Understanding Erosive Osteoarthritis

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Erosive osteoarthritis is considered an uncommon type of hand osteoarthritis (OA). It's unique because joint inflammation is present and leads to characteristic x-ray findings, as well as more severe joint pain and stiffness.

While it's not as common, you should know the signs and symptoms of erosive osteoarthritis. The condition can be more disabling than OA but also tends to be harder to diagnose.

Symptoms and Signs

Erosive osteoarthritis usually starts with the sudden onset of severe tenderness in multiple finger joints with variable degrees of redness, stiffness, warmth, and swelling.

The abrupt onset of symptoms seen in erosive osteoarthritis is in contrast to the gradual onset that is typical of hand osteoarthritis.

Hand x-rays of a person with erosive osteoarthritis will show breaks in the bone surface at the center of the joint called central erosions. They appear as "bare areas" where bone should be but is not.

There may also be other changes seen on an x-ray in erosive osteoarthritis, such as:

Women Are Affected More Than Men

The overall prevalence of erosive osteoarthritis is approximately 3% of the general population. Women are affected more than men.

However, it should be noted that the condition is debated by experts, partly due to the nature of the research that has been done.

Many of the studies that have examined the progression of hand osteoarthritis reported a high number of people with the condition exhibit "erosive changes." These findings suggest that many people with "hand osteoarthritis" may actually have "erosive hand osteoarthritis."

Therefore, there is a significant debate over whether erosive osteoarthritis is really its own disease or a phase of hand osteoarthritis progression.


The diagnosis of erosive osteoarthritis can be a tricky process, as there is currently no set criteria. Doctors use a combination of medical clues and x-rays to ultimately make the diagnosis.

Medical History

To diagnose erosive osteoarthritis, a doctor will start by taking a medical history and perform a physical examination. Your doctor will ask questions about your past or family history of arthritis, especially rheumatoid arthritis (which closely resembles erosive osteoarthritis).

Your doctor will also ask if you have experienced any whole-body symptoms like a low-grade fever, fatigue, or weight loss. While these symptoms don't typically occur with erosive osteoarthritis, asking about them helps a doctor figure out if you might have inflammatory-type arthritis such as rheumatoid or psoriatic arthritis.

Physical Examination

When examining your hands, your doctor may gently press on an individual finger joint to assess for swelling, tenderness, warmth, and redness. They will also test the range of motion and strength of your fingers.

In erosive osteoarthritis, there is an inflammatory process present (as evidenced by central erosions on x-ray). Therefore, stiffness and limited joint function tend to be more severe in erosive OA than in typical hand OA.

Your doctor will also look at the other joints in your body, such as wrists and elbows, that are commonly affected in rheumatoid arthritis but not erosive osteoarthritis.

Another clue doctors look for to diagnose erosive osteoarthritis is the specific finger joints involved. In erosive osteoarthritis, the joints closest to the fingertips (called the distal interphalangeal joints) of the hand are most frequently involved, followed by the joints closest to the knuckles (called the proximal interphalangeal joints).

The knuckles of the hand (called the metacarpophalangeal joints) and the thumb joint are also usually not affected in erosive osteoarthritis.

Blood Tests

Your doctor may order blood tests, but these are mainly to rule out other diseases rather than to confirm erosive osteoarthritis.

Common blood tests your doctor might order include:

  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CP)
  • Rheumatoid factor
  • Anti-cyclic citrullinated peptide antibody

These tests may be positive (or elevated) in rheumatoid arthritis but should be within the normal range in erosive osteoarthritis.

Imaging Tests

X-ray evidence of central erosions on the hands adds a lot of value when making the diagnosis of erosive osteoarthritis. This is in contrast to marginal erosions (bare areas on the sides) seen in rheumatoid or psoriatic arthritis.


The exact cause of erosive osteoarthritis is unknown, which makes diagnosis and treatment challenging. Currently, the treatment of erosive osteoarthritis is mainly focused on physical therapy and nonsteroidal anti-inflammatory drugs.

As research on erosive osteoarthritis evolves, newer therapies will hopefully emerge. For example, while evidence of its effectiveness is still new, a tumor necrosis factor inhibitor called adalimumab has been suggested as a possible treatment.

When possible, early treatment is best. Erosive osteoarthritis carries the risk of hand deformity and impaired hand function. However, unlike rheumatoid arthritis, there is evidence that the inflammation of erosive osteoarthritis can eventually subside.

A Word From Verywell

While the precise diagnosis and classification of erosive osteoarthritis are still debated among experts, the severity (as compared to typical hand osteoarthritis) and specific x-ray findings (central erosions) are hallmark features of the condition.

If you or a loved one has erosive osteoarthritis, find a doctor who specializes in joints (rheumatologist). With early diagnosis and a treatment plan that includes medications and physical therapy, it is possible to optimize your joint health.

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