Understanding Erosive Osteoarthritis

Erosive osteoarthritis is an uncommon type of hand osteoarthritis. Compared with typical hand osteoarthritis (OA), this condition is more disabling and causes more severe joint pain and stiffness. Erosive OA is characterized by severe joint inflammation and bone breakdown, leading to characteristic X-ray findings, but it can also take longer to diagnose than typical OA.

Mature woman holding hand
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Symptoms and Signs

Erosive OA usually starts with a sudden onset of severe tenderness in multiple finger joints. The abrupt onset of symptoms is in contrast to the gradual progression of symptoms typical of hand OA.

You can also have variable degrees of:

  • Redness
  • Stiffness
  • Warmth
  • Swelling

Women Are Affected More Than Men

Erosive OA affects approximately 3% of the general population. Women are affected more than men.

However, it should be noted that the definition of this condition is not completely agreed upon by experts.

Advanced OA has a higher correlation with the occurrence of erosive changes, implying that many people with erosive hand OA might actually have advanced hand OA.

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


The diagnosis of erosive osteoarthritis can be a tricky process, as there is currently no set criteria. Your doctor will consider your medical history, physical examination, and X-rays to ultimately make the diagnosis. Also, age, sex, diabetes, and obesity might constitute risk factors for the development of erosive hand OA.

Medical History

When you go to see your doctor, they will ask about hand injuries, hand overuse, your own history of arthritis, and whether you have a family history of arthritis—especially rheumatoid arthritis (which closely resembles erosive OA). A recent study showed that first-degree relatives were at a relatively higher risk of developing erosive hand OA.

Your doctor will also ask if you have experienced systemic symptoms like a low-grade fever, rash, fatigue, or weight loss. While these symptoms don't typically occur with erosive OA, they can occur with inflammatory-type arthritis, such as rheumatoid arthritis or psoriatic arthritis.

Physical Examination

During your physical examination, your doctor will check your hands for signs of swelling, tenderness, warmth, and redness. They will also test your range of motion and the strength of your fingers.

Stiffness and limited joint function tend to be more severe in erosive OA than in typical hand OA.

  • In erosive OA, the distal interphalangeal joints (the joints closest to the fingertips) of the hand are most frequently involved, followed by the proximal interphalangeal joints (the joints closest to the knuckles).
  • The metacarpophalangeal joints (knuckles of the hand) and the thumb joint are usually not affected in erosive OA.
  • Although erosive hand OA might affect the first carpometacarpal joint and the interphalangeal joints, it rarely affects both.

Your doctor will also look at the other joints in your body, such as your wrist and elbow joints. These are commonly affected in rheumatoid arthritis but not erosive OA.

Blood Tests

Blood tests tend to be normal in erosive OA. Your doctor may order blood tests to rule out other diseases that could be causing your symptoms.

Blood tests you may need include:

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

These tests may be abnormal in rheumatoid arthritis but should be within the normal range in erosive OA.

Imaging Tests

With erosive OA, hand X-rays will show central erosions, which are breaks in the bone surface at the center of the joint. This is known as the "gull-wing appearance".

With erosive OA, other changes on your X-ray can include:

In contrast, marginal erosions (bare areas on the sides), are seen in rheumatoid or psoriatic arthritis.


Erosive OA carries the risk of hand deformity and impaired hand function. The treatment of erosive OA is mainly focused on physical therapy and nonsteroidal anti-inflammatory drugs.

None of the treatments available for erosive OA change the progression or prognosis, and the erosions are permanent. However, unlike rheumatoid arthritis, there is evidence that the inflammation of erosive OA can eventually subside.

As research on erosive OA evolves, newer therapies may emerge. For example, a tumor necrosis factor inhibitor called adalimumab has been suggested as a possible treatment. However, the European League Against Rheumatism (EULAR) currently recommends patients with erosive hand OA NOT be treated with DMARDs (hydroxychloroquine, anakinra, adalimumab), as they have been shown to be ineffective in reducing erosions. Also, a recent study showed that magnetotherapy might be useful for the treatment of erosive hand OA.

A Word From Verywell

While the precise diagnostic criteria and classification of erosive OA are still debated among experts, the severity (as compared to typical hand OA) and specific X-ray findings are hallmark features of the condition.

If you or a loved one has erosive OA, you should see a rheumatologist, which is a doctor specialized in treating joint disease. 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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