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Erosive Osteoarthritis

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					   RADIOLOGY OORNER

Erosive Osteoarthritis
by Terry R. Yochum, D.C, D.A.C.B.R., Fellow, A.C.C.R., and Chad J. Maola, D.C.
History: This female patient complains of pain at the base of       liferative rheumatoid-like synovial abnormalities to cartilage
her thumb. An X-ray reveals what?                                   degeneration and bony proliferation as seen in primary degen-
                                                                    erative joint disease.
                                                                     Radiologie Features:
                                                                       Essentially, the radiographie changes are those of degenera-
                                                                    tive joint disease with superimposed bone erosions predomi-
                                                                    nately involving the distal and proximal interphalangeal joints.
                                                                    Occasional involvement of the thumb at the nictacarpophalan-
                                                                    geal and carpometacarpal joints may oeeur, as well as between
                                                                    the trapezium and scaphoid articulations. Involvement of the
                                                                    ulnar compartment of the carpus is significantly spared, dif-
                                                                    ferentiating involvement from rheumatoid arthritis. All other
                                                                    joints of the body are generally uninvolved,'
                                                                       Radiographie changes are characterized by osteophytes,
                                                                    loss of joint space and sclerosis. Osteophytes are identical to
                                                                    those seen in degenerative joint disease. They are marginal in
                                                                    origin, taper distally. and are often larger at the distal articular
                                                                    eomponent. Loss of joint spaee is usually non-unitbmi, with
                                                                    adjacent subehondral selerosis. Superimposed changes of ero-
                                                                    sions, periostitis and ankylosis on these degenerative features
                                                                    are characteristic of erosive osteoarthritis. Bone erosions are
                                                                    distinetively centrally located on the proximal articular surface
 Diagnosis: Observe the sclerosis and osteophytes at the base and more peripherally at the distal articular surface. The re-
 of the first metaearpal, which represents erosive osteoarthritis. sultant altered joint surface contour has been called the "gull
 Of incidental notation is eongenital fusion of the capitate and wings"" sign. Adjacent linear periostitis is oeeasionally seen.
 the hamate {carpal coalition).                                     Bony ankylosis is an uncommon but not unexpected sequel of
                                                                    one or more interphalangeal joints.'
 EROSIVE OSTEOARTHRITIS                                               The main differential considerations are rheumatoid arthritis,
General considerations:                                            psoriasis, and non-inflammatory degenerative joint disease.
   This is a distinctive clinical and radiographie variant of de- Rheumatoid arthritis rarely involves the distal intcrphalangeal
generative joint disease first delineated by Crain in 1961. The joints and has a positive RA latex test. Psoriatic arthropathy is
two most common terms applied to this arthropathy are erosive characterized by discrete marginal erosions with adjacent fluiTy
osteoarthritis and inflammatory osteoarthritis.'                   periostitis ("mouse ears" sign). Non-inflammatory degenerative
Clinical Features                                                  joint disease will show no erosions, but will otherwise appear
   In contrast to primary degenerative joint disease, the onset identieal to erosive osteoarthritis.'
of erosive osteoarthritis is characterized by episodie and acute
                                                                       Dr. Terry R. Yochum is a second generation chiropractor
inflammation of the distal and proximal interphalangeal joints and a Cum Laude Graduate of National College of Chi-
of both hands in a Symmetrie manner. Pain,, edema, redness, ropractic, where he subsequently completed his radiology
nodules and restricted motion are found at the involved ar- residency He is currently Director of the Rocky Mountain
ticulations of the hands. This arthropathy is most commonly ChiropracticRciäiological Center ¡n Denver. Colorado, ami
found in middle-aged females in the fourth or fifth decades of Adjunct Professor o/Radiolog}- at the Southern California University of
life. Laboratory investigations are inconclusive, with noraial Health Sciences, as well as an instructor of skeletal radiohg\- at the Uni-
                                                                   versity of Colorado School of Medicine. Denver. CO. Dr. Yochum can he
to slightly elevated erythrocyte sedimentation rate and negative
                                                                   reached at 1-303-940-9400 or by e-mail at ihrad(m@aol.,,wi
rheumatoid factor. Chronie progression of the disease is to be
expected with nodular, unstable and malaligned finger joints.         Dr. ChadJ. Maola is a ¡990 Magna Cum Laude Gtachi-
                                                                   ate of National College of Chiropractic. Dr Maola is a
The intensity of symptoms with each inflammatory episode
                                                                   Chiropractic Orthopedist and is available for post-graduate
may continue to be severe for many years. Approximately seminars. He may be reached at 1-303-690-H503 or e-mail
 15 percent may develop rheumatoid arthritis, with an aver- DC ß l@msn.com
age onset of twelve years after the initial episode of erosive
                                                                   Reference
osteoarthritis.'
                                                                    /,   Yochum TR, Rowe U: Essentials of Skeletal Radiology. 3rd ed.,
Pathologic Features:                                                     Williams & Wilkins. Baltimore. Maryland. 200>.
 Variable tissue changes are found. These range fi-om pro-

10 I The American Chiropractor I JULY 2008                                                                    www.amchiropractorcom