Arthritis Flashcards
What are the 5 types of degenerative arthritis?
DJD, DISH, SYnoviochondrometaplasia, neuropathic, erosive OA
What are the three types of arthritis?
Degenerative, inflammatory, metabolic
What are 7 types of inflammatory arthritis
RA,seronegative spondylopathy, sle, scleroderma, osteitis pubis, osteitis condensen ill, hypertrophic osteoarthropathy.
What are the seronegative spondylopathies
AS, psoriatic, reiters, enteropathic
What are the 4 types of metabolic
Gout, cppd, had, ochronosis
Out of DJD, inflammatory or metabolic which one is symmetric?
Some inflammatory
Out of DJD inflammatory, metabolic which one only effects one joint
Metabolic, DJD is variable
Which of the three has osteophytes? Which one has syndesmophytes?
DJD - osteophytes, inflammatory- syndesmophytes
Which one more likes causes erosion?
Inflammatory, some metabolic
Which one is associated with periostitis?
Inflammatory
Which one has decreased bone density?
Inflammatory
What is the most common joint disease
DJD(aka osteoarthritis)
What is the prevalence for OA
M>F until 45, then opposite
What is the pathology of OA?
Focal cartilage degeneration, gradually larger Synovial hypertrophy Cartilage metaplasia Growth of subchondral bone Deformity of articular surface
What are causes of DJD
1-idiopathic
2- trauma, infection,other arthropathies
What is the clinical presentation for OA/DJD?
Insidious onset with intermittent flares Aching pain Stiffness (relieved by activity, brought on by rest) Swelling, crepitus, decreases ROM, No lab changes Muscle atrophy
What are complications of OA/DJD
Stenosis and altered biomechanics
What are the locations for OA/DJD
Small joints of hands/feet: DIPs,1st metatarsalphalangeal, 1st carpometacarpal joint
Weight bearing: spine, hips, knees
AC joint
Potentially any other joint
Radio graphic findings for OA?
Asymmetric distb, nonuniform joint space loss, osteophytes, subchondral sclerosis/cysts, joint subluxation, articular surface deformity, intraarticular osteochondral bodies.
What are common sites for spinal DJD ?
Lower Cx and Lx.
What is DJD of the IVD called? What are the clinical features of it?
It is called spondylosis.
Clinical features: loss of disc ht, osteophytes, end plate sclerosis, vacuum cleft phenomenon, retrolisthesis, central stenosis uncommon, c-spine( intercalary bone, triangular ossicle at anterior disc space)
Uncvertebral joints are usually assc with what type of DJD? And what happens when this occurs?
Assc with IVD DJD.
Uncinates sharpen first, then hypertrophic changes, pseudofx in lateral view, IVD narrows.
DJD of the facet joints usually results in anterolisthesis than retro, occurs mostly in cx spine, causes lateral recess stenosis, uncommon in C0-1,1-2 and Thx .
True
What part of spine is coastal joint DJD more common and what is the most common change?
Lower tx. Sclerosis, osteophytes ( pain mimics visceral disease pain)
What is bastruups syndrome?
“Kissing spines” assc with excesss lordosis and DDD. Can be symptomatic or asymtomatic.
How does the SI joint get affected by DJD?
Lower 2/3’s of the joint. Joint space loss hard to see on X-rays ( mild changes). Subchondral sclerosis seen with osteophytes.
How does DJD affect the hip joint?
M/C affects the superior portion. Large subchondral cysts. Femoral head goes superior and laterally. Osteophytes best seen on lateral/infermedial portion. Medial femoral neck buttressing. Advanced DJD= malus coaxe senilis
How does DJD affect the knee? (At the femorotibial joint)
Affects medial side more than lateral. Do weight bearing films. Osteophytes, cysts and mild sclerosis seen =Sharpening of the tibial plateaus. Osteochondral bodies common.
How does DJD affect the patellofemoral joint?
Osteophytes at superior and inferior poles. “Tooth” sign. ( enthesopathy)
What are uncommon sites for DJD
Ankle, inter tarsal, GH, elbow, wrist ( except Ray 1), metacarpalphalangeal, suspected secondary DJD
What are treatments for DJD?
Diet, STM, chiro, monitor for complications
Is erosive OA is symmetric?
Yes, symmetric DIP and PIP involved
What population does EOA usually affect?
Females 30-50 years old
What is the onset of EOA
Acute inflammatory episodes with chronic progression
Approximately how many EOA pt develops RA
15%
What are key radio graphic changes for EOA?
Severe DJD, central erosions, gull wing sign, periostitis
What are some DDx for EOA
DJD. RA . Psoriatic.
Which of the EOA DDx conditions affect dips and which one affects pip
EOA and DJD and psoriatic affect dip
EOA, DJD and RA affect pip
Of EOA, DJD, RA and psoriatic which one has lab changes (esr inc)
All but DJD. RA has rf presence too
Of EOA, DJD, RA and psoriatic which ones have central erosions? Which ones marginal? Which ones none?
Central EOA, marginal RA psoriatic, none- DJD
What does DISH stand for?
Diffuse Idiopathic Skeletal Hyperostosis
What happens in DISH
Spinal (esp. ALL) and extraspinal ligaments and tendons calicify and ossify.
DISH occurs in what percentage of the US popn
12% of the US popn over 40
What are symptoms of DISH
Asymptomatic to sometimes mild pain/stiffness. 20% experience dysphagia. Joint motion is usually unaffected. Decreased lordosis, increased kyphosis
What are common sites of involvement for DISH?
M/C in Tx/Lower Cx/Upper Lx Spine. Superior SI joint. Extraspinal/enthesopathy”whiskering” (pelvis, patella, calcaneus, elbow)
What are clinically significant changes of DISH
OPLL in 50%. 50% also have DIABETES. Spinal stenosis d/t involvement of PLL, Ligamentum Flavum. Predisposition to new bone formation complicates joint prostheses.
What are radiographic findings of DISH
Thick flowing hyperostosis anterior to spine. 4 continous levels. Disc spaces maintained. No facet involvement. Lucent cleft seperates from anterior vertebral body and horizontal clefts at IVD
What are some DDX for DISH
DISH, DDD, AS, Psoriatic/Reiters
How is the IVD different in DDD versus DISH/AS/Reiters/Psoriatic
IVD in DDD is decreased and maintained in DISH, Psoartic/Reiters and also in AS (ballooned SI fusion early)
What is the ossification pattern of DISH/DDD/AS/Psoartic
DISH- thick flowing mid body. DDD- nonmarginal “claw”. AS- Thin marginal. Psoartic- Thick, non marginal.
What is OPL
thickening/ossification of PLL. Strong associatino with DISH (85%) can exist independantly. can be asymptomatic. may produce myelopathy (esp in Cx. spine). Dense strip paralleling posterior vertebral body margins (CT/MRI)
What is the treatment for DISH?
none. address symptoms. monitor for cx stenosis. conservatively tx for stenosis or surgery.
What is neuropathic arthropathy
secondary to loss of sensory/proprioceptive info. (diabetes, alcholism, tabes dorsalis, paralysis, syringomyelia). essentially severe, destructive DJD
What are the 6 D’s of neuropathic arthropathy’s radiographic findings
Distended joint, Density increase, Debris, Dislocation, Disorganization, Destruction. (atrophic/resorption)
What are the clinical presentation of neuropathic arthropathy
May develop over weeks, months, years. Signs of neurologic loss, early: recurrent painless effusions. painless instability. enlargement. crepitus “Bag of Bones”
What is Synoviochondrometaplasia?
metaplastic changes in sWhatynovium produce cartilaginous bodies (which may or may no calicify/ossify and may or may not be free within joint capsule)
What is another name of Synoviochondrometaplasia?
Chondromatosis and Osteochondromatosis.
What are radiographic features of SCM
Multiple round/oval well defined lesions (osseous/cartilag. densities within the joint capsule.
Cannot see on plain film if not calcified/ossified (approx 20% are)..athroscopy/mri if not
Erosive defects and/or signs of DJD may be seen in surrounding bone/joint
What are Signs and Symptoms of SCM
Asymptomatic, Joint locking, Crepitus, Pain, Effusion, Reduced motion, Secondary DJD. Symtoms are usually mild and chronic with slow progressive increase
What is the age and gender for SCM
20-50 YO. M:F 3;1
Where is is more likely to be found?
70% at knee
can occur at any joint with synovium. elbow/hip/ankle/shoulder/wrist
What are potential DDx for SCM
Osterochondritis dissecans, Single Osteochondral body (defect in host bone), Ossicle secondary to DJD, Neuropathic Arthroprathy, PVNS, Normal Sesamoids.
What is the prognosis and treatment for SCM
Significant risk of secondary DJD. Questionable rare risk of malignant transformation, surgical removal indicated, recurrent is uncommon.
What is RA
Generalized CT disorder, Autoimmune, Targets synovial tissue, Bilateral symmetry, Progressive
What sites does RA usually effect
Articulations (hand, feet, larger joints, cx spine), heart lungs, BV’s, NS, eyes and reticuloendothelial tissue.
What are the Pathological features of RA
antigen/antibody complex deposited in synovium with resulting inflammatory cascade. Acute synovitis: edema, congestion, effusion, hyperemia. Synovial proliferation= pannus
What is pannus?
hypertrophied vascular granulation tissue.
What is the pathalogical feature of RA
Pannus erodes bone and articular cartilage
Enthesopathy (mostly at SP but largely uncommon in RA)
Rheumatoid nodules (20% of pts)
What lab tests are positive for RA
RF, ESR, CRP, NN Anemia, Synovial fluid elevations, Synovium Biopsy
What are the peak demographics for RA
Onset 20-60, peaks at 40-50. F>M X3 till age 40 then 1:1.
Where do changes for RA usually begin?
Changes typically being at the metacarpophalangeal joint and PIP, wrist and LATER progress to larger joints and spine
What are some physical findings for RA
Fatigue, Malaise, Weakness, Fever, Morning stiffness that lasts more than one hour, Pain with motion/tenderness. ST swelling/Joint Effusion, no redness, Bilateral/Symmetrical jt swelling (except DIP), Subcutaneous nodules
What are key Radiographic findings for RA
Periarticular ST swelling, osteoporosis, Marginal erosions****. Bilateral symmetry, site and degree. Uniform joint space loss. Periostitis, single or solid layer Lareg pseudocyts Deformaties Secondary DJD Ankylosis
What are causes for the deformity
Cartilage loss, capsule changes, tendon rupture/contracture, msl weakness, osseous destruction
Where does RA affect the hand?
MCP, PIP, NOT DIPS. You will see spindle digit / sT swelling, marginal erosions esp. in radial margins of 2nd and 3rd MC head esp in Norgaard ot ballcatcher’s view.
What are some hand deformities called in RA
1) Boutinere: DIP extension, PIP flexion
2) Swan neck: DIP flecion, PIP extension
3) Zig-Zag:Ulnar deviation at MCP joint, Radial deviation of carpals
At the wrist what bone is most effected by RA
Ulnar styloid erosion. (also radiocarpal joint, triquetrum-pisiform)
What is the Spotty carpal sign assc with
gout, TB, Sudeck’ atrophy
What in the foot is affected by RA
Metatarsalphalangeal joint (MTP) and 1st IP and calcaneus erosions (plantar aponeurosis, achilles tendon insertion)
What is the Lanois deformity
Fibular deviation and flexion of the foot, due to RA
What part of the spine does RA affect the most
Cx spin 50-80%. few at TL. In Cx spine you will see dens erosion, C1/2 instability, Pseudobasilar invagination, facet involvement, stairstepping and IVS involvment. ** Pencil sharp SP**
What are the other joints that RA effects
Hip, Knee, SI joint, Shoulder, Elbow and Ankle
How does RA affect the Chest?
Pericarditis, Pulmonary nodules, Diffuse interstitial fibrosis, pleural effusions, Rib erosions
What is the treatment for RA
Refer out to Rheumotologist (DMARDS, life modification, support)
What is the prognosis for RA
Wide prognosis, variable with severity and onset
What is JRA
one of the several forms of juvenile chronic polyarthritis. Similar to adult onset RA. before age 16. prognosis is good
What is seropositive JRA and seronegative JRA
Seropositive: RF positive, adult form, poorest prognosis. 10% of pts
Seronegative: 3 presentations. Polyarticular, Pauciarticular, and classic systemic disease
What is a key radiographic findings for JRA
Ankylosis frequent at the wrist, ankle and cx facets with ballooned epiphysis or premature fusion. more frequent periosteal response and changes are similar to adults but less destructive
What is AS
It is a chronic inflammatory process that has no known etiology. Found to largely affect the axial skeleton. Affects younger males. Bony akylosis/Ligament ossification, enthesopathy. aka Marie Strumpells Ds
What are key clinical features of AS
Onset usually 15-35 YO, M»»F 9:1. LBstiffness, ache, esp in early AM. Involves the eyes, heart and great vessels, lungs, GI, GU tracts. Increased ESR and positive HLAB27
What is the pathology for AS
Synovial joints: inflammation, synovial proliferation, pannus, cartilage and bone destruction, fibrosis/anylosis
Entheses: Inflammation leading to erosion and repair leading to ossification
What are radiographic findings for AS
Starts in the SI joints/ TL. Erosion leads to ankylosis. Typically bilateral and symmetric
