(Carter Lecture) Flashcards
(43 cards)
RA involves the cervical spine in ____ to ____ % of patients
50-80%
- This varies by your source, however Carter believes this is still a high number. Note, that radiograpically, RA in the
C-Spine is about 30 %
Involves SI joints in _______ % of patients
25-35%
RA Involves thoracic and lumbar spine in less than _____ of patients
5%
Spinal involvement almost always occurs after the _________________________________
extremities have been involved
- The extremities are affected first always
RA in the Atlanto-Occipital area
Loss of ______ space with ________
Vertical translation of odontoid causing “________ -basilar
_________
Loss of joint space with erosion
Pseudo-basilar invagination
- Carter, called this a vertical subluxation of the odontoid*
This is a good place to draw McGregor’s or Chamberlain’s line
Chamberlain: 3mm
McGregors Male: 8mm
McGregors Female: 10mm
RA: Atlanto Axial
30-50% of patients
Erosion of the _____(“whittled_______”)
dens, whittled odontoid
RA: Atlanto Axial Areas of Involvement
ADI ___________
Bursitis between dens and _________ _________
Alar ligament attachment
Passible rupture of transverse ligament (increased ADI)
ADI synovitis
transverse ligament
Note: Identical changes can happen in this area (c1/c2) from PA, AS, Reiter’s, and SLE (PARS)
Flexion/extension films ARE indicated
RA in Cervical Spine: C 3,4, and 5
Multi level ________(esp. C2-C4) creating a “step ladder or
doorstep” appearance
Joint narrowing with erosions on the _______ joints (can lead to ________)
Disc _________with end-plate ________
Generalized osteoporosis
Occasionally can get erosions on SP’s causing tapering
“_________ ________ appearance”
Anterolisthesis (especially C2-C4)
apophyseal; ankylosis
Disc Narrowing and end-plate erosions
Sharpened pencil appearance
Note: Flexion films very helpful
RA vs OA Characteristics
AES SEA
RA
- ADI
- Erosions
- Stair stepping
OA
- Sclerosis
- Enlarged Facets
- Anterolisthesis (usually one level if present)
RA sequence
1.
2.
3.
4.
Synovitis
Marginal Erosions
Granulation Erosions
Subluxation, Dislocation
What area of the spine is RA frequent and detail its characteristics/findings?
Think of the Resnick
C3-C7
Facet Articulations
Endplates
Combination of the two lead to subluxations (marginal and articular erosions, subluxations, etc)
RA in SI joints
►Iliac ___________ and mild loss of joint space
►Sclerosis (minimal or absent) more dominant on ___ side
►Usually unilateral but if bilateral it is ___________
►Ankylosis is very rare
Erosions
Iliac
Asymmetric
Ankylosis is rare but if present, it would have a Rosary bead presentation, as there is in AS.
AS (Ankylosing Spondylitis) aka
Marie-Strumpell’s or Bechterew’s
AS starts in the _____ and ______ ____ the spine
Remember Carter’s 30 Under 30 rule
SI joints and Moves UP
Onset for AS is typically ___ to ___ yoa with an average of 26/27 years old
male or female predilection and MC in Caucasians
15-35
Male
Low back pain esp. on waking, possible leg pain which can ____________ sides
Progressive loss of ________
Decreased _________ expansion
Loss of secondary curves often with exaggerated head carriage
Alternate sides
Progressive loss of ROM
Decreased chest expansion
Loss of 2ndary curve and exaggerated head carriage
AS patients have 20x chance to develop ___issues or ____ disease
GI, Chron’s disease
AS: Extraskeletal Associations
Ocular - __________, and often precedes back pain by
Cardiac- ____________
Lungs: Upper lung fibrosis and/or cavitations
GI
OTHER Associations
Chronic pancreatitis (80%)
Renal failure from amyloidosis (8%)
Lab: elevated ESR, HLA-B27 in (90%),
Negative __________ factor
Iritis, which often precedes back pain by up to 6 months
Cardiac changes include aneurysms (usually thoracic)
Lungs: Upper lung fibrosis and/or cavitations
Crohn’s and ulcerative colitis in 18% (20 x greater chance to develop GI issues or Chron’s disease
Rheumatoid
Early AS (5 signs)
B/L and \_\_\_\_\_\_\_\_\_\_\_ Pseudo-\_\_\_\_\_\_ of joint Rosary bead erosions Sclerosis ( will always be more prominent on iliac side) and begin to \_\_\_\_\_\_ the si joint space intermediately Best seen on sacral tilt film
b/l and symmetric
pseudo-widening of the joint
obliterate
Chronic AS
\_\_\_sign (oblieration of jt. space) \_\_\_\_\_ sign (bridging ossification of the upper 1/3 of SI joints)
Compete fusion of SI joints
Ghost sign
Star sign
AS Moving up the Spine
Focal destruction and erosion of body rim at annulus
enthesis known as a “_________ lesion”
Healing of erosion causes transient reactive sclerosis resulting in “_____________________”
First changes occur at thoracolumbar junction
(60% of the time)
Romanus lesion
Shiny corner sign
Note as the SPINE gets involved, inflammation of the ALL occurs ALWAYS and followed by the facet joints, and sometimes the PLL.
AS: Marginal Syndesmophytes
- Thin ossification of ALL across disc spaces causing __________ syndesmophytes and leading to ________ spine/poker spine
The calcified ALL will fill the anterior body concavity (________) or slightly thicken it (barrel shaped)
marginal syndesmophytes, bamboo/poker spine
squaring or slightly thicken (barrel shape)
Anterior Ossification of ALL in AS is always ______ in comparison to DISH, which is thick.
Thin
AS in the Thoracic spine
Occasionally it may skip the thoracic spine however it can involve _________ articulations
Costovertebral
