DI 2 FINAL (Arthritides) Flashcards
Which common arthritis demonstrates non-uniform joint space narrowing, osteophytes, subchondral sclerosis and subchondral cysts?
Degenerative Joint Disease (most common joint disease)
(Also will see asymmetric distribution, joint subluxation, articular surface deformity, and intraarticular osteochondral bodies)
Which condition presents with a triangular sclerosis at the iliac portion of the lower sacroiliac joint?
Osteitis Condensans Ilii
Is osteitis condensans ilii more commonly unilateral or bilateral?
Bilateral
Is osteitis condensans ilii more commonly found in males or females?
Females Child bearing age
Osteitis pubis is commonly associated with which medical procedure?
Surgeries near the pubic symphysis
Osteitis pubis = inflammation of the pubic symphysis
What is the difference between marginal and non-marginal syndesmophytes?
Syndesmophyte = osseous excrescence attached to a ligament
Non-marginal: don’t come from the corners
Marginal: ossification of outer annulus fibrosis leading to thick, vertical radiodense areas – connect adjacent vertebrae
Marginal syndesmophytes seen in ankylosing spondylitisWhich spinal arthritides have marginal vs. non-marginal syndesmophytes?
Marginal: Ankylosing Spondylitis: bamboo spine, formed from extensive syndesmophytes
Non-marginal: Psoriatic arthritis (at thoracolumbar jxn), Reiter’s syndrome syndesmophytes skip levels with these two conditions
What systemic condition is commonly found in patients with (DISH) Diffuse idiopathic skeletal hyperostosis?
Diabetes (up to 50% of pts with DISH)
Dysphagia is common in which arthritic condition and why?
DISH – dysphagia due to spinal involvement, tendenous and extraspinal ligamentous calcification and ossification creates stiffness and difficulty swallowing
What part of the spine is DISH most commonly found?
Thoracic, lower cervical, upper lumbar
List the radiographic findings of neurotrophic arthropathy.
6D’s
Distended joint Density increase Debris Dislocation Disorganization Destruction
Which conditions may result in neurotrophic arthropathy?
Diabetes
Alcoholism
Tabes dorsalis (complication of syphilis leading to muscle weakness/paresthesia)
Paralysis
Syringomyelia (damage to spinal cord dt formation of fluid-filled area within cord)
What is synoviochondrometaplasia?
Metaplastic changes in synovium produce cartilaginous bodies
These bodies may or may not ossify or calcify
They also may or may not be free within joint capsule
Name the common sites of involvement of rheumatoid arthritis in the hand and wrist.
Hands: MCPs, PIPs (not DIPs) spindle digit (soft tissue swelling) marginal erosions (irregular with no sclerotic margin) especially of the 2nd and 3rd metacarpal head Hand Deformities: Boutonniere – DIP extension, PIP flexion Swan neck – Dip flexion, PIP extension Ulnar deviation at MCP joint Radial deviation of carpals Zig-zag deformity – ulnar deviation and radial deviation
Wrist: often occurs earlier and more severe than hand changes ulnar styloid erosion uniform loss of radiocarpal joint erosions at triquetrum-pisiform “spotty carpal” sign pancarpal involvement scapholunate dissociation
What is a marginal erosion and what category of arthritis is it seen with?
Seen in rheumatoid arthritis, especially in the radial margins of the 2nd and 3rd MC heads
Progressive marginal erosions
Irregular
Progressive marginal erosions erosion with no sclerotic margin
What is the significance of widening of the atlantodental interspace?
Seen in R.A.:
can create direct compression of the brainstem or cause neurological damage by creating excessive kyphosis
can create C1-C2 instability neurological damage, atlanto-axial subluxations
can get anterior-lysthesis if facet involvement: stair-stepping
Which conditions demonstrate laxity of the transverse ligament?
SLE, Down’s syndrome, possible with RA (but uncommon): The inflammatory arthridities tend to affect the tendons and ligaments rather than joint membranes
Is sacroiliac involvement common in rheumatoid arthritis?
No – if so, minimal sclerosis, unilateral or bilateral asymmetric
Describe the radiographic difference between rheumatoid arthritis and psoriatic arthritis in the hand & wrist.
*Psoriatic Arthritis
Psoriatic Arthritis HAND: DIPs and PIPs All three joints in a single digit involved = “ray pattern” Pencil-in-cup deformity (narrowing/tapering of middle bone like a pencil, with cup shaped distortion in end bone) Asymmetric Pseudowidening Osseous fusion Acro-osteolysis (see question 31)
IN GENERAL: Asymmetric Soft tissue swelling No osteopenia (unlike RA) Erosions Fluffy periostitis Narrowed or widened jt spaces ankylosis
Describe the radiographic difference between rheumatoid arthritis and psoriatic arthritis in the hand & wrist.
*rheumatoid arthritis
Rheumatoid Arthritis HAND: MCPs and PIPs (not DIPs) Soft tissue swelling (spindle digit) Marginal erosions (irregular with no sclerotic margins) Radial margins of 2nd and 3rd MC head eroded Boutonniere – DIP ext, PIP flex Swan neck – DIP flex, PIP ext Ulnar deviation at MCP Radial deviation of carpals “Zigzag” deformity: ulnar + radial deviation WRIST: often earlier and more severe than hand changes ulnar styloid erosion uniform loss of radiocarpal joint erosions at triquetrum-pisiform “spotty carpal” sign pancarpal involvement scapholunate dissociation
What is the gender incidence of rheumatoid arthritis?
F:M 3:1 until age 40, then 1:1
What is the first site of involvement with ankylosing spondylitis?
SI joint or thoracolumbar ->
-most classic finding
-bilateral, symmetric
-changes more prominent on iliac side and lower 2/3
pseudowidening-> erosions (“rosary bead” appearance) reactive sclerosis-> ankylosis (average 14 years)
approximately ½-> ankylosis
similar changes occur at pubic symphysis
What is the second site of involvement with ankylosing spondylitis?
Spine – disco vertebral joint (outer fibers of annulus erode-> sclerose-> ossify)
Also apophyseal joints, interspinous ligament ossification, costovertebral joints, cervical spine involved
Is sacroiliac involvement usually unilateral or bilateral in ankylosing spondylitis?
bilateral
What is the gender incidence of ankylosing spondylitis?
Younger males (15-35 years): M:F 9:1
Which condition demonstrates squaring of the vertebral body?
Ankylosing spondylitis
What is the shiny corner sign?
Increased radiodensity of vertebral body related to osteitis (in AS)
What is a “carrot stick” fracture?
A complication of ankylosing spondylitis, a fracture of an alkylosed segment of vertebrae, usually causing paralysis
Which condition demonstrates similar sacroiliac joint and vertebral column findings to ankylosing spondylitis?
Enteropathic arthropathy, secondary to ulcerative colitis, crohn’s dz, whipple’s dz, salmonella, shigella, Yersinia
Which two seronegative spondyloarthropathies demonstrate non-marginal syndesmophytes and peripheral arthritis?
Psoriatic and Reiters
Non-marginal syndesmophytes = thicker, not throughout the spine like in AS
Reversible deformities of the hand are seen in which condition?
Systemic Lupus Erythematous (SLE)
ulnar deviation, but pt can overcome this with muscle contraction or pushing down on the table
ligaments are lax, but joints are not destroyed
What is acro-osteolysis and which conditions demonstrates this finding?
resorption of the extremities (ie, distal phalanx “tufts”)
seen in scleroderma, psoriatic, SLE, hyperparathyroid
What is the overhanging margin sign and which condition is this seen in?
Pathognomonic finding in Gout, a C-shaped erosion that sticks out
What structures are primarily involved in CPPD?
CPPD = Calcium pyrophosphate dihydrate crystal deposition dz)
wrist, triangular fibrocartilage distal to ulnar styloid
knee, meniscus
pubic symphysis
involves calcification of cartilage chondrocalcinosis in intermediate layer
fibrous & hyaline cartilage
fibrous in meniscus and triangle
hyaline at end of bones: calcification parallel to cortex, thin, linear
AKA pseudogout
onset after 30, peaks at 60
Dx’ed by aspiration of synovial fluid
What structures are primarily involved in HADD?
HADD = Hydroxyapatite deposition disease
Common at shoulder and hip
Usually a single site of involvement
Causes calcific tendinitis (bursae, ligament, capsule)
