Arthritides Flashcards
Which condition presents with a triangular sclerosis at the iliac portion of the lower sacroiliac joint?
Osteitis Condensans Ilii
Which common arthritis demonstrates non-uniform joint space narrowing, osteophytes, subchondral sclerosis and subchondral cysts?
degenerative joint disease DJD
Is osteitis condensans ilii more commonly unilateral or bilateral?
Bilateral and symmetric sclerosis
Is osteitis condensans ilii more commonly found in males or females?
more commonly found in women of childbearing age
Osteitis pubis is commonly associated with which medical procedure?
surgery near the pubic symphysis, usu within 1-3 months/ in 1-3% of surgeries
What is the difference between marginal and non-marginal syndesmophytes?
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
Which spinal arthritides have marginal vs. non-marginal syndesmophytes?
marginal: ankylosing spndylitis
nonmarginal: DISH, reactive arthritis
What systemic condition is commonly found in patients with diffuse idiopathic skeletal hyperostosis?
Diabetes, Dyslipidemia, Hyperuricemia
Dysphagia is common in which arthritic condition and why?
DISH- d/t calcification/ossification of ALL/PLL
What part of the spine is DISH most commonly found?
ALL especially
usu see extraspinal enthesopathy “whiskering”
List the radiographic findings of neurotrophic arthropathy
6 D’s:
Distended Joint, Density increase, Debris, Dislocation, Disorganization, Destruction
Which conditions may result in neurotrophic arthropathy?
Diabetes, alcoholism, Tabes dorsalis, paralysis, syringomyelia
What is synoviochondrometaplasia?
metaplastic changes in synovium produce cartilaginous bodies that may or may not calcify or be free within the joint capsule
Name the common sites of involvement of rheumatoid arthritis in the hand and wrist
Changes typically begin at MCP and PIP joint and the wrist
changes are bilateral, symmetrical and simultaneous
What is a marginal erosion and what category of arthritis is it seen with?
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
What is the significance of widening of the atlantodental interspace?
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
Which conditions demonstrate laxity of the transverse ligament?
SLE, Downs Syndrome, possible in RA but rare
Is SI involvement common in rheumatoid arthritis?
No, if present it’s usually minimal sclerosis
uni/bilateral and asymmetrical
Describe the radiographic difference between rheumatoid and psoriatic arthritis in the hand and wrist.
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
What is the gender incidence of rheumatoid arthritis?
Onset at 20-60 y.o.; peak 40-50 y.o.
F:M 3:1 until age 40, then 1:1
What is the first site of involvement with ankylosing spondylitis?
Pelvis: iliac side and lower 2/3 of the SI joint
Spine: thoracolumbar jxn
What is the second site of involvement with ankylosing spondylitis?
may have peripheral involvement of hips, shoulders, heels but mainly SI and thoracolumbar joint involvement
Is sacroiliac involvement usually unilateral or bilateral in ankylosing spondylitis?
usually bilateral and symmetrical
What is the gender incidence of ankylosing spondylitis?
Male 9:1
Which condition demonstrates squaring of the vertebral body?
ankylosing spondylitis
What is the shiny corner sign?
Increased radiodensity of the corners of the vertebral body related to osteitis, reactive sclerosis that is seen in AS.
What is a carrot-stick fracture?
fracture of an ankylosed segment in AS–> usu causes paralysis
Which condition demonstrates similar sacroiliac joint and vertebral column findings to AS?
Enteropathic arthropathy, UC, Chrons, Whipples, Salmonella, Shigella, Yersinia
Which two seronegative spondyloarthropathies demonstrate non-marginal syndesmophytes and peripheral arthritis?
Psoriatic and Reiters
non marginal syndesmophytes are thicker, not throughout the spine as in AS
Reversible deformities of the hand are seen in which condition?
SLE: ie may have ulnar deviation that can be overcome with mm contraction (lax ligaments, not dt bone deformity)
What is acro-osteolysis and which conditions demonstrate this finding?
resorption of the extremities as seen in psoriatic arthritis
What is the overhanging margin sign and which condition is this seen in?
Pathognomonic finding in Gout–> sclerotic margin outside the joint capsule
What structures are primarily involved in CPPD?
(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
What structures are primarily involved in HADD?
(hydroxyapatite deposition disease)
Should and Hip MC; calcification a short distance from insertion of a tendon, MC supraspinatous/ bursa
