2nd half of Arthritis Lecture (slide 56 on) Flashcards
Calcium Deposition Diseases: -calcium can be deposited in joint _____
soft tissues in a number of entities
Calcium Deposition Diseases: -Calcification can be in:
articular cartilage, menisci, tendons, soft tissues, and bursae
**Chondrocalcinosis is technically the term for a condition of calcification of soft tissue articular structures as seen on imaging studies, calcifications seen in _____
cartilage, menisci, cruciate ligaments, and synovium with calcium compound crystals.
Chondrocalcinosis is found in a number of disease processes including: (hint: there’s a lot)
Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPDCDD is sometimes called Chondrocalcinosis and Pseudogout!!), Pseudogout, Tophaceous Pseudogout, Osteoarthritis, Familial CPPDDD, Basic Calcium Phosphate Crystal Deposition Disease, gout, hyperparathyroidism, hemochromatosis, hypophosphatasia, hypomagnesemia, ochronosis, Wilson’s Disease, acromegaly and entities mimicking rheumatoid arthritis, osteoarthritis and neuropathic arthropathy.
Calcium Pyrophosphate Dihydrate Crystal Deposition occurs in a number of disease entities, including the following:
Pseudogout, Tophaceous Pseudogout, Familial Calcium Pyrophosphate Dihydrate Deposition, and Osteoarthritis, pseudoosteoarthritis, pseudorheumatoid arthritis, and pseudoneuropathic arthropathy. (notes: just know that calcium will deposit into soft tissue, BUT there are also disease processes that deposit calcium into the joints)
Chondrocalcinosis is the condition of ______ _____ _____ calcifications as seen on medical imaging studies.
articular soft tissue
Calcium Pyrophosphate Dihydrate crystals are deposited in ______
articular soft tissues in a number of disease entities –>Need a joint aspiration to determine
Pseudogout is one of several disease entities in which calcium pyrophosphate dihydrate crystals are deposited in the _______
articular soft tissues
_______ is the MC of the calcium deposition arthropathies
pseudogout -The source of confusion: Pseudogout is also known as Calcium Pyrophosphate Deposition Disease, Calcium Pyrophosphate Dihydrate Deposition Disease, and Chondrocalcinosis, and some include it in a separate category as one of the CPPD Disease
Pseudogout: -is a disease of _____ -symptoms? -____ deposits cause an inflammatory gout-like process
-It is a disease of aging -It may be asymptomatic -Synovial (and fibrous and hyaline articular cartilage) Calcium Pyrophosphate crystal deposits cause an inflammatory gout like process
Gout itself is the accumulation of:
articular monosodium urate monohydrate crystals
Calcium Deposition – Chondrocalcinosis
note yellow arrows (Ca 2+ deposition)
Calcium Deposition – ChondrocalcinosisCPPDD
-**Note evidence of laxity of scapholunate ligament
Avascular Necrosis=Osteonecrosis aka Aseptic Necrosis: -usually seen in the _____ -how common?
-**femoral head -Increasingly common, accounts for 10% of Total Hip Replacements
Femoral Head is an end organ system with poor collateral circulation. Compromise of the arterial supply, especially the _____ _____ artery, causes ischemia.
**medial circumflex artery
Femoral head avascular necrosis can be seen 2/2: (lots of things)
-Trauma -Vasculitis -Vasospasm–>decompression -Circulating microemboli: –Hemoglobinopathies (Sickle Cell Disease) –Fat emboli –Hypercoagulable States –Decompression Sickness -Steroid Therapy -Alcoholism -Pancreatitis -Dialysis
Normal Hip: Normally there are thickened and prominent _______ seen in the Femoral Head. Maximal strength with minimal mass in response to _______
*trabeculae -mechanical stress.
Normal Hip MR: note _____
*symmetry
Avascular Necrosis: -imaging findings?
-Note mild osteoarthritis characterized by joint space narrowing, periarticular sclerosis and osteophytosis. -Note superimposed flattening of the femoral head indicating osteonecrosis with subchrondral fracture and buckling of the underlying trabeculae -Note: distorted trabeculae and collapse of subchondral bone
Describe Avascular Necrosis in the scaphoid bone -This is seen with which demographic?
-Similar phenomenon occurs in Scaphoid bone with compromised circulation -Seen with: alcoholism, steroids, Bends, arterial embolism/thrombosis, & Sickle Cell Anemia.
Avascular necrosis: -describe the circulation to the femoral head -Tx?
The blood supply to the Femoral head is primarily via the *Medial circumflex femoral artery, and to a lesser extent the *Lateral Circumflex artery. -There is also blood flow via the artery to the Ligamentum teres (a branch of the Obturator artery) -Compromise to this latter artery can also lead to Avascular Necrosis of the Femoral Head –tx of AVN–> replace the femoral head usually since you usually lose integrity of articular surfaces
Neuropathic ArthropathyCharcot’s Joint: describe this condition
-risk factors? (which Pt demographic)
=loss of deep sensation and proprioception–>leads to recurrent trauma and progressive destruction, degeneration, and disorganization of the joint. (they have repeated
- Also to be considered is neuromediated vascular reflex causing hyperemia and bone resorption.
- Diabetes, trauma, steroids, alcoholism, neurological and spinal disorders
Neuropathic ArthropathyCharcot’s Joint: -signs?
Joint effusions, destruction of articular surfaces, bone fragmentation, subluxation, osteophytosis, sclerosis
Neuropathic joint
Neuropathic Joint: associated tabes doralis (Tabes dorsalis is a slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain. The degenerating nerves are in the dorsal columns of the spinal cord) and also seen in Leprosy.
Tabes dorsalis: dorsal column spinal disease 2/2 tertiary sphyillis)
Neuropathic Joint: in DM
Diabetes: Note the degenerative arthritis in Ist MTP joint Note destructive changes in the tarsal bones
Ankylosing Spondylitis=
=Inflammation of multiple articular and para-articular sites -Spondylitis is related to the spine, ankylosing means fusion -An enthesopathy, an inflammatory process of the attachments to bone of the ligaments, tendons, and joint capsules with subsequent calcification and ossification and ankylosis.
Ankylosing Spondylitis:
add image —>On the left note sacroiliitis with subchondral sclerosis and erosions. This will progress to what is seen on the right, fusion of the sacroiliac joints
(image is what is seen after disease has progressed)
Ankylosing Spondylitis: note the ossification of ligaments bridging vertebral bodies ( syndesmophytes) and ______
facet joint fusion
Anklosing Spondylitis: key findings on Xray is ____ spine
*“bamboo spine” Bamboo Spine= Solid ankylosis of facet joints and syndesmophytosis of entire spine ligamentous structures (KNOW!)
Ankylosing Spondylitis: -The rigidity and loss of flexibility of the spine in Ankylosing Spondylitis makes it more vulnerable to:
fracture and resultant neurological injury
Reactive Arthritis–Reiter’s Syndrome: -describe? -associated with which antigen? -it’s a type of seronegative ______
=an arthritis complicating an infection elsewhere in the body and no organism can be cultured from the affected joint. -Associated with positive Histocompatibility Antigen called the Human Leukocye Antigen **HLA-B27 -*A type of seronegative (for rheumatoid factor) spondyloarthropathy
Reactive ArthritisReiter’s Syndrome: can be triggered by?
by bacterial pathogens related to dysentery and STDs, especially Chlamydia, also
“cant see–conjunctivitis, cant climb a tree- arthritis, urethritis-cant pee”
Reiter Syndrome is arthritis, conjunctivitis (or uveitis), and ______
urethritis
Reactive Arthritis can be mono or ____
poly arthropathic
Reactive arthritis: imaging study
add image findings: -Severe erosive changes on Left with subluxations -Small erosions in First MC heads with subluxations
(image shows severe erosive changes)
Pigmented Villonodular Synovitis= is a benign, _______ disorder of:
=Benign, proliferative disorder of thickened synovium with villous and nodular proliferation -**Nodular intra-articular masses= KEY finding
Complex Regional Pain Syndromeformally called________
Reflex Sympathetic Dystrophy
Complex Regional Pain Syndrome: -describe -related to? -Sx? -Plain films show _____
- Incompletely understood, over-response of the body to an external stimulus, usually trauma
- increased blood flow causes demineralization
- Possibly related to efferent sympathetic nervous system over- activity or abnormal neurological activity of central cord or peripheral neurons.
- Sx: Pt presents with characterized by pain and vasomotor disturbances with hyperemia and swelling.
Dx: Radionuclide 3 phase
-Plain films usually show osteopenia and swelling.
Complex Regional Pain Syndrome: test of choice is 3 phase _____
*three phase Radionuclide Bone Image (RNBI)
Complex Regional Pain Syndromeformally called Reflex Sympathetic Dystrophy: -Describe each phase of the 3 phase RNBI
Phase 1: gives information about blood flow perfusion and shows diffuse increased activity.
Phase 2: gives info about relative vascularity (blood pool) and shows diffuse increased activity also.
Phase 3: gives info about the bones themselves and shows increased activity
Hemophilia= articular changes are 2/2 _____
-recurrent hemorrhages into the joints. -The effects are secondary to direct chemical effects of blood on the synovium, cartilage, and bone causing joint destruction.
Hemophilia: imaging findings? -what is the KEY finding?
joint effusion, periarticular osteoporosis, irregular subchondral bone and **subchondral cysts, cartilage erosion -**There is hemosiderin deposition.
Hemophilia: MC involved joint?
**Knee MC involved.
Hemophilia: imaging study
Note hemarthrosis, eroded cartilage, subchondral cysts and hemosiderin deposition
Spondylolysis = -MC seen at which level?
-Spondy (spine) and lysis (unbind)= is a defect in the pars interarticularis of a vertebral body. -Can be congenital or acquired -Can be unilateral or bilateral -**Most commonly seen at the L5 level
Spondylolysis is the most common cause of low back pain in ______
adolescents –> Occurs in 8-14% of adolescent athletes
Spondylolisthesis =
Spondy (spine) and listhesis (slipping) -Of those with Spondylolyis, 15-25% will develop spondylolisthesis.
ON THE OBLIQUE FILM, THE NECK OF THE SCOTTY DOG IS THE _______
PARS INTERARTICULARIS **Spondylolysis – No neck Scotty Dog (L4-L5) (KNOW!!)
