S14:5 | Erosive hand osteoarthritis: premenopausal onset and more severe disease progression

Marta Favero¹, Giacomo Cozzi¹, Clarissa Benvoluti¹, Laura Scagnellato¹, Gianluca Poncina¹, Stefano Rizzetto¹, Mariagrazia Lorenzin¹, Roberta Ramonda¹ | ¹UOC di Reumatologia, Dipartimento di Medicina-DIMED, Università di Padova, Italy

Background. Erosive hand osteoarthritis (EHOA) is a particularly aggressive and inflammatory subset of hand osteoarthritis (OA). It predominantly affects women and typically manifests after the age of 50, coinciding with the menopausal transition. However, recent evidence suggests that patients with EHOA, compared with those affected by non-erosive forms, may experience an earlier onset and a more severe clinical course with greater functional and radiographic impairment. The main objectives of our study were to: 1. Assess the prevalence of premenopausal onset among patients with EHOA; 2. Compare clinical, functional, and radiographic characteristics between patients with premenopausal and postmenopausal onset. Materials and Methods. A retrospective study was conducted on a cohort of 87 patients diagnosed with EHOA, followed at the Joint Pathology Outpatient Clinic of our Rheumatology Unit between January 2015 and February 2025. EHOA was diagnosed based on the presence of at least one central radiographic erosion involving a proximal or distal interphalangeal joint. Demographic, clinical, and laboratory data were collected, with particular attention to the age of symptom onset, menopausal status, and use of hormone replacement therapy (HRT). Joint function was assessed using validated AUSCAN and DREISER indices. Radiographic damage was evaluated using the Altman scoring system on bilateral hand radiographs. A total composite radiographic score was calculated by summing the individual joint scores for all assessed hand joints. Statistical analyses included Student’s t-test, and linear and logistic regression models, with statistical significance set at p < 0.05. Results. Eighty-seven patients with EHOA were retrospectively enrolled, with a mean age of 63.17 ± 8.85 years; 77 were women (88.5%). Among female patients, 71 (92.21%) were postmenopausal, and 17 (22.08%) had previously used or were currently using HRT. The mean disease duration was 13.75 ± 9 years. In 42.9% of women, symptom onset occurred before menopause: mean age at premenopausal onset was 44.91 ± 6.97 years versus 58.00 ± 6.96 years for postmenopausal onset. Functional assessment showed moderate-to-severe disability (AUSCAN: 30.90 ± 12.49 on 60; DREISER: 10.61 ± 6.26 on 30). Premenopausal disease onset was significantly associated with greater joint space narrowing on total radiographic scoring, confirmed by logistic regression adjusted for age and disease duration (p = 0.017) (Table 1). Conclusiuons. Premenopausal onset of EHOA was associated with more pronounced radiographic damage, suggesting a potential role of hormonal and genetic factors in the disease pathogenesis. These findings highlight the importance of a personalized management approach based on age at disease onset.