Erosive Hand Osteoarthritis: Recent Advances and Future Treatments

Abstract

Purpose of the review: Erosive hand osteoarthritis (EHOA) is an aggressive form of hand osteoarthritis that leads to significant disability, and recent data suggests that it is increasing in prevalence. This review provides an update of our current understanding of epidemiology, genetic associations, biomarkers, pathogenesis, and treatment of EHOA, with particular focus on studies published within the last 5 years.

Recent findings: New studies of EHOA have identified new genetic loci associated with disease, including variants in genes involved in inflammation and bone remodeling. Preclinical studies implicate pathways of innate immunity, including some that may be causal in the condition. Recent novel studies showed that inflammatory features identified by ultrasound and MRI are associated with development of erosive lesions over time on conventional radiography. In the future, these imaging modalities may be useful in identifying patients at risk of adverse outcomes. Promising new findings in genetics, biomarkers, and treatment targets will hopefully allow for future therapeutic options for this debilitating condition.

Keywords: Biomarkers; Disability; Erosive hand osteoarthritis; Genetics; Inflammation.

Fig. 1

Erosive hand OA imaging. A X-ray demonstrating central erosions with “gull-wing” appearance (red asterisks), joint space narrowing with osteophytes (yellow asterisks), and lateral PIP subluxation of the 3rd and 4th fingers. B STIR MRI showing 2nd and 3rd PIP mild synovial thickening and fluid effusion with central subchondral erosions (red asterisks) and 3rd and 4th PIP joint space narrowing (yellow asterisks). C Ultrasound imaging of the 3rd IFP joint showing bone irregularity (green line), osteophytes (blue asterisk), bone erosion (white arrow), and capsule distention (red arrow)