Inflammatory Erosive Osteoarthritis - The Basics


Though some symptoms of Inflammatory Erosive Osteoarthritis (IEO) can mimic those of rheumatoid arthritis  -  pain and swelling in the joint, erosion, stiffness and increased pain with use – IEO is considered a subset of osteoarthritis, and differs from RA in both pathophysiology and treatment, says Scott Zashin, M.D., a rheumatologist in Dallas, Texas.

“IEO is mostly seen in middle-aged women, and typically involves the end knuckles closest to the nail bed and the middle knuckles,” he says.

IEO vs. Rheumatoid Arthritis
IEO is similar to rheumatoid arthritis in that the inflammatory process is taking place in the body, and over time, there is damage to the joint, which can be seen as erosion on an x-ray, he says. However, unlike RA, eventually the inflammation will subside.

“It may leave the patient with an enlarged joint,” he says, but the progression of damage is halted. This is why early aggressive treatment of IEO is not necessary, even though that is key to stopping joint damage with RA.

Even so, Dr. Zashin says IEO can be hard to distinguish and is not that common.  It takes a combination of x-rays, lab work, location of arthritis and symptoms to help determine the diagnosis.

IEO vs. Osteoarthritis
Though IEO is considered a subset of osteoarthritis, there are major differences. “There is more inflammation with the joint and there is a more rapid progression,” says Dr. Zashin. X-rays changes also look different in IEO compared to OA, because there is some erosion in the bone.

Where these two conditions meet is in the treatment, according to Dr. Zashin.
“We treat erosive osteoarthritis the same way we treat osteoarthritis,” he says. “We treat the symptoms.”

That includes both over-the-counter medications, such as Tylenol and topical anti-inflammatories, as well as prescription medications approved for osteoarthritis.  Joint injections are another option, says Dr. Zashin, “ and in resistant cases we use similar treatment to rheumatoid arthritis, such as Plaquenil, or a drug for gout called Colchicine.”

Another possible treatment is using TNF-blockers in the joint, he says, but it’s important to remember that these off-label treatments are all anecdotal.
One off-label treatment he won’t be trying is biologics. When asked about a study published in the Annals of Rheumatic Disease in 2006 ( Grunke and H Schulze-Koops) which suggests biologic drugs could benefit patients with IEO, Dr. Zashin remained skeptical.

“There is that one case of injected biologic, but I’ve never used that myself, and I would not consider doing it at this time.”

In addition, he says he has never heard of someone with IEO going on to develop RA.

What is the prognosis?
Going to see an occupational therapist could be beneficial, says, Dr. Zashin, but overall the prognosis with medication is good.

“There are a few patients who, unfortunately, it hits one joint and then moves to another, and it’s more of a chronic thing, but typically we are able to find something to control their pain and inflammation."