Radiology of Rheumatic Disorders Flashcards Preview

MED: Ortho/Rheum > Radiology of Rheumatic Disorders > Flashcards

Flashcards in Radiology of Rheumatic Disorders Deck (37):
1

What are the three types of arthritis that can be distinguished by radiographs?

1. Degenerative joint disease
--->Osteoarthritis
2. Inflammatory arthritis
--->Rheumatoid
---->Seronegative
---->Erosive
3. Metabolic arthritis
--->Gout
--->Pseudogout

2

what is the main cause of primary OA?

Abnormally high mechanical forces on normal join

3

What is primary OA?

Abnormally high mechanical forces on normal joint
No underlying local etiologic factors
Age related

4

what is the cause of secondary OA? what is the main cause?

Normal forces on abnormal joint
- TRAUMA!

5

What clinical findings will you have for DJD?

Characteristics of joint discomfort:
Aggravated by joint use; relieved by rest
Morning stiffness < 15 minutes

Joint Exam:
Local tenderness
Joint enlargement
Crepitus
Effusion
Gross deformity
Heberden’s nodules and Bouchard’s nodes

6

what joints are most frequently involved?

DIP, PIP, first carpometacarpal (CMC)
Hips, Knees, Spine
First metatarsal phalangeal (MTP)

7

what joints are commonly spared with OA?
are there systemic manifestations?

MCP
Wrist, elbow, shoulder, ankles
NO systemic manifestations

8

radiographic HIP OA findings:

- loss of superolateral joint space
- lateral subluxation of the femoral head
- large medial acetabular osteophyte
- sclerosis of the acetabulum, especially in the area of lost joint space

9

radiographic OA knee findings

- Joint space narrowing in the medial compartment
- osteophyte formation

10

what are the nodes found at the DIP? the PIP?

Heberden’s nodes in DIP

Bouchard’s nodes in PIP

11

The arthritis of the thumb, what will you see on radiographs?

Joint space between the trapezium and thumb metacarpal is obliterated
(also see joint space narrowing and osteophyte formation)

12

what are the FIVE hallmark features of radiographs for OA??

Narrowing of joint space, usually asymmetric
Subchondral sclerosis
Subchondral cysts (true cysts or pseudocysts)
Osteophytes
Lack of osteoporosis

13

What is eburnation?

Thinning and loss of articular cartilage
Results in exposure of subchondral bone
Bone becomes denser
Surfaces become worn and “polished”

14

what are subchondral space and cysts?

Sclerosis
Medial migration with remodeling of the acetabulum
Cystic changes are apparent on both sides of the joint, and loss of joint space is noted as well.

15

What is erosive OA?

1. OA with superimposed:
--Inflammatory changes
--Erosive changes
2. Erosive changes of DIP and PIP
3. Central erosions and marginal osteophytes
-Produces GULL-WING pattern
=Involvement of FIRST CMC may help distinguish from RA
=Interphalyngeal FUSION may occur

16

What is degenerative disc disease?

-->Affects the intervertebral symphyses
Amphiarthroses – cartilaginous junctions

-The loss of fluid in your discs
-Tiny tears or cracks in the outer layer (annulus or capsule) of the disc

--Is NOT technically DJD
--->Which affects diarthrodial (synovial) joints
Degenerative disk disease and DJD often, but not always, occur together

17

What pre-disposes someone to degenerative disc disease

These changes are more likely to occur in people who smoke cigarettes and those who do heavy physical work (such as repeated heavy lifting). People who are obese are also more likely to have symptoms of degenerative disc disease

18

What are the three types of inflammatory arthritis:

A. Autoimmune arthritis
--RA
--Scleroderma
--SLE
--Dermatomyositis

B. Seronegative spondylarthropathies
1. Ankylosing spondylitis
2. Reiter’s syndrome
3. Psoriasis
4. Enteropathic arthropaties

C. Erosive OA

19

What are the symptoms of RA?

Morning stiffness (indicator of inflammation)
Pain on motion (in at least one joint)
Swelling of one joint
Swelling of another joint
Symmetric swelling (DIP involvement excluded)
Subcutaneous nodules (exclude CPPD dep. dis.)
Typical radiological changes
Positive rheumatoid factor (> 1:64)
Synovial fluid (poor mucin clot formation)

20

What are the early changes of RA?

1. Periarticular soft tissue swelling
2. Juxtaarticular osteoporosis in symmetric distribution
3. Preferred sites of early involvement:
Hands: 2nd and 3rd MCP joint
Feet: 4th and 5th MTP joint

Juxta-articular osteoporosis
Small erosions
Soft tissue swelling
Uniform joint space loss at radiocarpal compartment of wrist

21

What are the late changes of RA?

Late Changes:
-Erosions (pannus formation, granulation tissue)
-Erosions of ulnar styloid and triquetrum
Subchondral cyst formation
Subluxations
Carpal instability
Fibrous ankylosing is a late finding

22

What will you see on the hips with RA radiographs?

1. Medial and superior migration of the femoral heads (black arrows)
2. Periarticular cystic and erosive changes (white arrows)
3. Sclerosis (arrowheads).

23

What are the extraarticular manifestations of RA?

-Abdominal:Secondary renal disease
-Arteritis: infarction, claudication
-Pulmonary:
Pleural effusion; interstitial fibrosis; Pulmonary nodules
-Caplan syndrome:
pneumoconiosis, rheumatoid lung nodules, RA
Pneumonitis (very rare)
-Cardiac:
Pericarditis and pericardial effusion, 30 %
Myocarditis
-Felty Syndrome
RA; splenomegaly; Neutropenia; Thrombocytopenia

24

What is scleroderma?

Manifests as:
-Soft tissue abnormalities : calcifications
-Erosive arthritis: DIP and PIP

25

What is SLE?

Manifests as:
-Nonerosive arthritis (in 90% of SLE)
-Ligamentous laxity and joint deformity
-Distribution similar to that seen in RA

26

What radiographic findings will you see with SLE?

Prominent subluxations of MCP
Usually bilateral and symmetric
No erosions
Soft tissue swelling may be the only indicator

27

what is the hallmark finding of DERMATOMYOSITIS?

Widespread soft tissue calcification

28

what is ANKYLOSING SPONDYLITIS?

Seronegative spondyloarthropathy
Males >> females
HLA-B27 in 90-95 %
Insidious onset of back pain and stiffness
Involves axial skeleton and proximal large joints

29

what is the initial site of involvement for ankylosing spondylitis?

1. Sacroilic joint initial site of involvement-->Bilateral, symmetric
2. Contiguous thoracolumbar involvement
--> bamboo spine
3. Arthritis of proximal joints

30

What are metabolic deposition disorders?

1. Accumulation of crystals or other substances in the joint
2. Involve cartilage and soft tissues
3. Crystals in joints elicit synovial inflammation

Secondary arthritis develops and presents as either:
Acute inflammatory arthritis
Chronic destructive arthropathy

31

Where are the most common sites for gout?

Lower ext > upper ext; small joints > large joints
First MTP most common site

32

What are some of the radiographic findings of gout?

-Marginal, pararticular erosions: overhanging edge
-Erosions may have sclerotic border
-Joint space is preserved
-Soft tissue and bursa deposition
Tophi: juxtaarticular, helix of ear
Bursitis: olecranon, prepatellar
Chondrocalcinosis

33

What are the two main radiographic features of pseudogout?

1. Chondrocalcinosis
Hyaline cartilage: linear calcification especially in knee
Fibrocartilage: menisci, wrist, shoulder, pelvis, spine

2. Arthropathy resembling OA
Differs in distribution
Predominance of knee (patellofemoral predilection)
Radiocarpal joint, second and third MCP
Subchondral cysts are a common and distinctive feature

34

what is the most commonly affected joint in psuedogout?

the knee

35

how does infectious arthritis usually spread?

via the blood, it spreads to the synovium and then to the joint itself

36

how do you diagnose a infectious joint and what is the most common organism?

Diagnosis made by joint aspiration
Staph aureus (most common)

37

what are three different radiographs ways to detect infectious spread?

1. xray
2. bone scan
3. mri

Plain film
-->Joint effusion
-->Juxtaarticular osteoporosis
-->Destruction of subchondral bone on both sides of joint
Bone Scan
-->Useful if underlying osteomyelitis is suspected
MRI
-->Joint effusion
-->Sensitive in detecting early cartilage damage