Erosive Arthritis of the Hand and Wrist in Hyperparathyroidism

Four cases of erosive arthritis of the hand and wrist associated with hyperparathyroidism are presented. The erosions show a predilection for radiocarpal, inferior radioulnar, and metacarpophalangeal joints, although more distal involvement does occur. Synovitis may be associated with adjacent periosteal inflammation, although the latter may be absent or minimal. Radiographic features allowing differentiation from rheumatoid arthritis include an ulnar-side erosive distribution, absence of joint space narrowing, marginal bone formation or “whiskering,” and relative sparing of proximal interphalangeal joints. Associated features such as chondrocalcinosis and capsular or periarticular calcifications may be noted.