Abstract
Objective
Erosive osteoarthritis is usually considered as an inflammatory subset of osteoarthritis (OA). However, an inflammatory component is now recognised in all subsets of OA, so this subgroup of erosive or inflammatory OA is more difficult to conceptualise. The aim of this study was to compare routine CR and MRI to investigate erosion numbers and morphology to determine whether hand OA in general is a more erosive disease than previously recognised.
Design and methods
Fifteen patients with clinical (OA) of the small joints of the hand underwent MRI of one of the affected proximal interphalangeal (PIP) or distal interphalangeal (DIP) joints. Conventional radiographs (CR) of the hand were also obtained. The MR images were reviewed by two observers for the presence of central and marginal erosions. The site and morphology of any erosions was recorded. CR images of the same hand joint were scored independently for central and marginal erosions by the same observers.
Results
There was 100% agreement between the observers for scoring erosions on CR. Agreement for the MRI scores was also excellent (kappa = 0.84). MRI detected 37 erosions, of which only 9 were seen on CR. The increase in sensitivity using MRI was much greater for marginal erosions (1 detected on CR, 19 on MRI) than for central erosions (8 on CR, 18 on MRI). Using MRI 80% of joints examined showed 1 or more erosions compared with 40% using CR. If only marginal erosions were considered 80% of joints were still considered erosive by MRI criteria, but only 1 showed evidence of erosion on CR. Morphologically central erosions appeared to represent areas of subchondral collapse and pressure atrophy. In contrast, marginal erosions resembled those seen in inflammatory arthritides.
Conclusion
Erosions, and particularly marginal erosions typical of those seen in inflammatory arthritis, are a more common feature of small joint OA than conventional radiographs have previously indicated.
Similar content being viewed by others
References
Ehrlich GE. Inflammatory osteoarthritis. I. The clinical syndrome. J Chronic Dis 1972;25: 317–328.
Utsinger PD, Resnick D, Shapiro RF, et al. Roentgenologic, immunologic, and therapeutic study of erosive (inflammatory) osteoarthritis. Arch Intern Med 1978;138: 693–697.
Kidd KL, Peter JB. Erosive osteoarthritis. Radiology 1966;86: 640–647.
Peter JB, Pearson CM, Marmor L. Erosive osteoarthritis of the hands. Arthritis Rheum 1966;9: 365–388.
Ehrlich GE. Erosive osteoarthritis: presentation, clinical pearls, and therapy. Curr Rheumatol Rep 2001;3: 484–488.
Punzi L, Ramonda R, Sfriso P. Erosive osteoarthritis. Best Pract Res Clin Rheumatol 2004;18: 739–758.
Keats TE, Johnstone WH, O’Brien WM. Large joint destruction in erosive osteoarthritis. Skeletal Radiol 1981;6: 267–269.
Resnick D. Degenerative disease of extraspinal locations. In: Resnick D, ed. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders; 2002: 1271–1381.
Martel W, Stuck KJ, Dworin AM, et al. Erosive osteoarthritis and psoriatic arthritis: a radiologic comparison in the hand, wrist, and foot. AJR Am J Roentgenol 1980;134: 125–135.
Ostergaard M, Hansen M, Stoltenberg M, et al. Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 1999;42: 918–929.
Ostendorf B, Peters R, Dann P, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001;44: 2492–2502.
Backhaus M, Burmester GR, Sandrock D, et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002;61: 895–904.
Backhaus M, Kamradt T, Sandrock D, et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42: 1232–1245.
McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 1998;57: 350–356.
Foley-Nolan D, Stack JP, Ryan M, et al. Magnetic resonance imaging in the assessment of rheumatoid arthritis—a comparison with plain film radiographs. Br J Rheumatol 1991;30: 101–106.
Klarlund M, Ostergaard M, Gideon P, et al. Wrist and finger joint MR imaging in rheumatoid arthritis. Acta Radiol 1999;40: 400–409.
Klarlund M, Ostergaard M, Jensen KE, et al. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis. The TIRA Group. Ann Rheum Dis 2000;59: 521–528.
Lindegaard H, Vallo J, Horslev-Petersen K, et al. Low field dedicated magnetic resonance imaging in untreated rheumatoid arthritis of recent onset. Ann Rheum Dis 2001;60: 770–776.
Ostergaard M, Gideon P, Sorensen K, et al. Scoring of synovial membrane hypertrophy and bone erosions by MR imaging in clinically active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995;24: 212–218.
Tan AL, Grainger AJ, Tanner SF, et al. A high-resolution magnetic resonance imaging study of distal interphalangeal joint arthropathy in psoriatic arthritis and osteoarthritis: are they the same? Arthritis Rheum 2006;54: 1328–1333.
Tan AL, Grainger AJ, Tanner SF, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum 2005;52: 2355–2365.
Altman R, Alarcon G, Appelrouth D, et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 1990;33: 1601–1610.
Hinton R, Moody RL, Davis AW, et al. Osteoarthritis: diagnosis and therapeutic considerations. Am Fam Physician 2002;65: 841–848.
Ideguchi H, Ohno S, Hattori H, et al. Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activity with conventional disease-modifying antirheumatic drugs. Arthritis Res Ther 2006;8: R76.
Hulsmans HM, Jacobs JW, van der Heijde DM, et al. The course of radiologic damage during the first six years of rheumatoid arthritis. Arthritis Rheum 2000;43: 1927–1940.
Van der Heijde DM, van Leeuwen MA, van Riel PL, et al. Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum 1992;35: 26–34.
Ostergaard M, Peterfy C, Conaghan P, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 2003;30: 1385–1386.
McQueen FM, Benton N, Perry D, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 2003;48: 1814–1827.
McQueen FM, Stewart N, Crabbe J, et al. Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals progression of erosions despite clinical improvement. Ann Rheum Dis 1999;58: 156–163.
Savnik A, Malmskov H, Thomsen HS, et al. MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions. Eur Radiol 2002;12: 1203–1210.
Hunter DJ, Felson DT. Osteoarthritis. BMJ 2006;332: 639–642.
Tan AL, Toumi H, Benjamin M, et al. Combined high-resolution magnetic resonance imaging and histology to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis 2006;65: 1267–1272.
Cobby M, Cushnaghan J, Creamer P, et al. Erosive osteoarthritis: is it a separate disease entity? Clin Radiol 1990;42: 258–263.
Ehrlich GE. Inflammatory osteoarthritis. II. The superimposition of rheumatoid arthritis. J Chronic Dis 1972;25: 635–643.
Ehrlich GE. Osteoarthritis beginning with inflammation. Definitions and correlations. JAMA 1975;232: 157–159.
Verbruggen G, Veys EM. Erosive and non-erosive hand osteoarthritis. Use and limitations of two scoring systems. Osteoarthritis Cartilage 2000;8 Suppl A: S45–S54.
Pincus T. Clinical evidence for osteoarthritis as an inflammatory disease. Curr Rheumatol Rep 2001;3: 524–534.
Brooks P. Inflammation as an important feature of osteoarthritis. Bull World Health Organ 2003;81: 689–690.
Abramson SB. Inflammation in osteoarthritis. J Rheumatol Suppl 2004;70: 70–76.
Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet 2005;365: 965–973.
Pelletier JP, Martel-Pelletier J, Abramson SB. Osteoarthritis, an inflammatory disease: potential implication for the selection of new therapeutic targets. Arthritis Rheum 2001;44: 1237–1247.
Acknowledgements
Supported by the Medical Research Council, UK and the Arthritis Research Campaign, UK.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Grainger, A.J., Farrant, J.M., O’Connor, P.J. et al. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive?. Skeletal Radiol 36, 737–745 (2007). https://doi.org/10.1007/s00256-007-0287-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-007-0287-5