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Erosive hand osteoarthritis: latest findings and outlook

Abstract

Osteoarthritis (OA) most commonly affects knee joints, and the next most commonly affected sites are the hands and hips. Three distinct hand OA phenotypes have been described: erosive hand OA (EHOA), nodal hand OA — also known as non-erosive hand OA (non-EHOA) — and first carpometacarpal joint OA. EHOA predominantly affects women and is the most aggressive form of hand OA, characterized by a severe clinical onset and progression, leading to joint damage, disability and reduction of quality of life. Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling and redness. Moreover, EHOA is characterized by radiographic features such as central erosion, saw-tooth and gull-wing lesions and, rarely, ankylosis. The aim of this Review is to report the latest findings on epidemiology, clinical features, pathology and aetiopathogenesis, biomarkers, imaging modalities and treatments for EHOA. The ongoing development of new hand OA classification criteria should facilitate standardization between studies.

Key points

  • Erosive hand osteoarthritis (EHOA) is a severe form of hand OA, and evidence suggests that it is characterized by genetic predisposition involving HLA, IL1B and SERPINA1 genes.

  • The radiological hallmark of EHOA is central erosion of the joint, and both radiography and ultrasonography are useful tools for the detection of EHOA.

  • Serological and synovial-fluid biomarkers such as soluble IL-2 receptor and myeloperoxidase are identifiable in EHOA, confirming the role of inflammation in this aggressive form.

  • EHOA biomarkers that are useful in clinical practice have not yet been identified.

  • EHOA is characterized by the presence of signs of inflammation, which correlates with symptoms and the appearance of bone erosions.

  • Currently, no specific treatments are available to slow disease progression in EHOA.

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Fig. 1: Features of erosive hand osteoarthritis.
Fig. 2: Clinical features of erosive hand osteoarthritis.
Fig. 3: Radiological features of erosive hand osteoarthritis and comparison with other arthritis types.

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Glossary

Osteophytes

Bone spurs that grow along bone–joint margins.

Subchondral cyst

Fluid-filled sac occurring in subchondral bone.

Subchondral sclerosis

Hardening of the bone just below the cartilage surface.

Ankylosis

Fusion of the joint.

Paraesthesia

Abnormal skin sensation (such as numbness or a burning feeling).

Gradient echo MRI sequence

The gradient echo sequence is an excitation sequence for rapid image acquisition.

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Favero, M., Belluzzi, E., Ortolan, A. et al. Erosive hand osteoarthritis: latest findings and outlook. Nat Rev Rheumatol 18, 171–183 (2022). https://doi.org/10.1038/s41584-021-00747-3

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