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Core (MSK) > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Most common sites of OA in the hand

A

DIP > 1st CMC > PIP

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2
Q

Underlying etiology of Heberden or Bouchard nodes

A

Large osteophytes cause local soft tissue swelling

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3
Q

Location of:

  1. Heberden nodes
  2. Bouchard nodes
A
  1. DIP
  2. PIP
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4
Q

Typical distribution of erosive OA

A

DIPs in the hands

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5
Q

Classic imaging finding in erosive OA

A

Gull-wing deformity

  • central erosions
  • marginal osteophytes
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6
Q

Most common sites of OA in the foot

A

1st MTP > talonavicular joint (dorsal beaking)

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7
Q

Migration pattern of the femoral head in OA of the hips

A

Superolateral > medial

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8
Q

Migration pattern of the femoral head in RA of the hips

A

Axial

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9
Q

Most likely diagnosis:

  • axial migration of femoral head
  • osteophytes present
A

Osteoarthritis

(very rare migration pattern)

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10
Q

What does gas within the vertebral body compression fracture indicate?

A

Avascular necrosis

(also called Kummel disease)

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11
Q

What ligament is often ossified in DISH?

A

Posterior longitudinal (PLL)

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12
Q

Diagnostic criteria of DISH:

  • flowing bridging anterior osteophytes ≥ 4 levels
  • ?
A

Normal disc spaces and sacroiliac joints

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13
Q

Most common initial areas affected by RA

A

Small joints in the hands, wrist and foot

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14
Q

Pathogenesis and pathologic hallmarks of RA

A
  • RF = antibodies against IgG
  • waxing/waning activation of complement cascade
  • cycles of repeated synovial inflammation
  • marginal erosions and periarticular osteopenia
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15
Q

Most common large joints affected by RA

A

Knees, hips, shoulders and cervical spine

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16
Q

Radiographic features of RA

A
  • marginal erosions
  • periarticular osteopenia
  • soft tissue swelling
  • symmetric joint space narrowing
  • joint subluxations
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17
Q

Most common affected joints in the hand with RA

A

MCP > PIP > carpals

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18
Q

Most common location of initial erosions in RA of the hand

A
  • radial aspect of the 2nd and 3rd metacarpal heads
  • radial and ulnar aspects of the phalangeal bases
  • ulnar styloid
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19
Q

Classic subluxation deformities in RA

(3)

A
  • Boutonierre (PIP flexed, DIP extended)
  • Swan neck (DIP flexed, PIP extended)
  • Ulnar subluxation at the MCPs
20
Q

Late-stage finding in the wrist that is rare in RA but common in JIA

A

Carpal ankylosis

21
Q

Most common location of RA in the feet

A

MTP joints

22
Q

Pathologic endpoint of RA in the hips

A

Concentric acetabular degeneration → axial migration → protrusio deformity

23
Q

Diagnostic criteria of protrusio deformity

A
  • males → > 3 mm
  • females → > 6 mm

(medial to the ilioischial line)

24
Q

Which joint is least commonly affected by erosions in RA?

A

Knees

25
Q

Type of cervical subluxation that occurs in RA with transverse ligament erosion

A

Anterior

  • most common
  • especially prominent with flexion
26
Q

Type of cervical subluxation that occurs in RA with facet joint erosion

A

Vertical impaction

  • protrusion of dens through foramen magnum
  • compression of midbrain
27
Q

Type of cervical subluxation that occurs in RA with odontoid erosion

A

Posterior subluxation

28
Q

Anterior atlanto-axial subluxation is present if the interval is…

A
  • > 3 mm (in adults)
  • > 5 mm (in children)
29
Q

Name the 4 inflammatory (seronegative) spondyloarthropathies

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Reactive arthritis
  4. IBD-associated arthritis
  • by definition, negative for RF
  • associated with HLA-B27
30
Q

Feature common to all of the inflammatory arthropathies

A

Sacroiliitis

  • usually only affects the inferior portion
  • erosions often affect the iliac aspect first
31
Q

Inflammatory arthropathies that cause symmetric sacroiliitis (vowels)

A
  • Ankylosing spondylitis
  • IBD-associated arthritis
32
Q

Inflammatory arthropathies that cause asymmetric sacroiliitis (consonants)

A
  • Psoriatic arthritis
  • Reactive arthritis
33
Q

Major differential diagnosis for unilateral sacroiliitis

A

Septic arthritis

34
Q

Earliest radiographic signs of ankylosing spondylitis

A

Symmetric erosions, widening and sclerosis of the SI joints

35
Q

Extra-skeletal conditions associated with ankylosing spondylitis

A
  • pulmonary fibrosis (upper lobe predominant)
  • cardiac conduction defects
  • aortitis
36
Q

How does ankylosing spondylitis progress through the spine?

A

Ascends from lumbar to cervical spine

37
Q

Initial pathologic feature of ankylosing spondylitis in the spine

A

Romanus lesions

  • erosions of the anterior superior/inferior endplate edges
  • caused by enthesitis at the attachment site of the disc
38
Q

Following Romanus lesions, how does ankylosing spondylitis progress throughout the spine?

A

Romanus lesions → shiny corners → squaring of corners → syndesmophytes

  • shiny corners represent sclerosis of Romanus lesions
39
Q

Complication of long-standing anklyosing spondylitis that can mimic osteomyelitis

A

Andersson lesion

  • aka spinal psuedoarthrosis (false functional joint)
  • destructive lesion through the disc-plate complex
  • only occurs in an area that is completely ankylosed
40
Q

Most common location for psoriatic arthritis

A

Hands

  • no periarticular osteopenia (unlike RA)
  • precedes skin manifestations in ~ 20% of cases
41
Q

Radiographic features of psoriatic arthritis in the hand

A
  • sausage digit
  • pencil-in-cup deformity (usually DIP)
  • fluffy periostitis
  • marginal erosions
42
Q

Radiographic hallmark of arthritis mutilans of the hand (end-stage psoriatic arthritis)

A

Telescoping digit

43
Q

Most common locations for psoriatic arthritis in the feet

A
  • IP joint of the great toe
  • MTP joints
44
Q

Radiographic features of psoriatic arthritis in the feet

A
  • ivory phalanx (osteosclerosis)
  • plantar calcaneal spur with periosteal reaction
45
Q

Radiographic hallmark of psoriatic arthritis in the spine

A

Bulky lateral outgrowths with bony bridging

46
Q

While psoriatic arthritis usually affects the hands, reactive arthritis usually affects…

A

…the feet

  • but otherwise has similar radiographic findings
47
Q
A

Core (MSK) (3 decks)

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