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1
Q

This is a chonic, inflammatory arthritis primarily affecting the articulations & ligs of the spine & pelvis

A

Ankylosing Spondylitis

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2
Q

Ankylosing Spondylitis is AKA?

A

Marie-Strumpell, Bechterev, rhizomelic spondylitis

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3
Q

Ankylosing Spondylitis is a common cause of low back pain in what group of people?

A

Young males (15-35 yrs of age; 9:1 M-to-F)

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4
Q

Where is aching/stiffness M/C w/ Ankylosing Spondylitis?

A

In sacral region

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5
Q

What is the typical clinical presentation of Ankylosing Spondylitis?

A 
Pain at max in morning
Pain/tenderness over bony prominences
Chest pain (costochondral involvement)
Fatigue,low grade fever
Iritis, heart problems, upper lung fibrosis
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6
Q

What % of pt’s w/ Ankylosing Spondylitis have peripheral involvement?

A

up to 50%

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7
Q

What are typical lab findings w/ Ankylosing Spondylitis?

A

Positive HLA-B27 (90-95% of cases)
ESR
Negative for RF

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8
Q

What are the characteristic sites of involvement for Ankylosing Spondylitis?

A 
SI joints (M/C; hallmark)
Apophyseal joints
Costovertebral joints
Pubic symphysis
Discovertebral
Manubriosternal joints
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9
Q

What are basic features of Ankylosing Spondylitis radiographically in the SI joints?

A 
Reactive Sclerosis
Osteoporosis
Bony ankylosis
Erosions
Typically bilateral & symmetrical
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10
Q

What are the most diagnostic views for Ankylosing Spondylitis in the SI joints?

A

PA angulated spots or SI views

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11
Q

What are the stage 1 changes in SI joints w/ Ankylosing Spondylitis?

A

Pseudo-widening of joint

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12
Q

What are the stage 2 changes in SI joints w/ Ankylosing Spondylitis?

A

Erosive & sclerotic changes

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13
Q

What are the stage 3 changes in SI joints w/ Ankylosing Spondylitis?

A

Ankylosis 50% (7-23 years)

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14
Q

What radiographic signs are assoc. w/ ankylosing spondylitis in the SI?

A

Ghost joint margins

Star sign

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15
Q

Erosive changes w/ ankylosing spondylitis in the SI are seen more on what part of the joint?

A

Iliac side of the joint & lower 1/3rd of the joint

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16
Q

Where are the earliest spinal manifestations radiographically of ankylosing spondylitis?

A

Thoracolumbar region (M/C)

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17
Q

This is an erosion at the corner of a vert. body assoc. w/ ankylosing spondylitis

A

Romanus lesion

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18
Q

Vert. bodies become what shape w/ ankylosing spondylitis?

A

Squared contour, barrel shaped

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19
Q

This radiographic sign is d/t osteitis in the spine of a pt w/ ankylosing spondylitis

A

Shiny corner sign

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20
Q

Ossification of the outer edges of the disc in a pt w/ ankylosing spondylitis is called what?

A

Marginal syndesmophytes

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21
Q

Names assoc. w/ ankylosing spondylitis in the spine?

A

Bamboo spine, Trolley-track, dagger sign

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22
Q

Type of fx assoc. w/ ankylosing spondylitis in the spine?

A

Carrot-stick fx

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23
Q

Lesion that is assoc. w/ ankylosing spondylitis that looks like an infection & is M/C in the C-spine

A

Anderson lesion

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24
Q

This arthropathy is assoc. w/ ulcerative colits & crohn’s disease

A

Enteropathic arthropathy

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25
Enteropathic Arthropathy affects what group of people?
Young adults
26
What is a typical clinical symptom of enteropathic arthropathy?
Peripheral arthralgias w/ rapid resolution (knee, ankle, elbow, wrist)
27
What % of time is there spinal involvement w/ enteropathic arthropathy?
5%
28
What lab test is positive w/ enteropathic arthropathy?
HLA-B27
29
How does enteropathic arthropathy appear radiographically?
Similar to ankylosing spondylitis (bilateral & symmetrical)
30
Common skin disorder assoc. w/ joint disease characterized by peripheral joint destruction & deformity, sacroiliitis, & non-marginal syndesmophytes
Psoriatic Arthritis
31
What is the pathophysiology of Psoriatic Arthritis?
Similar to RA Pannus affects cartilage less &erosions are smaller & slower in development Periostitis
32
What are the M/C joints affected by Psoriatic Arthritis?
DIP of hand & foot
33
What age group is M/C affected by Psoriatic Arthritis?
20-50 yrs of age
34
What are clinical features of Psoriatic Arthritis?
Skin lesions characteristic of psoriasis Nail changes (incidence of arthritis increased) Acute & chronic joint pain especially in DIP joints Morning stiffness Sausage digit
35
What are laboratory features seen w/ Psoriatic Arthritis?
Positive HLA-B27 (30%) Hyperuricemia Increased ESR
36
What is the M/C pattern of involvement w/ Psoriatic Arthritis?
Polyarthritis w/ DIP joint involvement
37
What are some radiographic features seen w/ Psoriatic Arthritis?
``` Soft tissue swelling (sausage digit) Normal bone mineralization Erosions & tapering of bone ends Juxta-articular fluffy periostitis Joint space may be wide Non-marginal syndesmophytes Sacroiliitis (bilateral asymmetrical) Sparring of pos. joints except C-spine ```
38
What is one radiographic feature seen w/ Psoriatic Arthritis but not RA?
Juxta-articular fluffy periostitis
39
Fluffy periostitis is AKA?
Mouse Ears
40
What radiographic feature is highly suggestive of Psoriatic Arthritis?
DIP & PIP ankylosis
41
What is an uncommon radiographic finding w/ Psoriatic Arthritis?
SI ankylosis
42
Type of deformity assoc. w/ Psoriatic Arthritis?
Pencil & cup deformity AKA mortar & pestal deformity
43
What view can you see marginal syndesmophytes?
AP view
44
This is AKA as Reactive arthritis?
Reiter's Syndrome AKA Conjuctivo-urethro-synovial syndrome
45
What triad is assoc. w/ Reiter's?
arthritis, conjuctivitis, & non-specific urethritis (Can't see, can't pee, can't dance w/ me)
46
Reiter's usually follows what?
Sexual intercourse or rarely certain types of dysentery
47
What ratio does Reiter's affect males to females?
50:1 M-to-F
48
What age group is affected by Reiter's?
20-40 yrs of age
49
Where is arthritis M/C w/ Reiter's?
Lower extremity
50
Rash that is assoc w/ Reiter's that appears on the palms of the hand & bottom of the feet?
Keratodermia blennorrhagica
51
What is the M/C clinical presentation of Reiter's?
Conjuctivitis
52
What lab test is positive in 75% of cases of Reiter's?
HLA-B27
53
What are radiographic features of Reiter's?
Lower extremities (MTP, IP, calcaneus, knee, ankle) SI (bilateral asymmetrical) Spine (thoracolumbar) Non marginal syndesmophytes, Soft tissue swelling, Osteoporosis, marginal erosions, uniform decrease of joint space, periosititis
54
What is one radiographic feature common w/ Reiter's but not psoriatic?
Osteoporosis
55
Condition assoc. w/ Reiter's where there is periostitis on calcaneous
Lover's Heel
56
Reiter's & psoriatic involve more peripheral joints or more axial joints?
Peripheral
57
Disorder of purine (adenine, guanine) metabolism that results in hyperuricemia which causes the deposition of monosodium urate crystals into joints & soft tissues
Gout (Gouty Arthritis)
58
What are the pathomechanics of Gout?
Tophi irritates the synovium which leads to hyperplasia & formation of granulation tissue (pannus) which leads to erosions & cartilage destruction
59
Which type of gout is caused by a metabolic disorder where hyper-uricemia is caused by uric acid overproduction
Primary
60
Who is affected M/C from Gout?
Males 20:1 age 30-60
61
Gout attacks are precipitated by what?
``` Surgery Trauma Dietary or alcohol excess Starvation Drugs (salicylates) ```
62
This particular group of women are prone to Gout?
Postmenopausal women on diuretics
63
What are some clinical signs of Gout?
``` Prodromal irritability Sudden onset of pain 20% develop renal calculi Red, hot, dry, swollen, tender joint Local edema Sometimes fever 20% have tophi around joints & ear cartilage ```
64
What is the clinical presentation of a pt w/ asymptomatic hyperuricemia?
No s/s Predisposed to gouty arthritis Renal calculi
65
S/S of acute gouty arthritis
Affects 1st MTP joint (M/C location to see gout) Swollen, hot, dry, joint Rapid recovery
66
Type of gout where radiographic changes are most frequently encountered
Polyarticular gouty arthritis
67
Type of gout that is not common seen & lasts on avg. 10-12 years
Chronic tophaceous gout
68
Hydroxyapapitite Deposition Disease (HADD) is M/C seen where?
Supraspinatus tendon (calcification about greater tuburosity of humerus
69
What are lab findings w/ gouty arthritis?
``` Elevated uric acid Moderate leucocytosis Increased ESR Low grade proteinuria Monosodium urate crystals in joint fluid ```
70
What % of gout attacks are monoarticular?
90%
71
What % of gout attacks involve the big toe?
75%
72
What are radiographic findings assoc. w/ gout?
Asymmetrical w/ lower extremity predilection Joint effusion Uniform joint narrowing (late) Bone erosions (marginal, periarticular, intraosseous) Soft tissue masses
73
What is a radiographic sign assoc. w/ gout?
Overhanging edge sign
74
What are 2 radiographic presentations that differentiates gout from RA?
Periarticular bone erosions & a lack of juxta-articular osteoporosis
75
What is a radiographic sign seen in RA & gout?
Spotty Carpal Sign
76
Where is the M/C location to see CPPD?
Knee
77
What is the key radiographic feature of CPPD?
Chondrocalcinosis (calcification in cartilage)
78
What are 3 presentations of CPPD?
Acute-symptomatic (pseudogout) Asymptomatic-chondrocalcinosis Chronic-Pyrophosphate Arthropathy
79
Which presentation of CPPD do you see bone changes in?
Chronic (Pyrophosphate Arthropathy)
80
What would you see radiographically that would suggest a chronic presentation of CPPD?
Degenerative changes in a joint that is not a primary location of OA (MCPs, glenohumeral, radiocarpal joints)
81
If you have degenerative changes in the knee & they're localized to the ________ joint then CPPD/Pyrophosphate Arthropathy should be a consideration
Patellofemoral joint
82
This is a bilateral symmetrical SI disorder predominately found in multiparous females
Osteitis Condensans ilii
83
Osteitis Condensans Ilii is AKA?
Hyperostosis Triangularis ilii
84
What causes Osteitis Condensans Ilii?
Combination of hormone-induced ligamentous laxity & increased mechanical joint stress that leads to low-grade inflammatory & sclerotic changes involving the iliac subchondral bone
85
What is the typical clinical presentation of Osteitis Condensans Ilii?
A multiparous woman b/w 20-40 yrs of age w/ chronic LBP & stiffness
86
What labs are typically seen w/ Osteitis Condensans Ilii?
Labs are typically normal
87
Where is Osteitis Condensans Ilii seen in the SI joint on xray?
Seen on the lower 2/3rds or 1/3rd
88
What differentiates Osteitis Condensans Ilii from sacroillitis?
Sclerosis but no marginal erosions

Skeletal Rad (5 decks)

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