetta G, Bianchi G, Ghirardo G, Monteforte P. Can worsening of erosive osteoarthritis of the hands be avoided? A case report. Curr Ther Res Clin Exp 1993. [DOI: 10.1016/s0011-393x(05)80644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
Erosive osteoarthritis is a disorder that most often involves the hands of postmenopausal women. It can begin abruptly with pain, swelling, and tenderness. Distal interphalangeal joints are involved most frequently, followed by proximal interphalangeal joints. Occasionally there is metacarpophalangeal, carpal, or large joint involvement. The female-to-male ratio is approximately 12:1. There are no known HLA associations. Laboratory studies generally are negative. A mild elevation of the sedimentation rate may occur. Radiologically, the disorder is characterized by central erosions and the "gull wing" deformity. Synovial pathology has shown changes consistent with both rheumatoid arthritis and osteoarthritis and manifests the stage of disease at the time of biopsy. The etiology remains obscure, but hormonal influences, metabolic disorders, and autoimmunity have been implicated. Treatment is largely supportive with physical therapy, nonsteroidal antiinflammatory drugs, and occasionally prednisone. Overall prognosis is good, although deformity and impairment of hand function may occur. For this reason, a reassessment of treatment strategies may be in order.
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Affiliation(s)
- L R Belhorn
- Department of Internal Medicine, University of Cincinnati Medical Sciences Center, OH 45267-0563
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Cobby M, Cushnaghan J, Creamer P, Dieppe P, Watt I. Erosive osteoarthritis: is it a separate disease entity? Clin Radiol 1990; 42:258-63. [PMID: 2225731 DOI: 10.1016/s0009-9260(05)82114-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- M Cobby
- Department of Radiodiagnosis, Bristol Royal Infirmary
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Abstract
An unusual, destructive form of erosive hand arthropathy is described in five postmenopausal women. Although early clinical and radiological findings were most in keeping with a diagnosis of erosive osteoarthritis (EOA), hand involvement progressed to a distribution intermediate between EOA and rheumatoid arthritis (RA). Although asymptomatic, all patients had features of Sjögren's syndrome (SS), including keratoconjunctivitis sicca (KCS) and lymphocytic foci in labial biopsy specimens. These cases, which are clinically unlike either RA or EOA, may represent a unique arthropathy associated with sicca features.
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Abstract
The radiographic examination plays an extremely important role in the diagnosis of unknown articular disorders. Appropriate radiographic techniques and modalities must be used. Accurate diagnosis is based on knowledge of specific radiographic signs that accompany a specific disorder and knowledge of the common sites in which these changes will be seen.
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Ehrlich GE. Inflammatory osteoarthritis. I. The clinical syndrome. JOURNAL OF CHRONIC DISEASES 1972; 25:317-28. [PMID: 4650928 DOI: 10.1016/0021-9681(72)90026-4] [Citation(s) in RCA: 97] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Swezey RL, Bjarnason DM, Alexander SJ, Forrester DB. Resorptive arthropathy and the opera-glass hand syndrome. Semin Arthritis Rheum 1972; 2:191-244. [PMID: 4581667 DOI: 10.1016/0049-0172(72)90009-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
MESH Headings
- Anemia, Sickle Cell/complications
- Animals
- Arthritis/complications
- Arthritis, Juvenile/complications
- Arthritis, Rheumatoid/complications
- Arthropathy, Neurogenic/diagnosis
- Bone Neoplasms/diagnosis
- Bone Resorption/complications
- Bone Resorption/diagnosis
- Bone and Bones/blood supply
- Diagnosis, Differential
- Glucocorticoids/adverse effects
- Gout/diagnosis
- Hand Deformities, Acquired/etiology
- Humans
- Hyperparathyroidism/diagnosis
- Ischemia/complications
- Joint Diseases/chemically induced
- Liver Cirrhosis, Biliary/complications
- Lupus Erythematosus, Systemic/complications
- Lymphatic Diseases/complications
- Necrosis
- Osteoarthritis/diagnosis
- Psoriasis/complications
- Sarcoidosis/diagnosis
- Scleroderma, Systemic/complications
- Spondylitis, Ankylosing/complications
- Tuberculosis, Osteoarticular/diagnosis
- Werner Syndrome/diagnosis
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