Typical causes for this compartment involvement are osteoarthrosis, inflammatory osteoarthritis, gout, and scleroderma. My opinion in this case is posttraumatic osteoarthrosis as there is chronic periosteal reaction along the medial aspect of the thumb metacarpal. Superimposed crystal deposition if the patient has gout is a possibility. Not typical of scleroderma although this is a great compartment for that diagnosis but the morphology is not typical and in some cases, intraaarticular and periarticular calcification is seen.
I don’t recall seeing an erosive arthropathy like this at the 1st CMC joint.
There’s central and peripheral erosions with reactive sclerosis and relatively preserved joint space….I want this to be gout, but it’s not really typical…or is it?
I think I see small smooth erosions of the scaphoid, distal ulna, the radial base of the index proximal phalanx and maybe the 2nd metacarpal base.
Absent the other small scattered ? erosions, would you consider indolent infection, something else?
