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Core MSK > Arthritis > Flashcards

Arthritis Flashcards

1
Q

Osteoarthritis generalities

A
  • OA involves the entire joint (bone, ligaments, menisci, joint capsule, synovium and musculature).
  • Affects weight-bearing joints and hands in a specific distribution.
  • Abnormal locations: shoulder, elbow and ankle –> Suspect trauma or arthitis.
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2
Q

Osteoarthritis Rx / CT findings (5)

A
  • Osteophytes.
  • Subchondral cystic changes.
  • Sclerosis of subcondral bone.
  • Lack of periarticular osteopenia.
  • Lack of Erosions
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3
Q

Osteoarthritis MRI findings (4)

A
  • Osteophytes.
  • Subchondral cystic change.
  • Subchondral edema.
  • Synovitis.
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4
Q

Osteoarthritis of the hand (Locations)

A
  • Distal interphalangeal joints (Heberden nodules).
  • Proximal interphalangeal joints (Bouchard nodules).
  • First carpometacarpal joint.
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5
Q

Erosive osteoarthritis of the hand - Generalities

A
  • Eldery females.
  • Combines clinical findings of AR and imaging features of OA.
  • Erosions are present (limited to the hand, commonly DIP).
  • Gull-wing appearance of the DIP.
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6
Q

Osteoarthritis other locations (Shoulder, foot and knee)

A
  • Shoulder: Glenohumeral joint narrowing (Grashey view RX - AP 40° external rotation).
  • Foot: 1° MTP –> Hallux rigidus. Also affects the talonavicular joint –> Dorsal beaking.
  • Knee: Asymmetrical involvement of the medial tibiofemoral compartment.
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7
Q

Osteoarthritis of the hip

A
  • Characteristic superolateral space narrowing.
  • Less commonly medial or axial concentric cartilage space loss.
  • Axial narrowing without osteophytes: Typical of AR.
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8
Q

Degenerative changes in the spine

A
  • OA affects: Zygapophyseal, atlantoaxial, uncovertebral , costovertebral and sacroiliac joints.
  • OA Doesn’t affect the disc-endplates.
  • Vaccuum phenomenon is pathognomonic for degenerative change.
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9
Q

Kümmell disease

A

Gas in a vertebral body compression fracture representing osteonecrosis.

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10
Q

Diffuse idiophatic skeletal hyperostosis (DISH). Generalities

A
  • Defined as flowing bridging anterior osteophytes spanning at least 4 vertebral levels.
  • May be associated with ossification of the posterior longitudinal ligament, which may cause spinal stenosis.
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11
Q

Rheumatoid arthritis generalities

A
  • Symmetrical joint pain, swelling and morning stiffness.
  • Rheumatoid factor is typically positive.
  • Affects (in order): Hands, wrists and feet. Advanced cases: cervical spine, knees, shoulders and hips.
  • Erosions are the imaging and pathologic hallmarks of AR.
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12
Q

Rheumatoid Artrhitis RX and CT findings (5)

A
  • Marginal erosions.
  • Soft-tissue swelling.
  • Diffuse, symmetric joint space narrowing.
  • Periarticular osteopenia.
  • Joint subluxations.
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13
Q

Rheumatoid Artrhitis MRI findings (4)

A
  • Marginal erosions.
  • Synovitis.
  • Subchondral edema.
  • Joint subluxations.
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14
Q

Rheumatoid Artrhitis in the hand

A
  • Affects PIP, MCP and the carpal articulations (DIPs are usually spared).
  • Erosions: radial aspect of 2° 3° metacarpal heads, the radial and ulnar aspects of the bases of proximal phalanges and the ulnar styloid.
  • Common subluxations: Bouttoniere deformity (PIP flexion and DIP hyperextension), Swan neck deformity (PIP hyperextension and DIP flexion), ulnar subluxation of the fingers at MCP.
  • Late-stage AR may produce ankylosis.
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15
Q

Rheumatoid arthritis in the feet and hip

A
  • Affects MTF joints and the talocalcaneonavicular joint.
  • Axial migration of the femoral head.
  • Protrusio deformity in severe cases.
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16
Q

Protrusio deformity definition

A
  • > 3 mm medial deviation of the femoral head beyond the ilioischial line (males).
  • > 5 mm deviation (females).
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17
Q

Reumathoid arthritis in the knee

A
  • All three joint spaces may be affected (medial and lateral tibiofemoral and patellofemoral).
  • Erosions are not a prominent manifestation on the knee.
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18
Q

Reumathoid arthritis in the spine

A
  • 70% of patients are affected.
  • Subluxation of multiple levels, osteopenia, erosions of the odontoid, facet joints, vertebral endplates and spinous processes.
  • Unlike OA there is no bone production.
  • Atlanto-axial C1-C2 subluxation: anterior, vertical and posterior.
19
Q

Atlanto-axial subluxations types (3)

A
  1. Anterior: By laxity of the transverse ligament. Atlanto-dental interval >2.5 mm in adults and >5 mm in children.
  2. Vertical: Atlantoaxial impaction, protrusion of the odontoid through the foramen magnum.
  3. Posterior: Due to odontoid erosion or fracture.
20
Q

Seronegative spondyloarthropaties generalities

A
  • 4 types: Ankylosing spondilitis, psoriatic arhtritis, reactive arthritis and IBD associated arthropathy.
  • Negative rheumatoid factor.
  • Usually HLA-B27 positive.
21
Q

Seronegative spondyloarthropaties sacroiliitis

A
  • Only the inferior aspect of the SI joint is affected.
  • Erosions first involve the iliac aspect of the SI joint.
  • Symmetric: IBD and ankylosing spondylitis.
  • Assimetric: Psoriatic arthritis and reactive arthropathy.
22
Q

Ankylosing spondylitis generalities

A
  • Young men with HLA B27.
  • Can be associated with: pulmonary fibrosis, aortitis and cardiac conduction defects.
  • Earliest findings: Symmetric erosions, widening and sclerosis of the sacroiliac joints.
  • May produce an Andresson lesion.
23
Q

Andersson lesions

A

Pseudoarthrosis occuring in a completely ankylosed spine

24
Q

Ankylosing spondylitis findings in the spine

A
  • Romanus and shiny corner lesions.
  • Delicate syndesmophites and bamboo spine.
  • Dagger sign.
  • Squaring of the vertebral body.
  • Cervical fusion.
25
Q

Psoriatic arthritis generalities

A
  • Most commonly affect the hands.
  • Mineralization is preserved.
  • Asymmetric sacroiliitis.
  • Patterns: Oligoarthritis, polyarthritis, spondiloarthropathy (bulky asymmetric brindging) and arthritis mutilans.
26
Q

Reactive arthropathy (Reiter disease)

A
  • Inflammatory arthritis sequela of infectious diarrhea, urethritis or cervicitis.
  • Asymmetrical sacroiliitis.
  • Predominantly affects the feet
  • Findings: diffuse soft-tissue swelling, joint space loss, agressive marginal erosions, juxta-articular osteopenia.
  • Calcaneus is affected with proliferative changes, erosions, enthesophytes, fluffly periosteal reaction.
  • Secondary Achilles tendinitis.
  • Hands: Interphalangeal joints, MTP with erosions and diaphyseal periostitis.
  • Coarse bony bridging of the spine (similar to psoriatic arthritis).
27
Q

Systemic lupus erythematosus arthopathy

A
  • Affects 90% of SLE patients.
  • Reducible subluxations of the MCP and PIP.
  • Subluxations become apparent in the Norgaar or oblique views.
28
Q

Jaccoud arthropathy

A
  • Secondary to recurrent rheumatic fever.
  • Identical to SLE arthropathy sharing the same type III hypersensivity mechanism.
29
Q

Scleroderma

A
  • Systemic collagen vascular disease, deposit of collagen in the skin and soft tissues.
  • Acro-osteolysis is characteristic.
  • Dystrophic soft-tissue and periarticular calcifications are common.
30
Q

Acro-osteolysis differential diagnosis (8)

A
  • Collagen vascular diseases (Schleroderma and Raynaud’s).
  • Neuropathy.
  • PVC exposure.
  • Thermal injury (burn of frostbite).
  • Hyperparathyroidism.
  • Hjdu-Cheney.
  • Psoriasis.
  • Pyknodysostosis.
31
Q

Crystal arthropathies generalities

A
  • Arthritis caused by intra-articular deposition of various crystals.
  • Two most common: Calcium pyrophosphate crystal arthritis and gout.
  • Calcium hydroxyapatite causes tendinopathy and much less common arthritis.
32
Q

Calcium pyrophosphate arthritis

A
  • Microsopically romboid crystals are positively birefrigent.
  • Causes: Idiopathic, hemochromatosis, hyperparathyroidism and hypophosphatasia.
  • Acute phase: May mimic septic arthritis.
  • Chronic phase: May mimic OA, gout, AR.
  • Hallmark: Chondrocalcinosis (Calcification of hyaline (articular) or fibro (meniscal/labral) cartilage.
  • CT RX: Thin lineal calcifications of the articular cartilage.
  • Wrist: Affects the triangular fibrocartilage complex, advanced disease may lead to scapholunate advanced collapse.
  • Knee: Patellofemoral compartment is affected first, but all three compartments may be involved.
  • Hand: Involvement of 2°-3° MCP joints, producing Hook-like osteophytes.
33
Q

Gout arthropathy

A
  • Deposition of sodium urate crystals in the joints.
  • Excess uric acid may be due under-excretion (more common, caused by renal insufficiency) or overproduction (rare, seen in younger patients).
  • Microscopically: needle-like crystals with neutrophils and negatively berefrigent.
  • The great toe is most commonly affected.
  • RX: Sharply marginated erosions with overhanging margins.
  • ECO: Double contour sign.
  • Tophaceous gout: Deposition of urate crystals, inflammatory cells and foreign body giant cells in the soft tissues (joint, tendons, ligament, bursae, etc.).
  • Dual energy CT is excellent for identifying urate and CPP crystals.
34
Q

Calcic hydroxyapatite

A
  • Calcific tendinitis, crystals are deposited in degenerating or hypoxic tendons, triggering a inflammatory response.
  • Commonly seen in DM.
  • Mineralization appears amorphous or globular, there cannot be any cortication or internal trabeculation.
  • May erode through tendons and cause adjacent calcific bursitis.
  • Rarely it can erode bone.
  • Shoulder is by far the most common site for calcific tendinopathy, supraspinatus tendon the most affected.
  • Also: tendons of the hip, including gluteal and rectus tendons.
  • Wrist: Flexor carpi ulnaris tendon.
  • Neck: Longus colli muscle.
  • Very rare Milwaukee shoulder (rapid destruction of the rotator cuff and the glenohumeral joint).
  • MR low signal intensity on all sequences, with surrounding edema/inflammatory changes.
  • US: Globular hyperechoic shadowing foci.
35
Q

Hemochromatosis arthropathy

A
  • Affects 50% of patients with hemochromatosis.
  • Deposition of iron and calcium pyrophosphate dihydrate crystals.
  • Affects MCP joints, produces hook-like osteophytes at the metacarpal heads.
  • DD: CPPD identical but affects only the 2° and 3° MCP. Acromegaly.
36
Q

Acromegaly arthropaty

A
  • Excess growth hormone.
  • Causes arthropathy due to enlargement of the articular cartilage and subsequent degeneration.
  • Joint spaces are widened
  • Later stages secondary OA occurs with cartilage space narrowing.
  • In the hand, beak-like osteophytes of the metacarpal heads and spade like enlargement of the terminal tufts are characteristic.
37
Q

Amyloid arthropathy

A
  • Rare non-inflammatory arthropathy due to infiltration of bones, joints and soft-tissues by beta-pleated sheets of aminoacids.
  • Primary: Monoclonal plasma cell dysplasia.
  • Secondary: Chronic underlying inflammation or infection, accumulation of B2-microglobulin in patients with chronic HD.
  • Shoulder pad sign.
  • Findings are non specific, but might resemble AR.
38
Q

Ochronosis

A
  • Connective tissue manifestation of alkaptonuria.
  • Defect in homogentisic acid oxidase, causing homogentisic acid polymerates to accumulate in visceral organs, joints and intervertebral disks.
  • Causes: Intervetebral disc calcifications at every level, with accompanying disc space narrowing.
39
Q

Sarcoidosis

A
  • Multisystemic granulomatous disease.
  • Affects: Lungs, adenopathies and parenchymal disease.
  • Body manifestations are rare, might produce lace-like lytic lesions in the middle or distal phalanges.
  • Might produce acute or chronic polyarthritis, suspect in ankle involvement, especially if bilateral or associated with erythema nodosum.
40
Q

Multicentric reticulohistiocytosis

A
  • Rare disease.
  • Lipid-laden marophages are deposited in soft-tissues and periarticular tendons, forming skin nodules with erosions and schlerotic margins.
  • Well defined erosions of DIP symmetrically.
  • Joint destruction may be rapid and progressive, producing arthritis mutilans appearance.
41
Q

Hemophilic arthropathy

A
  • X-linked inherited disorder of either factor VIII (Hemophilia A) or IX (Hemophilia B) deficiency, causing recurrent bleeding.
  • Affects knees, elbows and ankles.
  • Recurrent hemarthrosis results in synovial hyperemia and hyperthrophy, may cause epiphyseal enlargement and early fusion.
  • Knee: Widened intercondylar notch, metaphyseal flaring and uniform joint space narrowing.
  • Elbow: Enlargement of the radial head and trochlear notch with uniform joint space narrowing.
  • Secondary arthritis may lead to marked joint space narrowing.
  • Pseudotumor of hemophilia: benign lesion caused by recurrent intraosseous or subperiosteal bleeding.
42
Q

Juvenile idiophatic arthritis

A
  • Affects children <16 years old.
  • Monoarticular or pauciarticular (most common) on knees, ankles , elbows or wrists. Or polyarticular.
  • Still disease: Systemic disorder in <5 years old with fever, rash, adenopathy, pericarditis and arthralgias.
  • RX or CT findings: abnormal bone length or morphology, premature skeletal maturation and physeal fusion.
  • Hand: Brachydactyly.
  • Knee: Widened intercondylar notch, metaphyseal flaring and uniform joint space narrowing.
  • Elbow: Enlargement of the radial head and trochlear notch with uniform joint space narrowing.
  • Hips: Symmetrical cartilage space narrowing, protrusio deformity and gracile appearance of the femoral shaft.
  • Ankylosis in the wrist, zygapophyseal joints of cervical spine.
43
Q

Neuropathic arthropathy (Charcot joint)

A
  • Destructive form of arthritis caused by neurosensory defect.
  • Painless, swollen joint.
  • Causes: Diabetes, syringomyelia, alcohol, amyloid, spinal tumors, syphilis or leprosy.
  • Hypertrophic (more common): Anarchy in a joint, destruction, dislocation, debris, disorganization and no demineralization.
  • Artrophic: Humeral head resoption with a sharp surgical-like margin.
  • 6 D: density change, destruction, debris, distension, disorganisation and dislocation.

Core MSK (6 decks)

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