Objective To estimate the prevalence of erosive hand osteoarthritis (EOA) in the general population and its relation to symptomatic hand osteoarthritis (HOA), hand pain and disability. Methods Baseline data of participants from a population-based study (age >= 55 years) were used. Symptomatic HOA was defined as hand pain and in addition to radiographic HOA (at least one interphalangeal (IP) joint or 1st carpometacarpal joint with Kellgren-Lawrence grade >= 2). EOA was defined as having at least one IP joint with erosions according to the Verbruggen-Veys scoring method. Hand pain and disability were self-reported. Multivariate logistic regression analyses were used to estimate the effect of EOA on pain and disability. Results were presented as OR with a 95% CI, adjusted for age and sex. Results Of 3430 participants, radiographic HOA was seen in 56% (n = 1916) and symptomatic HOA in 11% (n = 371). Erosions were seen in 96 subjects. The prevalence of EOA in the general, radiographic and symptomatic HOA population was 2.8%, 5.0% and 10.2%, respectively. Presence of EOA led to adjusted ORs for pain of 3.6 (95% CI 2.4 to 5.6) and for disability 2.4 (95% CI 1.1 to 5.4). In radiographic HOA, people with erosion(s) had more hand pain (adjusted OR = 3.1, 95% CI 2.0 to 4.8) or disability (adjusted OR = 2.5, 95% CI 1.1 to 5.8) than people without erosion(s). Conclusion The prevalence of EOA is 2.8% in the general population and 10.2% in individuals with symptomatic HOA. It has a substantial impact on hand pain and disability.