Learning Radiology Book - Arthritis Flashcards Preview

Clin Med IV - Ortho > Learning Radiology Book - Arthritis > Flashcards

Flashcards in Learning Radiology Book - Arthritis Deck (43):
1

Types of arthritis that are diagnosed clinically (4)

- Septic (pyogenic) arthritis
- Psoriatic arthritis
- Gout
- Hemophilia

2

Types of arthritis that are diagnosed radiologically (6)

- Osteoarthritis
- Early rheumatoid arthritis
- Calcium pyrophosphate deposition
- Ankylosing spondylitis
- Septic (TB)
- Charcot (neuropathic) joint, late

3

Earliest structure involved in arthritis

Synovial membrane

4

Synovial membrane, synovial fluid and articular cartilage are not visible on ______ but are visible on _______

Not visible on X-ray
Visible on MRI, but X-ray still first

5

Arthritis almost always includes _______

Joint space narrowing

6

3 types of arthritis

- Hypertrophic arthritis → bone formation
- Erosive arthritis → inflammation, irregularly-shaped lytic lesions (erosions)
- Infectious arthritis

7

Osteophyte

Bone formation that protrudes from parent bone

8

How does infectious arthritis occur?

Hematogenous seeding of synovial membrane from infected source in body or direct extension from osteomyelitis near joint

9

Types of hypertrophic arthritis (4)

- Osteoarthritis/DJD
- Erosive osteoarthritis
- Charcot arthropathy (neuropathic joint)
- Calcium pyrophosphate deposition dz (CPPD)

10

Pathophysiology of primary osteoarthritis

Degeneration of articular cartilage from wear/tear in weight-bearing joints

11

Most common joints involved in primary osteoarthritis

- Hips (superior and lateral)
- Knees (medial)
- Hands (1st CMC joint, DIP joints)

12

What would you see on imaging of primary OA?

- Marginal osteophyte formation
- Subchondral sclerosis
- Subchondral cysts
- Narrowing of joint space

13

How would you differentiate secondary OA from primary?

Degeneration d/t underlying condition, e.g. trauma
- Younger patient (e.g. 20's)
- Unilateral/asymmetrical
- Atypical locations

14

Erosive osteoarthritis is more common in what pt population?

Perimenopausal women

15

Commonly affected joints in erosive OA (3)

PIP and DIP joints
1st digit joints

16

What might you see on imaging of erosive OA?

- Gull-wing deformity → central erosions within joint w/ small osteophytes
- Bony ankylosis (uncommon in DJD)

17

Pathophysiology of Charcot arthropathy

Neuropathic joint → disturbance in sensation leads to multiple microfractures, autonomic imbalance, hyperemia, bone resorption/fragmentation

18

Clinical presentation of Charcot arthropathy

- Sensory disturbance but associated pain
- Soft tissue swelling

19

Most common cause of Charcot arthropathy is _______

Diabetes

20

Charcot arthropathy commonly affects _______

Lower extremities, esp. feet & ankles

21

Hallmarks of Charcot arthropathy

- Fragmentation (numerous, small bony densities)
- Eventual destruction of joint

22

Charcot arthropathy and osteomyelitis can share similar radiologic findings. How do you differentiate the two?

Radioisotope-tagged white cell bone scan

23

Pathophysiology of calcium pyrophosphate deposition dz

Deposition in mostly hyaline cartilage and fibrocartilage

24

Ca++ pyrophosphate deposition dz most common affects _______ and _______

Triangular fibrocartilage of wrist
Menisci of knee

25

Radiologic findings of Ca++ pyrophosphate deposition dz

- Subchondral cysts (larger and more numerous than DJD)
- Hook-shaped bony excrescences along 2nd and 3rd metacarpal heads

26

Characteristic findings of Ca++ pyrophosphate deposition dz in wrist

- Calcification of triangular fibrocartilage
- Narrowing of radiocarpal joint
- Scapholunate dissociation and advanced collapse

27

Types of erosive arthritis (4)

- Rheumatoid arthritis
- Gout
- Psoriatic arthritis
- Ankylosing spondyitis

28

Clinical presentation of rheumatoid arthritis

- Bilateral, symmetrical
- Soft tissue swelling
- Osteoporosis
- Frequently affects proximal joints of hands and wrists

29

Pathophysiology of gout

Deposition of calcium urate crystals in joints

30

Dx gout

- Clinical diagnosis, not radiological b/c extremely long latent period (5-7 yrs) b/w sx onset and visible bone changes
- Monoarticular at onset then asymmetrical later

31

Gout most often affects ______

MTP joint of great toe

32

Hallmark of gout

Rat-bites → sharpy marginated juxtaarticular erosion that tends to have sclerotic border

33

Difference b/w Rheumatoid Arthritis and Gout

RA is more common in females, affects hands/wrists, bilateral, early changes include ostEoporosis

34

Findings in gout

- Asymmetrical
- Most often affects MTP joint of big toe
- Rat-bites
- Late findings: joint space narrowing, tophi (urate crystals in soft tissues)
- Olecranon bursitis

35

Hallmarks of psoriatic arthritis

- Juxtaarticular erosions, esp. DIP joints
- Enthesophytes → bony proliferations at tendon insertion sites
- Resorption of terminal phalanges or DIP joints with pencil-in-cup deformity
- Bilateral but asymmetric sacroiilitis

36

Pathophysiology of ankylosing spondylitis

Inflammation and eventual fusion of SI joints, spinal facet joints and involvement of paravertebral soft tissue

37

Findings of ankylosing spondylitis

- Ascends spine, starting at SI joint
+HLA-B27
- Sacroiilitis (hallmark)
- Ossification of outer fibers of annulus fibrosis → syndesmophytes → bamboo-spine

38

Most common causes of pyogenic (septic) arthritis

Staphylococcus
Gonococcus

39

Most common cause of nonpyogenic arthritis

M. tuberculosis from lungs

40

Risk factors for infectious arthritis

- IVDA
- Steroids
- Joint prosthesis
- Recent joint trauma

41

Most frequently affected joints in infectious arthritis

Knee
Knee + hip in peds

42

Dx infectious arthritis

Aspiration of joint (plain films insensitive)

43

Hallmark of infectious arthritis

Destruction of articular cartilage and long, contiguous segments of adjacent cortex d/t proteolytic enzymes released by inflamed synovium