(2,3) Other Degenerative Arthridities Flashcards
What is erosive osteoarthritis (EOA)?
inflammatory variant of OA
What population is primarily affected by erosive osteoarthritis?
middle-aged females
What joints are typically involved in erosive osteoarthritis?
bilateral symmetric:
- DIP
- PIP
What are the clinical findings of erosive osteoarthritis?
- pain
- edema
- redness
- normal labs
- chronic progressive changes w/ deformities
15% of patients with erosive osteoarthritis may progress to ____
rheumatoid arthritis
(refer to rheumatology)
What radiographic sign is associated with erosive osteoarthritis?
“gull-wing” deformity:
- distal bone = lat. osteophytes
- prox. bone = central intra-articular erosions
creates articular surface invagination
What populations are primarily affected by diffuse idiopathic skeletal hyperostosis (DISH)?
- 25% of men >50yrs
- 15% of women >50yrs
What are the clinical manifestations of diffuse idiopathic skeletal hyperostosis (DISH)?
- mild LBP & stiffness
- dysphagia (if in c/s)
What 2 conditions are associated with DISH?
- OPLL (in up to 50% of cases)
- diabetes mellitus (20%)
How would you know if you are safe to adjust a patient with DISH?
check ROM in flexion & extension
(only absolute contraindication if ankylosing)
What is the most common target site of DISH?
T7-T11
(may be more on R side d/t aorta)
What question should you ask your patient who has DISH in the cervical spine?
any problems swallowing solid foods?
(mechanical dysphagia)
What are the target sites of DISH?
- T7-T11
- c/s
- t/s
- l/s
- enthesophytes (lig/tendon attachment sites)
- ligament ossification (anterior to bodies & discs)
What is the diagnostic criteria for DISH?
- Flowing hyperostosis (ossification + hypertrophy) of the ALL of 4 contiguous segments (doesn’t have to bridge)
- no SI involvement
*need spinal imaging to Dx
What additional radiographic findings tend to be seen in DISH?
- preservation of disc spaces
- absence of DJD
- enthesophytes
What radiographic sign is pathognomonic for DISH?
cleavage plane
(lucency between ossified ALL and anterior vertebral bodies)
What is the normal thickness of the ALL?
2mm
What percent of patients with DISH also have OPLL?
up to 50%
What is another name for ossification of the posterior longitudinal ligament (OPLL)?
formerly called Japanese spine Dz
What is the diagnostic criteria for OPLL?
hyperostosis of PLL in at least 1 segment
(parallel & just posterior to posterior body line, hard to see b/c of facets)
What is the most common target site of OPLL?
C2-C4
What is the biggest concern for patients with OPLL?
severe central canal stenosis
(aggravated by extension)
What is the diagnosis for a patient who has flowing hyperostosis of the ALL from T8-T11 and of the PLL at C3?
DISH w/ OPLL
Name 4 common causes of neuropathic arthropathy (NA).
- diabetes mellitus
- alcoholism
- trauma (paralysis)
- syringomyelia
Name 4 uncommon causes of neuropathic arthritis.
- congenital insensitivity to pain
- neurosyphilis
- myelomeningocele
- leprosy (Hanson’s Dz)
What is Neuropathic Arthropathy?
progressive joint destruction secondary to a neurological disorder
What is the most common cause of neuropathic arthritis in the feet and lumbar spine?
diabetes mellitus
What is a common cause of neuropathic arthritis in the shoulder and upper extremity joints?
syringomyelia
What is a common cause of neuropathic arthritis in the lumbar spine and knee?
neurosyphilis (tertiary syphilis)
What is a common cause of neuropathic arthritis in the lower extremity?
leprosy (Hanson’s disease)
What are the 2 forms of Neuropathic arthropathy?
Hypertrophic & Atrophic
What are some buzz word terms used in describing the appearance of hypertrophic neuropathic arthropathy?
- “Bag of bones” appearance
- rocker bottom arch
- “tumbled building block” spine
What mnemonic can be used when describing the radiographic characteristics of Hypertrophic NA? What is required for diagnosis?
6 D’s (3 Dis words, 3 De words); require minimum of 3 D’s to Dx
- Distension
- Dislocation
- Disorganization
- Density (subchondral sclerosing)
- Debris
- Destruction
What are the radiographic characteristics of Atrophic NA?
(vascular component)
- “licked candy stick” appearance (tapered bone ends)
- surgically amputated appearance
- resorption of bone
What 2 buzz word terms are used exclusively in describing Atrophic NA?
- “licked candy stick” appearance
- “surgically amputated” appearance (common in shoulder)
What is the most common cause of neuropathic arthropathy?
diabetes
What are alternative names for Synoviochondrometaplasia (SCM)?
Synovial osteochondromatosis
what is SCM?
creation of osteochondral loose bodies inside the joint capsule
what are the forms of SCM?
- primary SCM (idiopathic)
- secondary SCM (2* to a degeneration)
what are the clinical features of SCM?
(non-specific)
- joint pain
- swelling
- crepitus
- locking
what is the #1 symptom of SCM?
joint locking
what is the #1 cause of joint locking in the knee?
meniscal tear
what are the radiographic features of primary SCM?
- loose bodies w/ similar size + shape (only seen if ossified)
- none-mild DJD
what is the treatment for primary SCM? what are the consequences and subsequent management of this treatment?
Loose body resection
partial Synovectomy: synovium lining removed to prevent recurrence
- no synovium = decrease immune function, decrease lubrication, & ^DJD
- lubricant injection every 6 months (glucosaminoglycan)
what are the radiographic features of 2* SCM?
- loose bodies w/ different size + shape (only seen if ossified)
- pre-exisiting moderate to severe degenerative change
what is the treatment for secondary SCM?
- conservative management, NSAIDs
- Arthroscopic loose body removal: vacuum out loose bodies (degeneration isn’t of concern b/c pre-exists)
What age group is primarily affected by SCM?
30-50 yrs
What are the most common joints targeted by SCM?
- knee
- hip
- ankle
- elbow
- wrist
