Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition

Abstract

Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.

The sonographic identification of cortical bone interruptions in rheumatoid arthritis: a morphological approach

“…In fact, several imaging studies have documented different mimickers of bone erosions (pseudo-erosions) including physiological cortical vascular channels and cortical irregularities (osteophytes, cortical bone notches and subcortical bone cysts). 26,28,29,[37][38][39][40][41] Pseudoerosions may satisfy the OMERACT US definition of bone erosion, reducing the specificity of US in the assessment of bone erosions, 25,26,28,29 particularly when cortical defects are smaller than 2 mm. In fact, the prevalence of the OMERACTdefined bone erosions at metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints ranges from 0% to 18% of healthy subjects, [42][43][44] and increases with age.…”

Rheumatoid Arthritis from Pathogenesis to Therapeutic Strategies

“…Hirter et al [ 9 ] reviewed the literature on pseudo-erosions and came to three conclusions: (A) Pseudo-erosions may be related to normal anatomy or technical artefacts. (B) So-called calcified zones can be part of classical anatomical structures, such as subchondral, sub-tendinous or -ligamentous bone.…”