1.) Arthritis Flashcards
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Chronic AS
- Ghost Sign: Obliterated joint space
- Star Sign: Bridging ossification of upper portion of the SI joint
What classical finding of ankylosing spondylitis (AS) is pictured?
Anterior Body Squaring
- Thin ossification of the ALL across disc spaces
- The calcified ALL will fill the anterior body concavity causing squaring
- Anterior body squaring is only seen in 2 disorders:
- Ankylosing spondylitis
- Paget’s disease
What disorder is pictured?
Infectious Spondylodiscitis
Adult pattern of spread
- Infection begins in disc then spreads to vertebra (slowest blood flow) then involves end-plate then disc then opposite end-plate
What disorder is pictured?
Reiter’s Syndrome aka Reactive Arthritis
Spinal & SI involvement of PA and Reiter’s Syndrome are identical
What disorder is pictured?
Rheumatoid Arthritis (RA)
- Erosions
- Stair-stepping
- ADI
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Intermediate AS
- Sclerosis begins to obliterate the joint space
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Marginal Syndesmophytes: Thin ossification of ALL across disc space
- Anterior Body Squaring
- Barrel Shaped Anterior Body
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Trolly Track Sign: Facet fusion
- Dagger Sign: Intra & supraspinous ossification
What complication of carrot stick fracture (fx) is pictured?
Andersson Lesion
Development of pseudoarthrosis
- Rapid loss of adjacent endplates
- Sclerosis
- Fragmentation of vertebral body
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves atlantoaxial joint in 50-50% of RA patients
- “Whittled odontoid”: Caused by erosions at dens
- ADI synovitis
- Bursitis between dens & transverse ligament
- Alar ligament attachment
- Increased ADI
- Caused by rupture of transverse ligament
- Identical changes can happen here in:
- Ankylosing Spondylitis (AS)
- Psoriatic Arthritis (PA)
- Reiter’s Syndrome
- Systemic Lupus Erythemous (SLE)
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves the cervical spine in 50-80% of patients
- “Step ladder” or “doorstep” appearance
- Caused by multi-level anterolisthesis
- Joint narrowing with erosions on apophyseal joints
- Can lead to ankylosis
- Disc narrowing w/end-plate erosions
- “Sharpened pencil” appearance
- Erosions on SPs causing tapering
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Moving up the Spine: First changes at thoracolumbar junction in 60% of AS patients
- Romanus Lesion: Focal destruction & erosion of body rim at annulus enthesis
- Shiny Corner Sign: Transient reactive sclerosis caused by the healing of erosions
What disorder is pictured?
Infectious Spondylodiscitis
MRI helpful in diagnosis
- Prior to skeletal maturity the infection begins in disc then spreads to vertebra
- In adults the infection begins in the anterior superior vertebral body then involves end-plate then disc opposite end-plate
What disorder is pictured?
SI Infection
- Unilateral
- Loss of articular cortex
- Not really erosions
- Sclerosis
What phase of ankylosing spondylitis (AS) is pictured?
Early to Intermediate AS
- Rosary bead erosions
- Reactive sclerosis
What classical finding of ankylosing spondylitis (AS) is pictured?
Marginal Syndesmophytes
- Thin ossification of ALL across disc spaces
- Leads to:
- Bamboo spine or poker spine
- Anterior Body Squaring: The calcified ALL will fill the anterior body concavity
- Barrel Shaped Body: Slightly thickened anterior body
- Leads to:
What disorder is pictured?
Infectious Spondylodiscitis
- Prior to skeletal maturity the infection begins in disc then spreads to vertebra
- In adults the infection begins in the anterior superior vertebral body then involves end-plate then disc opposite end-plate
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Occasionally skips thoracic spine
- Hardest area of the spine to see AS
- Can involve costovertebral or costotransverse joints
What complication of carrot stick fracture (fx) is pictured?
Andersson Lesion
Development of pseudoarthrosis
- Rapid loss of adjacent endplates
- Sclerosis
- Fragmentation of vertebral body
What disorder is pictured?
Psoriatic Arthritis (PA)
CT of non-marginal syndesmophytes
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Bamboo Spine Appearance
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Thin anterior ossification
- Lower SI involved
What classical finding of psoriatic arthritis (PA) is pictured?
Non-Marginal Syndesmophytes
in Psoriatic Arthritis (PA)
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Upper cervical involvement in 2-15% of AS patients
What disorder is pictured?
Psoriatic Arthritis (PA)
-
Non-Marginal Syndesmopytes
- Spinal changes in PA identical to those seen with Reiter’s syndrome
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Marginal Syndesmophytes: Thin ossification of ALL across disc spaces
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves the cervical spine in 50-80% of patients
- “Step ladder” or “doorstep” appearance
- Caused by multi-level anterolisthesis
- Joint narrowing with erosions on apophyseal joints
- Can lead to ankylosis
- Disc narrowing w/end-plate erosions
- “Sharpened pencil” appearance
- Erosions on SPs causing tapering
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Shiny Corner Sign: Transient reactive sclerosis caused by the healing of erosions
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Marginal Syndesmophytes: Thin ossification of ALL across disc spaces
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Early AS
- Bilateral & symmetric
- Pseudo-widening of joint
- Rosary bead erosions
- Sclerosis: Always more prominent on iliac side
- Best seen on sacral tilt film
- Easy to overlook early changes
What classical finding of ankylosing spondylitis (AS) is pictured?
Poker Spine Appearance
What classical finding of ankylosing spondylitis is pictured?
Bamboo Spine
What phase/type of ankylosing spondylitis (AS) is pictured?
Chronic Ankylosing Spondylitis
- Ghost Sign: Obliterated joint space
- Star Sign: Bridging ossification of upper portion of the SI joint
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Costovertebral & costotransverse fusion
What disorder is pictured?
Infectious Spondylodiscitis
MRI helpful in diagnosis
- Prior to skeletal maturity the infection begins in disc then spreads to vertebra
- In adults the infection begins in the anterior superior vertebral body then involves end-plate then disc opposite end-plate
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves atlantoaxial joint in 50-50% of RA patients
- “Whittled odontoid”: Caused by erosions at dens
- ADI synovitis
- Bursitis between dens & transverse ligament
- Alar ligament attachment
- Increased ADI
- Caused by rupture of transverse ligament
- Identical changes can happen here in:
- Ankylosing Spondylitis (AS)
- Psoriatic Arthritis (PA)
- Reiter’s Syndrome
- Systemic Lupus Erythemous (SLE)
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Dagger Sign: Ossification of the intra & supraspinous ligaments causing a vertical central radiolucent shadow
What phase of ankylosing spondylitis (AS) is pictured?
Early Ankylosing Spondylitis
- Bilateral & Symmetric
- Pseudo-widening of joint
- Rosary bead erosions
- Sclerosis: Always more prominent on iliac side
- Best seen on sacral tilt film
- Easy to overlook early changes
What 2 classical findings of ankylosing spondylitis are pictured?
1.) Trolley Track Sign: Facet Fusion
2.) Dagger Sign: Intra & Supraspinous Ossification
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves atlantoaxial joint in 50-50% of RA patients
- “Whittled odontoid”: Caused by erosions at dens
- ADI synovitis
- Bursitis between dens & transverse ligament
- Alar ligament attachment
- Increased ADI
- Caused by rupture of transverse ligament
- Identical changes can happen here in:
- Ankylosing Spondylitis (AS)
- Psoriatic Arthritis (PA)
- Reiter’s Syndrome
- Systemic Lupus Erythemous (SLE)
What disorder is pictured?
DISH
Diffuse Idiopathic Skeletal Hyperostosis
- Thick disc & mid-body
- No lower SI involvement
- May have upper SI involvement
What disorder is pictured?
Osteoarthritis (OA) aka Degenerative Joint Disease (DJD)
- Sclerosis
- Enlarged facets
- Anterolisthesis: Usually one level if present
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
- Marginal Syndesmophytes: Thin ossification of ALL across disc spaces
What disorder is pictured?
Infectious Spondylodiscitis
MRI helpful in diagnosis
- Prior to skeletal maturity the infection begins in disc then spreads to vertebra
- In adults the infection begins in the anterior superior vertebral body then involves end-plate then disc opposite end-plate
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Early AS
- Widened joint
- Frayed joint margin
- Sclerosis on the iliac side of the SI joints
What disorder is pictured?
Infectious Spondylodiscitis
May end with vertebral fusion
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves the SI joints in 25-35% of patients
- Mild loss of joint space
- Iliac erosions
- Sclerosis is minimal or absent
- Usually unilateral
- If bilateral = asymmetric
- Ankylosis very rare
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Upper cervical involvement in 2-15% of AS patients
What classical finding of ankylosing spondylitis is pictured?
Shiny Corner Sign
Transient reactive sclerosis caused by the healing of erosions
What disorder is pictured?
Psoriatic Arthritis (PA)
SI joint involvement in 30-50% of PA patients
- Usually bilateral asymmetrical
- Can be unilateral
- Erosions with mild sclerosis
- Typically does not proceed to fusion
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Anterior body squaring
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves the cervical spine in 50-80% of patients
- “Step ladder” or “doorstep” appearance
- Caused by multi-level anterolisthesis
- Joint narrowing with erosions on apophyseal joints
- Can lead to ankylosis
- Disc narrowing w/end-plate erosions
- “Sharpened pencil” appearance
- Erosions on SPs causing tapering
What disorder is pictured?
Ankylosing Spondylitis (AS) aka Marie-Strumpell’s aka Bechterew’s Disease
Poker Spine Appearance
What disorder is pictured?
Rheumatoid Arthritis (RA)
Common in the atlanto-occipital joint
- Loss of joint space w/erosions
- Vertical translation of odontoid
- Causes “Pseudo-basilar invagination”
What phase of ankylosing spondylitis (AS) is pictured?
Intermediate AS
- Sclerosis begins to obliterate the joint space
What disorder is pictured?
Infectious Spondylodiscitis
- Prior to skeletal maturity the infection begins in disc then spreads to vertebra
- In adults the infection begins in the anterior superior vertebral body then involves end-plate then disc opposite end-plate
What disorder is pictured?
Rheumatoid Arthritis (RA)
Involves the cervical spine in 50-80% of patients
- “Step ladder” or “doorstep” appearance
- Caused by multi-level anterolisthesis
- Joint narrowing with erosions on apophyseal joints
- Can lead to ankylosis
- Disc narrowing w/end-plate erosions
- “Sharpened pencil” appearance
- Erosions on SPs causing tapering
What classical finding of ankylosing spondylitis (AS) is pictured?
Carrot Stick Fx
- MC in lower cervical & T/L junction
- Causes epidural hematoma in 20% of carrot stick fxs
