Arthridities

Question 1

Types of arthridities

Answer 1

Degenerative/hypertrophic- OA & charcot
Inflammatory/erosive: gout, RA, AS, PA, SLE
Infective: septic

Question 2

OA sites and demographics

Answer 2

<45 more common males, >45 more common females
DIPS, PIPS, metcarpals/ tarsals, spine, hips, knees, AC
Most commonly c5-7,m L4-s1, T6-L1

Question 3

OA treatment

Answer 3

NSAIDs, corticosteroids, non-weight bearing exercise, glucosamine, fish oils

Question 4

Radiographic features OA

Answer 4

Subchondral sclerosis
Subchondral bone cyst (synovial fluid) 
Assymetrical joint space narrowing
Osteophyte formation
Vacuum phenomenon: in spine, collection of nitrogen, line of radiolucency

Question 5

RA demographics and sites

Answer 5

Generalised CT disorder that targets synovial tissue.
Bilateral symmetry
Can affect the heart, lungs, blood vessels, NS, eyes
20-60, female
feelings of fatigue, malaise, raynauds, fever
gradual onset of pain, swelling, stiffness in joint
80% of cases end up in cx spine

Question 6

RA radiographic findings hand

Answer 6

Boutoniere: PIP flexed DIP extended
Swan neck: PIP extends DIP flexed (Ralph)
Mallet finger: DIP fixed in flexion
Hitchhikers thumb: boutoniere in thumb
Zig-zag deformity: ulnar and radial deviation

Question 7

Initial RA process

Answer 7

Acute synovitis and oedema
Formation of Pannus starts at bearer area (where synovial membrane attaches) and eventually spreads whole capsule
Pannus causes bone reabsorption at bearer area and then subchondral bone forming subchondral cysts
then cartilage is destroyed, so pannus undergoes fibrosis and there us ankylosis

Question 8

RA radiological findings

Answer 8

bilateral symmetry
juxta articular osteopoenia (epophyseal and metaphyseal osteopoenia)
uniform loss of joint space
rat bite erosions at bare area 
Ulnar deviations

Question 9

Ankylosing Spondylitis clinical features

Answer 9

Male, 15-35
stiff aching back and buttocks
pain worse in AM, PM and during night

Question 10

General Radiological findings AS

Answer 10

Bilateral and symmetrical osteoporosis, erosions and reactive sclerosis
ankylosis of SIJ, facet, costovertebral, pubic symph, TL then LS

Question 11

SIJ radiological findings AS

Answer 11

sclerosis along SI joint line , erosions, reduced joint space, : ankylosis, generalised osteoporosis, ghost joint, star sign (ossification of superior SIJ ligs)

Question 12

Spine radiological fidings AS

Answer 12

Sydesmophytes: calcification of soft tissue insertions (might look like phyte), discovertebral joint
shiny corner sign
bamboo spine: marginal syndesmophytes of the outer annulus
osteoporosis of vertebrae

Question 13

Psoriatic arthritis features

Answer 13

15% of pateitns with psoriasis
hands and feet
sometimes spine, SI and hips, knees
Psoriatic lesions, 20-50 yo, DIP swelling, mutilans,

Question 14

Radiological findingings Psoriatic arthritis

Answer 14

Asymmetrical
Soft tissue swelling (earliest sign in digits)
Lack of osteoporosis (RA has juxtaarticular osteopoenia) normal bone mineralisation
corticol erosions
Ray pattern: DIP, PIP and MCP are all affected on the single digit
Mouse ears: fluffy looking periostitis at joints
Pencil in cup deformity

Question 15

Pathophysiologgy PA

Answer 15

Synovitis forming a pannus, Pannus then undergoes fibrosis, erosions of cartilage and corticol margins and joint space narrowing. No osteoporosis

Question 16

SLE general radiographic findings

Answer 16

Bilateral, symmetrical, reversible hand/ finger deformities
Osteoporosis
Soft tissue atrophy and calcification
boutonniere and swan neck: lax ligaments
normal joint spaces
osteonecrosis

Question 17

Gout radiological findings

Answer 17

tophi
reduced joint space
bone erosion
overhanging margin sign