Erosive osteoarthritis is a type of osteoarthritis that primarily affects the fingers. Symptoms include pain, swelling, warmth, and redness. Women around age 50 are most at risk, possibly due to loss of estrogen.

Erosive osteoarthritis is a type of inflammatory osteoarthritis. It can develop in the hinge joints of the fingers and less frequently in the toes. Clinically, these joints are known as the interphalangeal joints.

Research suggests that less than 3% of people develop erosive osteoarthritis. About 10% of people with symptomatic osteoarthritis have this inflammatory joint condition.

Erosive osteoarthritis can cause:

  • a hardening of the bone near the cartilage, known as subchondral sclerosis
  • a narrowing of the space between bones
  • the destruction of some bone material (erosions)

This article examines the symptoms, causes, diagnosis, and treatment of erosive osteoarthritis.

Image of hand alongside X-ray of same hand with erosive arthritisShare on Pinterest
Image of hand with erosive osteoarthritis. Copyright © 2014 The Authors. Arthritis Care & Research is published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.

Erosive osteoarthritis can be challenging for doctors to diagnose, even with X-rays and other imaging tests. An analysis of dozens of studies found some doctors disagreed about what joint changes indicate erosive osteoarthritis.

One generally accepted sign of the condition is its sudden appearance. Stiffness and soreness associated with conventional osteoarthritis tend to build gradually. However, symptoms of erosive osteoarthritis usually come on without warning.

Those symptoms primarily affect the fingers and usually include:

  • sudden-onset pain
  • swelling
  • warmth
  • redness
  • reduced function of the hand (it becomes harder to grip objects, for example)

Joint function changes usually occur in the fingers’ proximal joints (in the middle of the fingers) rather than the distal joints (nearer the fingertips).

Health experts disagree about whether erosive osteoarthritis is an aggressive form of osteoarthritis or a distinct type of arthritis.

Typical osteoarthritis is due to wear and tear of the joints over time or an injury that doesn’t heal properly. Erosive osteoarthritis doesn’t share those origins. Researchers believe hormones may be involved because women are affected more often than men.

Another possibility is an autoimmune condition.

Erosive osteoarthritis most often affects women around the age of 50. Researchers believe that the loss of estrogen may play a role, particularly since typical osteoarthritis of the hands and knees is much more common in people after menopause.

A family history of erosive osteoarthritis also raises your risk of developing the condition.

The presence of typical osteoarthritis may also increase risk. The estimated prevalence of erosive osteoarthritis in the general population is less than 3%. However, the rate climbs to approximately 10% among people with symptomatic hand osteoarthritis.

For perspective, the CDC reports that nearly 50% of people ages 65 and older have received a diagnosis for some type of arthritis.

Women receive arthritis diagnoses more commonly than men.

Erosive osteoarthritis symptoms, such as painful and swollen fingers, can be similar to those of rheumatoid arthritis (RA). Psoriatic arthritis can also begin in the fingers. Sometimes, doctors may misdiagnose erosive osteoarthritis at first.

One important distinction is that erosive osteoarthritis usually doesn’t involve the wrist or the joints where the fingers meet the palm — two common areas affected by RA.

A doctor will start their diagnosis with a thorough review of symptoms and personal and family medical histories. Imaging tests are also essential in getting a proper diagnosis. One telltale distinction is subchondral cysts or geodes in the fingers caused by the destruction of cartilage and bone in the joints.

Another sign of erosive osteoarthritis that distinguishes it from standard osteoarthritis is the presence of bone erosion.

Subchondral cysts or geodes vs bone erosions: What’s the difference?

Subchondral bone is directly under the cartilage. When a cyst or geode forms here, the cortical bone (outer shell of bone) remains intact.

Bone erosions typically occur in the middle of an articular joint. The bone erosion indicates a break in the cortical bone.

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There is no cure for erosive osteoarthritis. It’s a progressive condition that is not reversible. The goal of treatment is to manage the severity of symptoms and maintain joint function.

Many erosive osteoarthritis treatments are the same as standard osteoarthritis treatments. However, the severity of your symptoms will determine the best approach for you.

NSAIDs and analgesics

Over-the-counter and prescription-strength pain relievers are usually the first-line treatments for erosive osteoarthritis.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can help reduce the inflammation associated with the condition.

Analgesics, including acetaminophen (Tylenol), can be very effective pain relievers that are especially helpful for people who cannot take NSAIDs.

Steroid injections

Steroid injections aim to reduce inflammation and pain, but you can only have an injection in an individual joint a few times a year. Typically, they are more effective in temporarily easing symptoms in larger joints, such as the knee or shoulder, rather than the smaller joints of the hand.

Biologics: An area of future study

Biologics are medications made from living microorganisms. A 2018 trial found that a biologic called etanercept helped reduce pain after 1 year and improve bone health in a small group of individuals with erosive osteoarthritis. However, researchers acknowledged that a larger, longer-term study was needed to confirm their findings.

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Occupational therapy

When finger and hand function become impaired, basic tasks like buttoning a shirt or using eating utensils can become challenging. An occupational therapist can teach you modified ways to perform everyday tasks on your own or with the help of special tools and devices.

An occupational therapist will encourage people with erosive osteoarthritis to do exercises to strengthen the affected joints and improve their function.

Heat therapy

The use of hot compresses or hot water soaks is a mainstay of arthritis treatment. Heat helps open up blood vessels to deliver more oxygen and nutrients to the tissue of your joints, easing stiffness and relieving pain.

Heat therapy can be an effective complement to oral medications and other treatments.

Living with erosive osteoarthritis may involve using a variety of therapies to manage your symptoms and retain the use of your hands.

Though there is no cure, the medical community is increasingly accepting that erosive osteoarthritis warrants greater research to better understand its origins and identify treatments.

Despite the pain and frustration that this condition can cause, being proactive and following your treatment plan can help you maintain a good quality of life.

Most types of arthritis involve some degree of joint pain, swelling, and stiffness. But there are some distinctions that may help you and your doctor determine just what condition is causing your symptoms.

Erosive osteoarthritis vs. traditional osteoarthritis

Typically, erosive osteoarthritis produces more pain, swelling, and functional disability in an affected joint than traditional osteoarthritis. It also involves the erosion or destruction of bone.

Typical osteoarthritis usually involves the loss of cartilage and commonly affects the base of the thumb joint, which does not occur in erosive osteoarthritis.

Erosive osteoarthritis vs. rheumatoid arthritis

Rheumatoid arthritis often begins in the hands but usually involves other joints, such as the wrists and elbows. Erosive osteoarthritis is usually isolated in the fingers, though it sometimes affects the toes.

Most people with RA also test positive for certain biomarkers, including anti-cyclic citrullinated peptide (anti-CCP) antibodies, while people with erosive osteoarthritis test negative for those antibodies.

Erosive osteoarthritis vs. psoriatic arthritis

Sometimes, doctors have difficulty distinguishing between these two types of arthritis if there are no signs of psoriasis — a scaly rash that forms on the skin.

People with psoriatic arthritis may rarely develop painful arthritis symptoms before they have any changes to the skin. Once you have received a psoriasis diagnosis, it may be easier for your doctor to rule out erosive osteoarthritis as the cause.

Erosive osteoarthritis presents with many of the same symptoms as traditional osteoarthritis, though the pain, swelling, and other symptoms are usually limited to the fingers.

If you have arthritic symptoms, see your doctor or a rheumatologist. The earlier you receive a diagnosis and a treatment plan, the sooner you can slow down the progression of erosive osteoarthritis and manage symptoms.