Arthritis Flashcards
most common arthritide
osteoarthritis of DJD
etiology of DJD
caused by trauma– either overt or as an accumulation of microtrauma over years
hereditary form of DJD occurs primarily at what population
middle-aged women
hallmarks of DJD
joint space narrowing, sclerosis, osteophytosis
the only disorder that will cause osteophytosis without sclerosis or joint space narrowing is
diffuse idiopathic skeletal hyperostosis
DISH is a common bone-forming disorder that at first glance resembles DJD, except that there is no ____ and no _____
no joint space narrowing and there is no sclerosis
DJD are common in what 4 body parts
hands, knees, hips and spine
primary DJD are commonly seen in what 4 body part
hands, DIP, PIP and base of thumb in bilaterally symmetrical fashion
type of osteoarthritis that can be very painful and debilitating is
erosive osteoarthritis/Kellgren arthritis
there are few exceptions to the classic triad of findings seen in DJD. Several joints may also exhibit erosions, that can be seen in these 4 body parts
TNJ, acromioclavicular joint, SI joints and symphysis pubis
cystic formations that occur around joints in various disorders, including, in addition to DJD, RA, calcium pyrophosphate dihydrate crystal deposition disease and AVN
geode
one method of geode formation
synovial fluid is forced into the subchondral bone, causing a cystic collection of joint fluid; could also cyst from contused bone
4 radiographic hallmarks of RA
soft tissue swelling, osteoporosis, joint space narrowing, marginal erosion
characteristic of erosion in RA
marginal; away from weight bearing portion of joint
In the hip, femoral head tends to migrate ____ in RA
axially
femoral heads tend to migrate _____ in OA
superolaterlally
in RA, humeral head tends to appear
high-riding
high-riding humeral head can be seen in (3)
RA, torn rotator cuff and CPPD
these disorders are linked to HLA-B27 histocompatibility antigen (4)
- ankylosing spondylitis,
- IBD,
- psoriatic arthritis,
- reactive arthritis (also called Reiter syndrome)
these group of arthritides are characterized by bony ankylosis, proliferative new bone formation, predominantly axial (spinal) involvement
HLA-B27 spondyloarthropathies
syndesmophytes can be seen in
HLA-B27 spondyloarthropathies
a paravertebral ossification that resembles an osteophyte, except it runs vertically
syndesmophytes
orientation of osteophyte
horizontal
bamboo spine is classic finding in (2)
ankylosing spondylitis and IBD
characteristic of syndesmophyte in ankylosing spondylitis
marginal and symmetrical
characteristic of syndesmophyte in IBD
nonmarginal, asymmetrical, large and bulky
characteristic of syndesmophyte in psoriatic arthritis and reactive arthritis
unilateral, asymmetrical
ankylosing spondylitis and IBD tyically cause unilateral or bilateral SI joint disease?
bilateral
large joint involvement with HLA-B27 spondyloarthropathies is uncommon, but when it occurs, the arthropathy will resemble _____ and what body part is involved 50% of the time
RA, hips
cause a distinctive arthropathy that is characterized by its distal predominance, proliferative erosions, soft tissue swelling and periostitis
psoriasis
- proliferative erosions are different from the clean-cut, sharply marginated erosions, seen in all arthritides in that they have
- fuzzy margins with wisps of periostitis emanating from them
- reactive arthritis occurs almost exclusively in men or women?
- men
commonly affected body part in reactive arthritis
interphalangeal joint of great toe
A. crystal-induce arthritides include (4)
B. The abnormal pigmentation, brown-black in color, may be observed in various connective
tissues in patients with alkaptonuria. It describes the bluish-black pigmentation of connective tissue that may be apparent at such sites as the skin, sclera, and ear in patients with alkaptonuria
C. associated with distinctive skeletal abnormalities, including osteopenia, bone fragmentation
and cyst formation, ossicles, poorly defined subchondral bone, and osteochondritis dissecans. These findings superficially resemble the changes in hemochromatosis and idiopathic CPPD crystal deposition disease.
A.
- gout and
- pseudogout,
- onchronosis and
- Wilson disease
B. Ochronosis
C. Wilson’s disease
Wilson’s disease (hepatolenticular degeneration) is a rare autosomal recessive disorder characterized by degenerative changes in the brain, particularly the basal ganglia; cirrhosis of the liver; and diagnostic Kayser-Fleischer rings of greenish brown pigment at the limbus of the cornea. The primary abnormality in Wilson’s disease is not known. It is certain, however, that the clinical symptoms and signs of Wilson’s disease result from the relentless accumulation of copper in the body. The copper concentration is increased in the liver, brain, and other tissues; levels of serum copper and copper-binding protein
(ceruloplasmin) are generally decreased.
metabolic disorder that results in hyperuricemia and leads to monosodium urate crystals being deposited in various sites in the body, especially joints
Gout
4 hallmarks of gout
well-defined erosions (sclerotic margins, overhanging edge),
soft tissue nodules,
random distribution,
no osteoporosis
it takes how many years before gout becomes radiographically apparent
4 to 6 years
soft tissue nodules in gout calcify if there is accompanying what condition
renal failure
gout typically affects what body part
metatarsophalangeal joint of great toe
patients with gout often have
CPPD
triad of CPPD
- pain,
- cartilage calcification and
- joint destruction
CPPD = CPD
most common location of chondrocalcinosis in CPPD (3)
KTS
- knee,
- triangular fibrocartilage of wrist,
- symphysis pubis
DJD of CPPD has a proclivity for what body parts (5)
SPERM
- shoulder,
- elbow,
- radiocarpal joint in the wrist,
- patellofemoral joint of the knee,
- metacarpophalangeal joints in the hand
three diseases that have a high degree of association with CPPD
PGH
- primary hyperparathyroidism,
- gout,
- hemochromatosis
drooping osteophytes are often seen in (2)
CPPD and hemochromatosis
elbow is an unusual place for DJD to occur except in the setting of (2)
CPPD or trauma
hallmarks of SLE in the hand
marked soft tissue wasting as noted by the concavity in the hypothenar eminence, with ulnar deviation of phalanges
collagen vascular diseases causing arthritis include (4)
SS-DM
- scleroderma,
- SLE,
- dermatomyositis,
- mixed connective tissue disease
striking abnormality of the hands in collagen vascular diseases
osteoporosis and soft tissue wasting
erosions are generally not a feature of these disorders
collagen vascular diseases
soft tissue calcifications are typically present in what collagen vascular disease (2)
scleroderma and dermatomyositis
calcifications in scleroderma are typically
subcutaneous
calcifications in dermatomyositis are
intramuscular in location
mixed connective tissue disease is an overlap of (4)
- scleroderma,
- SLE,
- polymyositis,
- RA
disease that causes if deposition of granulomatous tissue in the body, primarily in the lungs, but also in bones
sarcoidosis
in skeletal sytem, sarcoidosis has a predilection for the
hands, where it causes lytic destructive lesions in the cortex (lace-like appearance)
disease of excess iron deposition in tissues throughout the body leading to fibrosis and eventual organ failure
hemachromotosis
in this condition, classic radiographic changes are essentially DJD, which involves second through the fourth MCP joints
hemochromatosis
squaring of metacarpal heads are seen in
hemochromatosis
classic triad of neuropathic or charcot joint
- joint destruction,
- dislocation and
- heterotopic new bone formation
progressive joint destruction occurs in a ____ because the joint is rendered unstable by inaccurate muscle action and is unprotected by intact nerve reflexes
neuropathic joint
has also been termed debris or detritus and consists of soft tissue calcification or clumps of ossification adjacent to the joint
heterotopic new bone
most commonly seen charcot joint today is
foot of a diabetic patient
in charcot joint of DM foot, it typically affects the
first and second tarsometatarsal joints in a fashion similar to a Lisfranc fracture-dislocation
classic findings of JRA and hemophilia are
overgrowth of the ends of the bones (epiphyseal enlargement) associated with gracile diaphyses
process that can mimic the findings in JRA and hemophilia is a
joint that has undergone disuse from paralysis
common denominator shared by JRA, hemophilia and paralysis is
disuse
relatively common disorder caused by a benign neoplasia of the synovium, resulting in deposition of nodules of cartilage in the joint
synovial chondromatosis
synovial chondromatosis is most commonly seen in the (3)
- knee,
- hip and
- elbow
loose bodies are tightly packed in a joint giving the appearance on MRI of a tumor. this has been termed
tumefactive synovial chondromatosis
true or false: no malignant tumors arise in joints
true
apple core appearance of bone due to pressure erosion of multiple nonossified chondral bodies. this condition is called
nonossified synovial chondromatosis
uncommon chronic inflammatory process of the synovium that causes synovial proliferation
pigmented villonodular synovitis
has been termed giant cell tumor of tendon sheath and tendon sheath xanthoma when it occurs in a tendon sheath
pigmented villonodular synovitis
pigmented villonodular synovitis are radiographically identical to
noncalcified synovial chondromatosis
characteristic appearance of pigmented villonodular synovitis in MRI
low-signal intensity hemosiderin seen lining the synovium on both T1 and T2
also known as shoulder-hand syndrome, reflex sympathetic dystrophy and chronic regional pain syndrome. it is a poorly understood joint affliction that typically occurs after minor trauma to an extremity, resulting in pain, swelling and dysfunction
sudeck atrophy
radiographically seen in sudeck atrophy (2)
severe patchy osteoporosis and soft tissue swelling
sudeck atrophy typically affects
distal part of an extremity such as a hand or foot
most joint effusion are clinically obvious and do not require radiographic validation. _____ is an exception,, if effusion is found in that body part, a fracture is present
elbow
the only fat pad around the hip that gets displaced with an effusion is the _____
obturator internus
the radiographic sign for a knee effusion that seems to be the most reliable is the
measurement of between the suprapatellar fat pad and anterior femoral fat pad (more than 10 mm is definite evidence of effusion)
normal measurement between the suprapatellar fat pad and anterior femoral fat pad
less than 5 mm
can occur around almost any joint for a host of reasons including steroids, trauma, various underlying disease states and even idiopathic. often seen in renal transplant patients
avascular necrosis or osteonecrosis
hallmark of AVN
increased bone density at an otherwise normal joint
earliest sign of VN is
joint effusion
next sign of AVN after joint effusion
patchy or mottled density
next sign of AVN after patchy or mottled density
subchondral lucency
final sign of AVN
collapse if articular surface and joint fragmentation; only on one side of the joint
focal area of AVN that is most likely due to trauma is called
osteochondritis dessicans
most sensitive imaging in detecting AVN
MRI
AVN of lunate is called
Kienbock malacia
type of ulnar variance that is said to have a high association with Kienbock malacia
negative ulnar variance
osteochondritis dessicans usually occur in what body part (2)
knee at the medial epicondyle,
zone of talus
osteochondritis dessicans frequently leads to a small fragment of bone becoming a free fragment in the joint called a
joint mouse
it is the only condition in which a geode can occur in a normal joint
AVN
AVN of tarsal navicular
Kohler disease
AVN of metatarsal heads
Freiberg infarction
AVN of femoral head
Legg-Perthes disease
AVN of apophyseal ring epiphyses of the spine
Scheuermann disease
AVN of tibial tubercle
Osgood-Schlatter disease also termed surfer knees
