Arthritides

Question 0

Which condition presents with a triangular sclerosis at the iliac portion of the lower sacroiliac joint?

Answer 0

Osteitis Condensans Ilii

Question 1

Which common arthritis demonstrates non-uniform joint space narrowing, osteophytes, subchondral sclerosis and subchondral cysts?

Answer 1

degenerative joint disease DJD

Question 2

Is osteitis condensans ilii more commonly unilateral or bilateral?

Answer 2

Bilateral and symmetric sclerosis

Question 3

Is osteitis condensans ilii more commonly found in males or females?

Answer 3

more commonly found in women of childbearing age

Question 4

Osteitis pubis is commonly associated with which medical procedure?

Answer 4

surgery near the pubic symphysis, usu within 1-3 months/ in 1-3% of surgeries

Question 5

What is the difference between marginal and non-marginal syndesmophytes?

Answer 5

marginal syndesmophytes (intervertebral bony bridges, delicate, symmetric) are more commonly seen in ankylosing spndylitis
non-marginal (bulky, discontinuous) syndesmophytes are more commonly seen in reactive arthritis and DISH

Question 6

Which spinal arthritides have marginal vs. non-marginal syndesmophytes?

Answer 6

marginal: ankylosing spndylitis
nonmarginal: DISH, reactive arthritis

Question 7

What systemic condition is commonly found in patients with diffuse idiopathic skeletal hyperostosis?

Answer 7

Diabetes, Dyslipidemia, Hyperuricemia

Question 8

Dysphagia is common in which arthritic condition and why?

Answer 8

DISH- d/t calcification/ossification of ALL/PLL

Question 9

What part of the spine is DISH most commonly found?

Answer 9

ALL especially

usu see extraspinal enthesopathy “whiskering”

Question 10

List the radiographic findings of neurotrophic arthropathy

Answer 10

6 D’s:

Distended Joint, Density increase, Debris, Dislocation, Disorganization, Destruction

Question 11

Which conditions may result in neurotrophic arthropathy?

Answer 11

Diabetes, alcoholism, Tabes dorsalis, paralysis, syringomyelia

Question 12

What is synoviochondrometaplasia?

Answer 12

metaplastic changes in synovium produce cartilaginous bodies that may or may not calcify or be free within the joint capsule

Question 13

Name the common sites of involvement of rheumatoid arthritis in the hand and wrist

Answer 13

Changes typically begin at MCP and PIP joint and the wrist

changes are bilateral, symmetrical and simultaneous

Question 14

What is a marginal erosion and what category of arthritis is it seen with?

Answer 14

marginal erosions are irregular with no sclerotic margin
usu at radial margins of 2nd and 3rd MC head in Norgaard/ballcatchers view
seen with RA

Question 15

What is the significance of widening of the atlantodental interspace?

Answer 15

can lead to direct compression of the brainstem or cause neurological damage by excessive kyphosis
• Cervical (MC) spine involvement in 50-80%; few at T/L junction
• Odontoid/dens erosions
• C1-C2 instability → neurologic damage (enlarged; N <5 in child); atlanto-axial subluxations
• Pseudobasilar invagination
• Facet involvement; stair-stepping (anterior-lysthesis; can get with DJD as well)
• IVD involvement

Question 16

Which conditions demonstrate laxity of the transverse ligament?

Answer 16

SLE, Downs Syndrome, possible in RA but rare

Question 18

Is SI involvement common in rheumatoid arthritis?

Answer 18

No, if present it’s usually minimal sclerosis

uni/bilateral and asymmetrical

Question 19

Describe the radiographic difference between rheumatoid and psoriatic arthritis in the hand and wrist.

Answer 19

Psoriatic looks similar to RA except w/o hyperemia
PA: DIP and PIP joints of the hand, Ray pattern (affects all joints of a single digit), ST swelling, Fluffy periostitis, “Pencil in a cup” deformity, marginal erosions, tapered bone ends, asymmetrical with uniform joint space loss
RA: MCPs and PIPs, marginal arosions, radial margins of 2nd, 3rd MC head, DIPs extend, PIPs flex, ulnar deviation at MCP joint

Question 20

What is the gender incidence of rheumatoid arthritis?

Answer 20

Onset at 20-60 y.o.; peak 40-50 y.o.

F:M 3:1 until age 40, then 1:1

Question 21

What is the first site of involvement with ankylosing spondylitis?

Answer 21

Pelvis: iliac side and lower 2/3 of the SI joint
Spine: thoracolumbar jxn

Question 22

What is the second site of involvement with ankylosing spondylitis?

Answer 22

may have peripheral involvement of hips, shoulders, heels but mainly SI and thoracolumbar joint involvement

Question 23

Is sacroiliac involvement usually unilateral or bilateral in ankylosing spondylitis?

Answer 23

usually bilateral and symmetrical

Question 24

What is the gender incidence of ankylosing spondylitis?

Answer 24

Male 9:1

Question 25

Which condition demonstrates squaring of the vertebral body?

Answer 25

ankylosing spondylitis

Question 26

What is the shiny corner sign?

Answer 26

Increased radiodensity of the corners of the vertebral body related to osteitis, reactive sclerosis that is seen in AS.

Question 27

What is a carrot-stick fracture?

Answer 27

fracture of an ankylosed segment in AS–> usu causes paralysis

Question 28

Which condition demonstrates similar sacroiliac joint and vertebral column findings to AS?

Answer 28

Enteropathic arthropathy, UC, Chrons, Whipples, Salmonella, Shigella, Yersinia

Question 29

Which two seronegative spondyloarthropathies demonstrate non-marginal syndesmophytes and peripheral arthritis?

Answer 29

Psoriatic and Reiters

non marginal syndesmophytes are thicker, not throughout the spine as in AS

Question 30

Reversible deformities of the hand are seen in which condition?

Answer 30

SLE: ie may have ulnar deviation that can be overcome with mm contraction (lax ligaments, not dt bone deformity)

Question 31

What is acro-osteolysis and which conditions demonstrate this finding?

Answer 31

resorption of the extremities as seen in psoriatic arthritis

Question 32

What is the overhanging margin sign and which condition is this seen in?

Answer 32

Pathognomonic finding in Gout–> sclerotic margin outside the joint capsule

Question 33

What structures are primarily involved in CPPD?

Answer 33

(calcium pyrophosphate dehydrate crystal deposition disease)
fibrous and hyaline cartilage of the knee, wrist, pubic sym.
triangular fibrous tissue in meniscus
thick, irregular poor defined menisci

Question 34

What structures are primarily involved in HADD?

Answer 34

(hydroxyapatite deposition disease)

Should and Hip MC; calcification a short distance from insertion of a tendon, MC supraspinatous/ bursa