Arthritis Flashcards
5 broad categories of arthritis
- Degenerative )OA)
- inflammatory (RA, spondyloarthropathy, JIA)
- Crystal deposition (Gout, CPPD, HADD)
- hematologic
- metabolic
radiographic hallmarks of OA
Asymmetical joint space narrowing
sclerosis of subchondral bone
osteophytosis
subchondral cystic change
lack of periarticular osteopenia
OA in hand
- Distribution in hand
- DIPs (2nd dip is most common). 1st CMC, PIPs.
Unlike RA, MCPs not usually involved
- Heberden node - soft tissue swelling around DIP
Bouchard node: swelling around PIP
- OA in shoulder - which view is best?
- OA in foot (which 2 joints)
- Grashey, shows loss of joint space
- 1st MTP - Hallux Rigidus.
talonavicular joint - dorsal beaking
OA in knee - tends to be bilateral
- Which compartment is most involved
- Which view is best for assessment of joint narrowing?
- asymmetric involvement of medial tibiofemoral comp.
- Standing weight bearing views.
OA in hip - tends to be bilateral
- Direction of femoral head migration?
- Femoral head migration is usually superiolateral, and less often medial. (axial migration is seen inRA)
Degenerative chane in spine - Vertebral body-disc articulations are cartilagenous joints
- What are 3 parts of intervertebral disck?
- Which joints in spine get OA (aka, which joints are synovail)
- findings of DDD
- Vacuum phenomenon vs. Kummel disease
- Complications of DDD
- Annulus fibrosis, nucleuous pulposis, cartilagenous endplates
- facet, atlanto-axial, uncovertebral, costovertebral, inferior inferior sacroiliac
- Dessication, disc endplate sclerosis, osteophytosis.
- Vacuum phenomenon. Gas in Disc, pathognomonic of DDD. Kummel: Gas in vertebral body. compression fracture - representing necrosis.
- Spinal stenosis, nf stenosis, spondylolisthesis.
DISH - Diffuse idiopathic skeletal hyperostosis
- Describe
- A/w what?
- Exuberant osteophytes - at least 4 vertebral bodies.Normal disc spaces and SI joint.
- Ossification of posterior longitudinal ligament.
OA at the SI joint. Which area is affected?
Only inferior portion is effected because that is the synovial portion.
The upper 1/3 is syndesmotic ligament
Erosive OA
- clinical findings and demograpics
- Findings
- erroisve changes and swelling in hand. Occurs in elderly women
- swelling and erosions. Only in the hand. Distribution of OA
Central erosions = gullwing sign
RA
- Which joints are involved
- radiographic hallmarks (5)
- Explain Marginal erosions and ‘bare areas”
- First foot and hands, then Cervical spine, knees, shoulders, and hips.
- marginal erosions (bare areas), soft tissue swelling, diffuse, symmetric joint space narrowing, periarticular osteopenia, joint subluxations
- Marginal erosions explanation: They occur because at the “bare areas” there is synovium directly on bone with no cartilage protection. Therefore, the inflammatory process eats the bone which is not protected by overlying articular cartilage
- RA in the hand/wrist.
- Earlierst radiographic sign?
- where are first erosions typically
- Late disease has bony ankylosis, irriducible ulnar deviation, and swan neck/boutiers. What is difference between swan neck and Boutiers
- MCPs, PIPs, carpal articulations. DIPs are usually spared.
- Articular soft tissue swelling. Periarticuluar osteopenia (synovitis and hyperemia)
- radial aspects of 2nd and 3rd metacarpal heads. bases of proximal phalanges, and ulnar styloid.
- Swan neck has DIP flexion
- RA in foot: Which joints are involved?
- RA in hip. Name of severe deformity in hip
- RA in knee
- MtP, talocalcaneonavicular
- Symmetric acetabular cartilage loss, axial migration of femoral head
Protrusio deformity is severe axial migration: >3mm medial deviation of femoral head beyond ilioischial line in males and >6mm in females
- All 3 joint compartments involved. Erosions not as prominent as you would think.
RA in spine - mostly cervical spine. Osteopenia, erosions of odontoid, facet joints, vertebral endplates, spinous process.
- Characteristic finding
- atlantoaxial subluxation (most commonly anterior, but can be any direction)
Anterior: Laxity of transverse ligament. >2.5mm ADI
Vertical: results from facet erosion and collapse. Protrosion of odontoid through foramen magnum.
Posterior: usually due to odontoid erosion or odontoid fracture.
- RA in shoulder - characteristic finding. Where do erosions occur?
RA can involve elbow in 1/3 of patients.
- chronic rotator cuff tears - high riding humerus.
Erosions occur at latera aspect of humeral heads, AC joints. Erosions may lead to penciling of distal clavicle
Seronegative Spondyloarthropathies - by definition RF negative. Usually HLA B27 positive
- Name the 4, Which are symmetric vs. asymmetric
- Which portion of the SI joint is involved?
Septic joint - unilateral
- Ankylosing Spondylitis and IBD associated (symmetric)
Reiter’s and psoriatic (asymmetric)
- Inferior portion is synovial
- IBD - what causes it?
- UC, Crohn disease, Whipple disease, s/p gastric bypass
Ankylosing Spondylitis - young men w/ HLA B27, back stiffness
- Associations (3)
- Earliest radiographic sign?
- Sequence of findings in spine (ascends from lumbar to cervical)
- Andersson lesion
- Pulm fibrosis (upper lobes), aortitis, cardiac conduction
- symmetric erosions, widening, sclerosis of SI
- Romanus - erosions of anterior superior or inferior edges of vertebral endplate, causted by enesthesis (inflammation of of annulus fibrosus)
Shiny corners - sclerosis of romanus
Squaring - bone loss
Delicate syndesmophytes - bony bridgening, bamboo spine
- Pseudoarthrosis occuring in a compleely ankylosed spine
Psoriatic arthritis
- Most commonly affects what?
- 2 contrasts from RA
- Name of severe form of arthritis effecting hands?
- Radiographic hallmark?
- fancy name for “telescoping digits?’
- PA in foot
- PA in spine
- Hand. Can affect any joint in hand
- mineralization is presevered. Fusiform swelling (opposed to articular swelling)
- Arthritis mutilans
- Fusiform swelling of entire digit producing sausage digit. Pencil incup erosions
- Main-en-lorgnette (pera glass hand
- Great toe and MTP most commonly affected.
Ivory phalynx and osteosclerosis.
Plantar calcaneal spur
- coarse bony bridging.
Reactive Arthropathy - PA of the feet
- Caused by what?
- radiographic findings?
- Calcaneus findings
- Findings in hands and spine
- diarrhea, urethritis, cervicitis. Usually asymmetric
- diffuse sweling, joint space loss, marginal erosions, juxta-articular osteopenia
- erosions, enthesophytes, and fluffy periosteal reaction in calcaneous. Secondary achilles tendinitis is posible.
- hands; IP and MTPs. In spine, coarse bony bridging, like PA.
Connective tissue disorders of joints (4)
- SLE, Jaccoud, scleroderma, polymyositis/dermatomyositis.
- SLE joints - key radiographic abnormality. Best view?
- What is a similar disease to SLE of joints, but different name?
- Reducible subluxations of MCPs and PIPs. Alighnment may be normal when hands are compessed against radiographic plate, and become apparent on Nogarrd (ballcatcher’s) or oblique views.
- Jaccoud arthropathy
- Scleroderma key findings
- Calcifications of soft tissues. Acro-osteolysis, peri-articular calcifications
Acroosteolysis Ddx (6)
Collagen vascular disease
Neuropathy
Polyvinyl chloride exposure
thermal injury (in frostbite, thumb may be spared due to clenched fist.
Hperparathyroidism
Hajdu-Cheney - rare autosomal cominant syndrome - shoft stature, craniofacial changes.
Entity: Intramuscular and subcutaneous calcifications
Polymositis and dermatomyositis - Periarticular osteopenia may also be present
- CPPD stands for what?
- Microscopic appearance?
- Hallmark?
- Common locations
- Complication
- Calcium pyrophosphate dihydrate deposition disease
- rhomboid crystals - positively birefringent
- Chondrocalcinosis (calcification of hyaline cartilage)
- TFCC, radiocarpal joint, knee, MCPs of hand
- Scapholunate advanced disease (SLAC Wrist) - proximal micration of capitate b/w the dissociated scaphoid/lunate
(SLAC can also ben seen in RA and trauma)
Name the arthritis; patellofemoral degenration, prominent subcondral cysts in effected joints
CPPD
- HADD - full name, nickname
- Where does it deposit? Most common tendon involved
- variant that can mimic prevertebral abscess
- Severe intra-articular shoulder variant
- Calcium Hydroxyapatite deposition disease, AKA calcific tendinitis
- Deposition of calcium in tendons. Supraspinatous is most affeced
- HADD of prevertebral longus muscle; neck pain, odonophagia, fever, prevertebral effusion.
- Milwaukee shoulder. Rapid destruction of rotator cuff, glenohueral joint.
Gout - takes 20 years for uric acid to build before symptoms
- microscopic appearance
- Most common joint
- Radiogrpahic hallmarks
- How do joint spaces look?
- needle like - negatively birofringent
- Great toe
- Sharply marginated erosions. Overhanging margins. Soft tissue gouty tophi
- Joint spaces are well preserved (they are just crystals. They don’t destry the cartilage)
Hemochromatosis arthropathy - deposition of iron and calcium pyrophosphate dihidrate crystals
- Typical location in hand
- Typical look of osteophytes
- MCP joints in hand (may involve all MCPs, unlike CPPD)
- Hook-like osteophytes
metabolic, hematologic, and other arthropathies
Hemochromatosis, acromegaly, amyloid arthropathy, ochronosis (alkaptonuria), multicentric reticulohistiocytosis, hemophilic arthropathy, JIA, Charcot joint, sarcoidosis
- Acromegaly findings
- Joints widened in early disease due to cartilage hypertrophy. Later there is osteoarthritis with space narrowing.
Beak like osteophytes of metacarpal head ans spade like enlargement of terminal tufts are characteristic.
Name the entity: bulky soft tissue noduels in the shoulder, supoerimposed on atrophic shoulder muscles
Shoulder pad sign - amyloid arthropathy
Imaging findings of amyloid arthorpathy are nonspecific but soft tissue nodules and erosions may be present.
Aunt Minnie
Ochronosis (alkaptonuria)
Intervertebral disc calcs at every level w/ disc space narrowing.
Defect in homogentisic acid oxidase - causing homogentisic acid polymers to accumulate in visceral organs.
Entity: Well defined erosion affecting DIPs symmetrically. Soft tissue nodules
Multicentric reticulocytosis
Lipid laden macrophages are doposited in soft tisssues and periarticular tendons forming skin nodules and erosions.
Can have rapid joint destruction (arthritis mutilnans appearance)
hemophilic arthropathy
- Most common locations
- Findings in elbow and knee
- Other findings
- Psuedotumor hemophilia
- Knees, elbows, ankles
- hyperemia can cause epiphyseal enlargement and early fusion. (At the elbow, this is an enlarged radial head and widened trochlear notch. At the knee this is squaring of th epatella and widened intertrochlear notch.
- increased soft tissue density around joints.
Joint space narrowing
- Benign lesion caused by recurrent intraosseous or subperiosteal bleeding. Caues bony scalloping and pressure erosion, often w/ an associated soft tissue mass
Juvenile idiopathic arthritis (children under 16)
Can be mono, pauci-articular, or polyarticular
- Which joints are effected?
- What is a variant of JIA?
- radiographic hallmarks of JIA
hand
knee (similar to hemophilia)
Elbow (similar to hemophilia)
- In mono and pauci-articular, its big joints (knees, elbows, ankles wrists). In Poly ist all those plus hands, feet, cervical spine.
- Still disease (systemic disorder affecting children younger than 5, febrile illness, rash, adenopathy, pericarditis, mild arthralgias.
- abnormal bone length or morhphology in skeletally immature patient.
In hand, premature fusion of growth plate may cause brachydactaly.
Knee: widened intercondylar notch, metaphyseal flaring, uniform joint space narrowing.
Elbow: enlargement of radial head and trochlear notch, uniform cartilage space
hips; symmetrical cartilage space narrowing, protrusio deformity (like RA). gracile appearance of femoral shaft is
Neuropathic arthopaty (Charcot joint) -
Normal clinical presentation is painless swollen joint
- Causes
- 2 variants
- any process that effects sensory nerves: syringomyelia, diabetes, chronic alcohol abuse, amyloid, spinal tumors, syphilis or leprosy
- hypertrophic (more common) - anarchy of the joint.
atrophic - occurs mor commonly in shoulder. classic radiographic appearance of humeral head resorption.
Name the entity
- manifestations in bone
- lace-like or punched out lytic lesions in middle or distal phalanges.
May also manifest as acute or chronic polyarthritis.
