Flashcards in Radiology of Rheumatic Disorders Deck (37):
What are the three types of arthritis that can be distinguished by radiographs?
1. Degenerative joint disease
2. Inflammatory arthritis
3. Metabolic arthritis
what is the main cause of primary OA?
Abnormally high mechanical forces on normal join
What is primary OA?
Abnormally high mechanical forces on normal joint
No underlying local etiologic factors
what is the cause of secondary OA? what is the main cause?
Normal forces on abnormal joint
What clinical findings will you have for DJD?
Characteristics of joint discomfort:
Aggravated by joint use; relieved by rest
Morning stiffness < 15 minutes
Heberden’s nodules and Bouchard’s nodes
what joints are most frequently involved?
DIP, PIP, first carpometacarpal (CMC)
Hips, Knees, Spine
First metatarsal phalangeal (MTP)
what joints are commonly spared with OA?
are there systemic manifestations?
Wrist, elbow, shoulder, ankles
NO systemic manifestations
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
radiographic OA knee findings
- Joint space narrowing in the medial compartment
- osteophyte formation
what are the nodes found at the DIP? the PIP?
Heberden’s nodes in DIP
Bouchard’s nodes in PIP
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)
what are the FIVE hallmark features of radiographs for OA??
Narrowing of joint space, usually asymmetric
Subchondral cysts (true cysts or pseudocysts)
Lack of osteoporosis
What is eburnation?
Thinning and loss of articular cartilage
Results in exposure of subchondral bone
Bone becomes denser
Surfaces become worn and “polished”
what are subchondral space and cysts?
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.
What is erosive OA?
1. OA with superimposed:
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
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
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
What are the three types of inflammatory arthritis:
A. Autoimmune arthritis
B. Seronegative spondylarthropathies
1. Ankylosing spondylitis
2. Reiter’s syndrome
4. Enteropathic arthropaties
C. Erosive OA
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)
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
Soft tissue swelling
Uniform joint space loss at radiocarpal compartment of wrist
What are the late changes of RA?
-Erosions (pannus formation, granulation tissue)
-Erosions of ulnar styloid and triquetrum
Subchondral cyst formation
Fibrous ankylosing is a late finding
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).
What are the extraarticular manifestations of RA?
-Abdominal:Secondary renal disease
-Arteritis: infarction, claudication
Pleural effusion; interstitial fibrosis; Pulmonary nodules
pneumoconiosis, rheumatoid lung nodules, RA
Pneumonitis (very rare)
Pericarditis and pericardial effusion, 30 %
RA; splenomegaly; Neutropenia; Thrombocytopenia
What is scleroderma?
-Soft tissue abnormalities : calcifications
-Erosive arthritis: DIP and PIP
What is SLE?
-Nonerosive arthritis (in 90% of SLE)
-Ligamentous laxity and joint deformity
-Distribution similar to that seen in RA
What radiographic findings will you see with SLE?
Prominent subluxations of MCP
Usually bilateral and symmetric
Soft tissue swelling may be the only indicator
what is the hallmark finding of DERMATOMYOSITIS?
Widespread soft tissue calcification
what is ANKYLOSING SPONDYLITIS?
Males >> females
HLA-B27 in 90-95 %
Insidious onset of back pain and stiffness
Involves axial skeleton and proximal large joints
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
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
Where are the most common sites for gout?
Lower ext > upper ext; small joints > large joints
First MTP most common site
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
What are the two main radiographic features of pseudogout?
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
what is the most commonly affected joint in psuedogout?
how does infectious arthritis usually spread?
via the blood, it spreads to the synovium and then to the joint itself
how do you diagnose a infectious joint and what is the most common organism?
Diagnosis made by joint aspiration
Staph aureus (most common)