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Erosive Osteoarthritis — SCE Rheumatology MCQ

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ModerateOsteoarthritisErosive OsteoarthritisSCE Rheumatology

A 58-year-old woman has an 18-month history of episodic pain, swelling and warmth affecting several distal and proximal interphalangeal joints of both hands. Examination also shows bony enlargement of the affected joints. She has no psoriasis, nail dystrophy, dactylitis or tophi. Hand radiographs demonstrate joint-space narrowing and osteophytes at multiple DIP and PIP joints, with central subchondral erosions producing a gull-wing configuration. The MCP joints and wrists are spared, and there is no chondrocalcinosis. What is the most likely diagnosis?

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Correct answer: C — Erosive osteoarthritis

The diagnosis is erosive osteoarthritis. It typically affects middle-aged or older women and causes episodically inflammatory disease of the DIP and PIP joints. The discriminating radiographic feature is a central subchondral erosion, which combines with marginal osteophytes to produce the gull-wing configuration. Rheumatoid arthritis usually spares the DIP joints and causes marginal erosions, predominantly at the MCP joints and wrists. Psoriatic arthritis can involve DIP joints but more typically produces marginal erosions, periostitis, dactylitis, nail disease or pencil-in-cup change. CPPD arthropathy favours the wrists and MCP joints and may show chondrocalcinosis or hook osteophytes. Gout causes well-defined punched-out erosions with overhanging edges and may be associated with tophi.

Reference: Bean MB, Favero M, Ramonda R, Scanzello CR. Erosive Hand Osteoarthritis: Recent Advances and Future Treatments. Current Rheumatology Reports. 2024;26:103–111. https://pubmed.ncbi.nlm.nih.gov/22392788/