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Bone Path II > 6. Degenerative Arthritis > Flashcards

6. Degenerative Arthritis Flashcards

1
Q

What are the three types of arthritis?

A

Degenerative
Inflammatory
Metabolic

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2
Q

What are the 4 kinds of degenerative arthritis?

A

1- Degenerative joint disease (DJD)
2- Diffuse idiopathic skeletal hyperostosis (DISH)
3- Synoviochondrometaplasia
4- Neuropathic arthropathy

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3
Q

What are the 5 kinds of inflammatory arthritis?

A 
1- rheumatoid arthritis
2- ankylosis spondylitis
3- psoriatic arthritis
4- reactive arthritis (Reuter)
5- enteropathic arthropathy
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4
Q

What are the 3 kinds of metabolic /crystal arthritis?

A

1- gout
2- CPPD
3- HADD

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5
Q

What is the Hx for inflammatory arthritis vs. non-inflammatory arthritis?

A 
inflammatory arthritis
•Morning stiffness >1 hour
• Low-grade temp
• Fatigue
• Rash

Non-inflammatory
• morning stiffness <1 hour

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6
Q

What is thePE for inflammatory arthritis vs. non-inflammatory arthritis?

A 
inflammatory arthritis 
• rubor - erythema
• color - warmth
• tumor- swelling
• dolor - tenderness
• loss of function

Non-inflammatory
•bony proliferation in osteoarthritis

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7
Q

What is the labs for inflammatory arthritis vs. non-inflammatory arthritis?

A

Inflammatory arthritis
• (+)ve ESR, CRP
• anemia of chronic disease
• (+)ve rheumatoid or anti-CCP antibodies

Non-inflamm
• WNL

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8
Q

What is the radiographs for inflammatory arthritis vs. non-inflammatory arthritis?

A

Inflamm
• erosions
• periostitis
•joint-space narrowing

Non-inflamm
•joint-space narrowing
• osteophytes
• subchondral sclerosis

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9
Q

What is the synovial fluid for inflammatory arthritis (infectious, non infectious) vs. non-inflammatory arthritis?

A

NON-INFECTIOUS inflam
• leukocyte count >2k
(Mostly neutrophils)

INFECTIOUS inflamm
• leukocyte count >50K

Non-inflamm
• leukocyte count <2k
(Less than 50% are neutrophils)

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10
Q

What is the MC joint disease?

A

Degenerative Joint Disease (AKA osteoarthritis)

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11
Q

Describe the pathology that is DJD?

A 
Focal cartilage degen that gradually involves larger areas
Synovial hypertrophy
Growth of subchondral bone
Microfractures of subchondral bone
Deformity of articular surface
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12
Q

What is the clinical presentation of DJD?

A 
Insidious onset with intermittent exacerbation
Achin P
Stiffness that decreases w/30 min activity
Swelling
Crepitus
Decreased ROM
Palpable excrescences
Adjacencies mm atrophy

NO lab changes

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13
Q

What are the possible locations for DJD?

A

Small joints of hands, feet
What bearing joints
A-C joint

ANY JOINT

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14
Q

What are 4 main radiographic features of DJD?

A

[insert slide 17 photo]

Non-uniform joint space loss
Osteophytes
Subchondral sclerosis
Subchondral cysts

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15
Q

Spinal DJD is MC in what part of the spine?

A

Lower Cx and Lx

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16
Q

Sharpening of the uncinates (uncovertebral joints) and then hypertrophic changes are usually associated with what disease?

A

IVD DJD

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17
Q

What are the causes of neurologic compromises 2˚to DJD in the spine (causes of spinal stenosis)?

A

Osteophytes
Ligament hypertrophy
Listhesis
Disc herniation

18
Q

What is “kissing spine” syndrome?

A

Baastrup syndrome

19
Q

Describe Baastrup syndrome

A

Signs of DJD at opposing SP surfaces

  • remodeling of cortical surface
  • osteophytes
  • sclerosis

Associated with extremes lordosis

20
Q

What part of the SI joint is most affected in SI joint DJD

A

Mid and lower thirds

21
Q

What is the “tooth” sign related to?

A

The “tooth” sign represents the relief of severe osteophyte formation in the bundle of the quadriceps tendon at its insertion into the patella.

22
Q

Treatment (4) for DJD?

A

Maintain/restore mobility
Nutritional support
NSAIDS
Surgery maybe eventually to replace the joint

23
Q

What is erosive osteoarthritis?

A

It has features of DJD + inflammatory arthritis

Acute, inflammatory onset and episodes

24
Q

Describe the DIP and PIP involvement of erosive osteoarthritis

A

Bilateral, symmetric DIP and PIP

25
Q

Who gets erosive OA?

A

Females
30-50 yo

And 15% of these people will develope RA

26
Q

What is “gull wing” sign associated with?

A

Severe DJD plus erosions

27
Q

What does DISH stand for? And what is DISH?

A

Diffuse Idiopathic Skeletal Hyperostosis

Spinal, esp ALL, and extra spinal ligamentous and tendinous calcification and ossification. NOTE: NORMAL DISC SPACES

ALL = anterior longitudinal ligament

28
Q

Where is DISH most commonly located? (3)

A

Thoracic spine
Lower cervical
Upper lumbar

29
Q

What is visualized extraspinal in DISH?

A

Enthesopathy / whiskering in the pelvis, patella, calcaneus, elbow

30
Q

On radiograph, what is seen with DISH?

A

[insert photo]

Thick, flowing hyperostosis anterior to spine for about 4 contiguous levels.

31
Q

Are disc spaces smaller in DISH?

A

No: disc spaces are maintained

32
Q

Is there ankylosis of facets or sacroilitis (SI joint) in DISH?

A

No

33
Q

What is the radiographic difference between DISH and DDD in regards to IVDs?

A

DISH: IVDs are maintained

DDD: IVDs are decreased

34
Q

Know the difference between DISH, DDD, AS, Psoriatic / Reactive.

A

DISH: ossification is thick, flowing, at mid-body, IVDs are maintained, and there is extraspinal enthesophytes

DDD: ossification is non-marginal and like a “claw” and IVD space is decreased

AS: ossification is thin and marginal, IVDs are either WNL or “ballooned “ and SI joints fuse early

Psoriatic/Reactive: ossification is thick, non marginal, IVDs are maintained, and there is some enthesopathy

35
Q

What percent of DISH patients will have ossification of the Posterior Longitudinal Ligament?

A

50%

Concern about spinal stenosis

36
Q

What % of DISH has diabetes?

A

50%

37
Q

What is the best method for imaging PLL?

A

CT

MRI is good

38
Q

What is the Tx for DISH?

A

No specific Tx
Treat symptoms: CMT, STM, PT, lifestyle

Monitor for signs of central stenosis

39
Q

What is neuropathic arthropathy aka Charcot joint?

A

Progressive degen / destructive joint disorder in the presence of abnormal sensation / proprioception.

40
Q

What is the most common reason for neuropathic arthropathy aka Charcot joint?

A

Diabetes

Syringomyelia
Alcoholism
Tabes dorsalis
Spinal cord injury

41
Q

What are the radiographic findings of neuropathic arthropathy aka Charcot joint? (6 Ds)

A

3 start with Di
3 start with De

Distended joint
Dislocation
Disorganization

Destruction
Density increase
Debris

Bone Path II (9 decks)

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