Background/Purpose:

Erosive osteoarthritis (EOA) is a potentially important subtype of osteoarthritis initially described in the 1960s.  Since that time, EOA has been the focus of substantial literature describing its clinical presentation, epidemiology, genetics, and response to therapy.  We set out to review clinical studies of EOA in order to determine if there was general agreement about diagnostic criteria.

Methods:

Ovid, Pubmed, and Google Scholar were searched using the phrase “erosive osteoarthritis” from the years 1962-2015.  References that were not pertaining to EOA, were exclusively animal studies, or were not in English were eliminated from review.    

Results:

After reviewing all 180 papers, we identified 50 papers which described the inclusion and exclusion criteria utilized in the study and included more than 3 patients.  The numbers of patients varied between 9 and 355.  A synopsis of the inclusion/exclusion criteria is shown in Table 1. Six of the 50 studies used no clinical inclusion criteria, which we defined as features obtained by history or physical examination.  In the remaining 44 studies, ACR criteria for hand OA were the most commonly used clinical inclusion criteria (33/44).  Radiographic inclusion criteria were cited in all 50 studies but varied widely.  Eighteen studies required only a single involved joint.  The Verbruggen-Veys scale was designed to stage hand osteoarthritis and was used in 7/50 papers.  In the majority of studies (35/50) the authors designed their own radiographic definitions.  Sixteen of the 50 studies described no exclusion criteria.  The most frequently employed exclusion criteria were an alternative diagnosis (31/50), a positive rheumatoid factor or anti- CCP antibody (8/50), or a family history of psoriasis (7/50).  There were no clear trends with time in the choice of diagnostic criteria.

Table 1. The number of published studies of EOA utilizing various types of diagnostic criteria out of a total of 50 studies. *

V-V is Verbruggen-Veys

Conclusion:

The considerable heterogeneity in the definition of EOA renders this literature difficult to interpret.  Despite a heavy reliance on radiographic findings, there is little agreement about even a radiographic definition of this disease.  Progress in understanding and treating patients with EOA will require the development of clear classification criteria.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lack-of-uniform-diagnostic-criteria-for-erosive-oa-a-systematic-review/