Arthritis (midterm) Flashcards
What is the foremost crippler in the US?
arthritis
How common is arthritis?
1 in 7 people
What is the most common arthritis?
osteoarthritis (OA/DJD)
What is the only arthritis with the onset of 0-20 years old?
juvenile RA
What does ABCs stand for when evaluating patients for arthritis?
A= alignment
B= bone
C= cartilage
s= soft tissue
What is the anatomical term for transition zone between bone and ligament/tendon?
enthesis
Inflammatory cellular infiltrate at the bone/ligament or bone/tendon junction. Seen in inflammatory arthritides, especially AS, as cortical erosion and periosititis
enthesopath
loss of bone due to pressure atrophy or active breakdown of bone tissue
erosion
single joint involved
monoarticular
2-4 joints involved in disease process
pauciarticular
> 4 joints involved
polyarticular
comparing 1 side of the body with the other or 1 joint to another
symmetrical pattern of joint involvement
Entire joint cavity is decreased due to complete loss of cartilage
uniform loss of joint space
Uniform loss of joint space is a sign of?
inflammatory arthritis
localized decrease in joint cavity due to isolated loss of cartilage, usually at site of most stress, is a sign of degenerative change
non uniform loss of joint space
degenerative bony outgrowth continuous with underlying cortex, covered with a cartilaginous cap, occurring at the insertion of the capsular ligament
osteophyte
(tries to stabilize weakened area)
inflammatory ossification within a spinal ligament
test q
syndesmophyte
localized periosteal new bone, seen in inflammatory arthritides
periostitis
What type of arthritis has these characteristics?
-soft tissue swelling
-edema
-uniform loss of joint space
-bone erosion
-juxta-articular osteoporosis
inflammatory arthritis
What type of arthritis has these characteristics?
-non-uniform loss of joint space
-osteophytes
-subchondral sclerosis
-asymmetrical distribution
-intra-articular loose bodies (cartilage degeneration) and deformity
-subchondral cysts/geode
degenerative arthritis
What is the other name for subchondral bone cyst found in degenerative arthritis?
geode
focal regions of loss in bone density within subarticular bone, geographic lucency, stimulates a neoplasm such as a chondroblastoma
subchondral cyst
gout is what type of arthritis?
metabolic
What are the other names for degenerative joint disease (DJD)?
-osteoarthritis (OA)
-DDD
-discogenic spondylosis
Which arthritis has these sites of involvement?
-weight bearing articulation of the hips, spine, and knees
-1st MTP
-1st metacarpal trapezium and DIP
DJD
Which arthritis would have these radiographic features?
-asymmetrical distribution
-non-uniform loss of joint space
-osteophytes
-IVF encroachment in cervical spine
-bone spurs
-subchondral sclerosis and cysts/geode
-intra-articular loose bodies (aka joint mice, flaking/fragmentation of bone and cartilage)
-intra-articular deformity
-vacuum sign/Knuttson’s sign
-gull sign
DJD
Where is DJD the most common spot?
knee
What arthritis has a vacuum sign/knuttson’s sign?
DJD
What arthritis has gull sign?
DJD
What is this sign called?
-linear radiolucency in the disc space represents collection of nitrogen gas in nuclear and annular fissures
vacuum sign/ Knuttson’s sign
What is this sign called?
-biconcave articular contour at distal and proximal interphalangeal joints (DIP and PIP)
gull sign
herberden’s nodes=
DIP joints
bouchard’s nodes=
PIP joints
haygarth’s nodes=
MCP joints
define disc desiccation
disc drying up
What is this?
herberden’s nodes with OA
What is this?
test q
bouchard’s nodes with OA
What are the other names for diffuse idiopathic skeletal hyperostosis (DISH)?
-Forestier’s disease
-spondylosis hyperostotica
-spondylitis ossifcans ligamentosa
-senile ankylosing hyperostosis
Which arthritis may have calcification of the ALL, dysphagia, and hoarse voice, AND/OR PLL calcification?
DISH
Which arthritis is associated with diabetes mellitus?
DISH
Which arthritis has a carrot stick fracture appearance?
DISH or AS
What is the most common site of involvement for DISH?
C5-C7
What arthritis would have these radiographic features?
-flowing ossification of at LEAST 4 contiguous segments
-normal disc height
-hyperostosis, usually anterior
-flame configuration
-PLL calcification
DISH
Which arthritis has the flame configuration?
DISH
What are the aka’s for flame configuration of DISH?
-dripping candle wax
-flame shaped osteophytes
-flowing hyperostosis
-candle flame hyperostosis
Which arthritis would have hyperinsulinemia after glucose challenge tests and HLA-B8?
DISH
Which arthritis would have these clinical features?
-low grade fever
-fatigue
-weight loss
RA
Which arthritis would have ulnar deviation with cortical/marginal/rat bite erosions, boutonniere deformity, and swan neck deformity?
test q
RA
What is this deformity called?
-hyperextension of the DIP joint, while the PIP is flexed
test q
boutonniere deformity
What is this deformity called?
-hyperextension of the PIP joint, while the DIP joint is flexed
test q
swan neck deformity
Where is RA most common?
hands and feet
If RA is found in the cervical spine, then what can be seen with ADI and IVD spaces?
ADI spaces are increased, IVD spaces are decreased
Bilateral acetabular protusion = ________ until proven otherwise
RA
What is the other name for juvenile RA?
Still’s disease
“juveniles don’t stay still”
Which arthritis is this?
-develops before age 16
-lacks RA factor
-HLA-B27 is present especially with spinal involvement
juvenile RA
Which arthritis has the posterior motor unit fused from C2->C5?
juvenile RA
(if anterior motor unit is also fused then its congenital block not juvenile RA!)
What are the other names for ankylosing spondylitis (AS)?
-Marie Strumpell’s disease
-von Bechterew disease
-spondylitis rhizomelie
Which arthritis is this?
-bilateral sciatica which progresses to thoracolumbar segments**
-HLA-B27
-marginal syndesmophyte formation on outer annulus fibers*
-shiny corner sign (erosions with surrounding sclerosis)
AS
bilateral sciatica= ________ until proven otherwise
AS
Which arthritis has shiny corner sign?
AS (usually in thoracolumbar region)
When multiple segments have marginal syndesmophyte =
bamboo spine/poker spine
Which arthritis has bamboo spine/poker spine?
AS
In the lumbar spine, facet fusion is called?
trolley track sign
Which arthritis has trolley track sign?
AS
Which arthritis has dagger sign?
AS
Which arthritis is this?
-usually targets DIP joints
-pencil in cup deformity
-if present at MCP, PIP, AND DIP= ray pattern
-mouse ears sign
-increased ADI space
psoriatic arthritis
Which arthritis has pencil in cup deformity?
psoriatic arthritis
Which arthritis has ray pattern?
psoriatic arthritis
Which arthritis has mouse ears sign?
psoriatic arthritis
What is this?
mouse ears sign= psoriatic arthritis
What is this?
pencil in cup deformity= psoriatic arthritis
What is this?
ray pattern= psoriatic arthritis
What is this?
-bilateral symmetrical SI joint disorder
-bilateral, dense, triangular shapes, iliac subchondral sclerosis involving the lower half of the joint margin
osteitis condensans ilii
What is this?
-joint surface erosion
-widened joint space
-moth eaten localized osteoporosis
-looks like infection
osteitis pubis
What are the 2 stages of osteitis pubis?
erosive and sclerotic stage
What is this?
-disorder of purine metabolism
-deposition of sodium monourate crystals in and around joints which cause inflammatory arthritis, mainly in lower extremities
gout
Which arthritis has tophi?
gout
Which arthritis is this?
-leukocytosis
-hyperuricemia
-marginal and periarticular erosions called overhanging margin sign
gout
Which arthritis has overhanging margin sign?
gout
podagra=
gout in foot
What are the other names for calcium pyrophosphate dihydrate crystal deposition disease (CPPD)?
-pseudogout*
-chondrocalcinosis
-pyrophosphate arthropathy
Which disease is characterized by gout like symptoms?
pseudogout/CPPD
What is this?
-in joints only, not surrounding tissue
-cartilage calcification (chondrocalcinosis)
-step ladder appearance/ Terry Thomas sign in wrist
pseudogout/CPPD
Where is the most common site of involvement for pseudogout/CPPD?
knee
What is this sign called?
-scaphoid moves proximally and the lunate moves distally in the wrist
step ladder appearance/Terry Thomas sign
What has step ladder appearance/Terry Thomas sign?
pseudogout/CPPD
What are the other names for hydroxyapatite deposition disease (HADD)?
-calcifying tendinitis
-peritendinitis calcarea
-periarthritis calcarea
-hydroxyapatite rheumatism
What is this?
-calcification within tendons, bursa, and other periarticular soft tissues
-nucleus pulposis and/or annulus fibrosus calcification
calcium deposits
-drooping shoulder sign
HADD
What tendon is the most common to calcify in the shoulder for HADD?
supraspinatus tendon
What tendon is the most common to calcify in the hip for HADD?
gluteus maximus tendon
What has drooping shoulder sign?
HADD
What is another name for neurotrophic arthropathy?
charcot joint
What is this?
-destructive articular disease which occurs secondary to a loss of impairment in joint proprioception
-involved joint undergoes premature and excessive traumatic degeneration
-leads to severe destruction and instability
-patient cannot feel the deformity occurring
neurotrophic arthropathy/ charcot joint
What are the 2 basic types of neurotrophic arthropathy/ charcot joint?
hypertrophic and atrophic
What is this?
hypertrophic neurotrophic arthropathy/ charcot joint
What is this?
atrophic neurotrophic arthropathy/ charcot joint
What is this?
-resorbed articular surface
-tapered “licked candy stick” appearance
-looks like infection
atrophic neurotrophic arthropathy/ charcot joint
What may cause acquired neurotrophic arthropathy/ charcot joint?
-alcoholism
-diabetes mellitus
-MS
-leprosy
-neurosyphilis
-syringomyelia
What is another name for ochronosis?
alkaptonuria
What is this?
-hereditary degenerative arthritis
-affects large joints and the spine
-abnormal tyrosine metabolism
ochronosis/alkaptonuria
Which arthritis has these radiographic features?
-premature DDD
-chondrocalcinosis
-ligament calcification
-total disc calcification
-calcification of interspinous ligament
-begins in lumbars and ascends
ochronosis/alkaptonuria
What is another name for sarcoidosis?
BOECK’s sarcoid
What is this?
-formation of noncaseating granulomas
coarsened trabeculae with numerous areas of decreased density, lace like pattern of long bones of hands and feet
sarcoidosis
What are the other names for progressive systemic sclerosis (PSS)?
-scleroderma
-crest syndrome
-acrosclerosis
What has a high incidence of Raynaud’s phenomenon?
progressive systemic sclerosis (PSS)/ scleroderma
What is CREST syndrome?
C=calcinosis
R= Raynaud’s phenomenon
E= esophageal abnormality
S= sclerodactyly
T= telangectasia
What has these radiographic features?
-tapered fingers
-distal tuft resorption with possible cutis
progressive systemic sclerosis (PSS)/ scleroderma
What are the other names for synoviochondrometaplasia?
-synovial chondromatosis
-osteochondromatosis
-osteochondral loose bodies
-joint mice
What is this?
-benign arthropathy
-synovial tissue undergoes metaplastic transformation (forms cartilage. calcifies. ossifies. loose bodies)
-most common in knee
-each loose body in the joint is round, ovoid, and smooth**
midterm q
synoviochondrometaplasia
