Artrites

Question 1

Sinais típicos de doenças degenerativas

Answer 1

1. Osteófitos
2. Esclerose subcondral

Question 2

Sinais atípicos de doenças degenerativas pensar em

Answer 2

1. Trauma
2. CPPD
3. Neuropática
4. Artrite hemolítica

Question 3

Inflamatória sinais

Answer 3

1. Erosão óssea
2. Osteopenia
3. Edema de tecidos moles
4. Diminuição dos espaços articulares simétricamente

Question 4

Indica artrite reumatóide

Answer 4

1. Articulações múltiplas
2. Simétricas
3. Proximais
4. Ausência de proliferação óssea

Question 5

Mnemônico para artrites

Answer 5

A - articular
B - bones
C - cartilage
D - distribution
E - extra, tecidos moles

Question 6

Erosões marginais pensar (2)

Answer 6

1. AR
2. Artrite psoriásica

Question 7

Erosões subcondrais pensar

Answer 7

Artrite erosiva

Question 8

Padrão pencil in a cup, pensar

Answer 8

Artrite psoriásica

Question 9

Erosões periarticulares pensar

Answer 9

Gota

Question 10

Esclerose subcondral pensar

Answer 10

Artrite neuropática

Question 11

Dica pra cartilagem

Answer 11

Degenerativas afetam de maneira assimétrica.

Inflamatória, simétrica.

Question 12

Definição condrocalcinose

Answer 12

Fina lâmina

Geralmente joelho e radiocarpal

Question 13

ABCDE osteoartrite

Answer 13

1. Articular: no erosions
2. Bone: no osteopenia.
3. Cartilage: non-uniform joint space narrowing. Subchondral cyst formation (geode).
4. Distribution: mais distal
5. Extra findings: subluxations associated with hallux valgus or hallux rigidus
   Soft tissue: Heberden‘s nodes in DIP-joints or Bouchard’s node in PIP-joints.

Question 14

ABCDE AR

Answer 14

1. Articular: erosions, typically at the marginal area
2. Bone: periarticular osteopenia.
3. Cartilage: uniform cartilage destruction.
4. Distribution: symmetric peripheral distribution.
5. Extra findings: autoimmune inflammatory disease that affects many organs, such as the lungs, skin, eyes or the heart.
   Soft tissue: fusiform swelling, nodes, deformity

Question 15

Luxação atlanto axial

Answer 15

Espaço entre o dente de C2 - arco de C1 > 3 mm

Question 16

ABCDE artrite séptica

Answer 16

Radiological findings

Articular: efusão gás. Aumento sinóvia. Erosões.

Bone: diminui espaço articular.

Cartilage: Late cartilage destruction

Distribution: mono-arthritis.

Extra findings: fever, bacteria in synovial fluid.

Soft tissue: erythema, warmth and swelling. MRI shows thickened enhancing synovium. Outpouching of the synovium and microabscesses can be see

Question 17

Achados espondilite anquilosante

Answer 17

1. Cantos brilhantes dos corpos vertebrais
2. Coluna em bambu
3. Sacroileíte

Question 18

Fisiopatologia da coluna em bambu

Answer 18

Fusão dos corpos vertebrais lombares por sindesmófitos e ossificação dos ligamentos paraespinhais.

Question 19

Sinal da adaga

Answer 19

Linha central radiopaca (por ossificação da coluna) = espondilite anquilosante

Question 20

Sinais sacroileíte

Answer 20

Esclerose subcondral bilateral
Erosão da sacroilíaca

Question 21

Sinal do machado

Answer 21

Erosão circunscrita da parte latero-dorsal da cabeça umeral. Típica espondilite anquilosante.

Question 22

Diferença do sinal do machado da necrose avascular

Answer 22

Na necrose avascular a deformidade é progressiva

Question 23

Síndrome do ombro de Milwaukee

Answer 23

Artropatia do ombro.

Ruptura do manguito rotador e grandes derrames articulares
Depósito de hidroxiapatita -> destruição da articulação glenoumeral

Erode acromio
Migração cefálica da cabeça do úmero

Question 24

ABCDE da artrite psoriásica

Answer 24

Articular: small marginal bone erosions, arthritis mutilans with acro-osteolysis and pencil-in-cup deformities, joint subluxation, interphalangeal ankylosis, sacroiliitis (frequently asymmetrical).

Bone: bone productive changes, periostitis, Ivory phalanx (distal phalanx dig 1), spondylitis (asymmetrical paravertebral ossifications).

Cartilage: joint space narrowing

Distribution: see illustration, asymmetric and predominantly peripheral.

Extra findings: skin lesions, telescoping fingers.
Soft tissue: Enthesitis, dactylitis (sausage digit), onycholysis (the nail separates from the skin).

Question 25

ABCDE Artrite reativa

Answer 25

Articular: in later disease ill-defined erosions like psoriatic arthritis (typically calcaneus is involved)

Bone: Bone proliferation but also juxta-articular osteoporosis and enthesopathy/enthesitis

Cartilage: uniform joint space narrowing.

Distribution: asymmetric, see illustration

Extra findings: usually triggered by a preceding infection
Soft tissue: swelling soft tissue (also sausage digit)

Question 26

Hiperostose esquelética idiopática difusa (DISH / Doença de Forestier)

Answer 26

Proliferação e calcificação das inserções ligamentosas e tendinosas da coluna e da pelve

Mais comum em idosos

Question 27

ABCDE da gota

Answer 27

Articular: “punched out “ erosions > 5 mm, that spare part of the joint with an overhanging edge of new bone. Lesão saco bocado

Bone: bone mineralization is normal. Chondrocalcinosis or osteonecrosis can occur.

Cartilage: joint effusion (earliest sign), preservation of joint space

Distribution: see illustration, there is a predilection for peripheral joints. Most often it has an asymmetric, random distribution.

Extra findings: usually male, hyperuricemia

Soft tissue: tophi: pathognomonic, eccentric nodular soft tissue swelling due to crystal deposition around the joints is common. These may be hyperdens due to the crystals and may calcify. Olecranon and prepatellar bursitis.