6. Degenerative Arthritis Flashcards by Beck Forsland

What are the three types of arthritis?

Degenerative
Inflammatory
Metabolic

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What are the 4 kinds of degenerative arthritis?

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

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What are the 5 kinds of inflammatory arthritis?

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

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What are the 3 kinds of metabolic /crystal arthritis?

1- gout
2- CPPD
3- HADD

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

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

Non-inflammatory
• morning stiffness <1 hour

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

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

Non-inflammatory
•bony proliferation in osteoarthritis

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

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

Non-inflamm
• WNL

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

Inflamm
• erosions
• periostitis
•joint-space narrowing

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

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

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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What is the MC joint disease?

Degenerative Joint Disease (AKA osteoarthritis)

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Describe the pathology that is DJD?

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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What is the clinical presentation of DJD?

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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What are the possible locations for DJD?

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

ANY JOINT

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What are 4 main radiographic features of DJD?

[insert slide 17 photo]

Non-uniform joint space loss
Osteophytes
Subchondral sclerosis
Subchondral cysts

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Spinal DJD is MC in what part of the spine?

Lower Cx and Lx

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

IVD DJD

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

Osteophytes
Ligament hypertrophy
Listhesis
Disc herniation

What is “kissing spine” syndrome?

Baastrup syndrome

Describe Baastrup syndrome

Signs of DJD at opposing SP surfaces

remodeling of cortical surface
osteophytes
sclerosis

Associated with extremes lordosis

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

Mid and lower thirds

What is the “tooth” sign related to?

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

Treatment (4) for DJD?

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

What is erosive osteoarthritis?

It has features of DJD + inflammatory arthritis

Acute, inflammatory onset and episodes

Describe the DIP and PIP involvement of erosive osteoarthritis

Bilateral, symmetric DIP and PIP

Who gets erosive OA?

Females 30-50 yo And 15% of these people will develope RA

What is “gull wing” sign associated with?

Severe DJD plus erosions

What does DISH stand for? And what is DISH?

Diffuse Idiopathic Skeletal Hyperostosis Spinal, esp ALL, and extra spinal ligamentous and tendinous calcification and ossification. NOTE: NORMAL DISC SPACES ALL = anterior longitudinal ligament

Where is DISH most commonly located? (3)

Thoracic spine Lower cervical Upper lumbar

What is visualized extraspinal in DISH?

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

On radiograph, what is seen with DISH?

[insert photo] Thick, flowing hyperostosis anterior to spine for about 4 contiguous levels.

Are disc spaces smaller in DISH?

No: disc spaces are maintained

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

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

DISH: IVDs are maintained DDD: IVDs are decreased

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

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

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

50% Concern about spinal stenosis

What % of DISH has diabetes?

50%

What is the best method for imaging PLL?

CT MRI is good

What is the Tx for DISH?

No specific Tx Treat symptoms: CMT, STM, PT, lifestyle Monitor for signs of central stenosis

What is neuropathic arthropathy aka Charcot joint?

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

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

Diabetes Syringomyelia Alcoholism Tabes dorsalis Spinal cord injury

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

3 start with Di 3 start with De Distended joint Dislocation Disorganization Destruction Density increase Debris