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DXI II > Exam 2: [Diseases, Deformities & Signs] > Flashcards

Exam 2: [Diseases, Deformities & Signs] Flashcards

1
Q

DJD is generally characterized by:

A

1) bone proliferation
2) asymmetrical non-uniform joint space loss
3) locations of weight bearing/high use

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2
Q

Hip DJD: Radiographic Features

A

1) non-uniform joint space loss
2) Circumferential (collar) Osteophytes
3) Cortical buttressing
4) Subchondral Cysts & Subchondral Sclerosis
5) Superior migration of femoral head
6) Intra-articular loose bodies

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3
Q

Advanced Hip DJD can lead to

A

Malum Coxae Senilis

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4
Q

Knee DJD: Radiographic Features

A

1) Joint space loss (M -> L -> patellofemoral)
2) Patellofemoral involvement
3) Loose bodies (joint mice)

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5
Q

Patellofemoral involvement in Knee DJD…

A

Without substantial findings in other compartments should raise suspicion of Pyrophosphate (CPPD) arthropathy

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6
Q

Ankle DJD: Occurs…

A

Secondary too trauma, occupational or activity stressors

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7
Q

Ankle DJD: Calcaneal Enthesophytes

A

Are unrelated to joint degeneration (even though frequently present)

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8
Q

Foot DJD: MC Location

A

1st MCP Joint

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9
Q

Foot DJD is associated w/

A

Bunion Formation

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10
Q

What is a Bunion?

A

Hyperostosis on medial aspect of 1st metatarsal head

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11
Q

Shoulder DJD: MC vs. Uncommon Sites

A

MC: AC Joint
Uncommon: GH Joint

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12
Q

GH Joint DJD

A

Should consider Pyrophosphate (CPPD) arthropathy in a sense of:
1) trauma
2) altered biomechanics (rot cuff tendinopathy)

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13
Q

Elbow DJD: Occurs…

A

Secondary to trauma, occupational or activity based stressors

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14
Q

Elbow DJD: Features

A
  • Loose Bodies (joint mice)
  • Triceps Enthesophyte may accompany
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15
Q

Wrist DJD: Areas Affected

A
  • 1st Carpometacarpal Joint (trapezium/metacarpal)
  • Trapezium/Scaphoid Joint
  • Radiocarpal Joint
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16
Q

Wrist DJD: Occurs…

A

Secondary to trauma, occupational or activity based stressors OR altered biomechanics

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17
Q

Altered biomechanics preceding Wrist DJD:

A
  • Carpal instability syndromes
  • Ulnar variance
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18
Q

Hand DJD: MC Location

A

Interphalangela joints (DIPs & PIPs)

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19
Q

Hand DJD: Occurs…

A

Secondary to trauma, occupational or activity based stressors

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20
Q

Hand DJD: Clinical Feature***

A

Heberden (DIPs) & Bouchard (PIPs) Nodes

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21
Q

DISH: a.k.a.

A

Forestier’s Disease

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22
Q

DISH: Features***

A
  • Spondylosis Hyperostotica
  • Spondylitis Ossificans Ligamentosa
  • (Senile) ankylosing Hyperostosis of the spine
  • Juxta-Articular ossification of vertebral ligaments
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23
Q

DISH: What is it?

A

Skeletal disorder characterized by ligamentous calcification & ossification

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24
Q

DISH: most prominent location

A

In the Spine involving the Anterior Longitudinal Ligament (ALL)

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25
Q

DISH: Population Affected

A

Males slightly > Females
> 50 years old

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26
Q

DISH: Signs & Symptoms

A

1) Asymptomatic
2) Loss of Lordosis/Increased Kyphosis
3) Pain & Stiffness
4) Dysphagia
5) Joint Pain
6) Tendon Pain
7) Synovitis

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27
Q

DISH & Diabetes

A

Adult-Onset Diabetes seen in 13-32% of people with DISH
HLA-B8 positive = 40%

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28
Q

DISH diff Dx from IVOC Includes:

A
  • preservation of disc height
  • absence of DDD signs (vacuum phenomenon & vertebral body marginal sclerosis)
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29
Q

DISH diff Dx from AS Includes:

A
  • Absence of facet joint ankylosis
  • SI Joint erosion, sclerosis or intra-articular osseous fusion
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30
Q

Strict Dx Criteria for DISH:

A

1) anterolateral ossification in 4 cont. vertebra
2) relative preservation of disc height
3) absence of facet joint ankylosis

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31
Q

DISH: MC site

A

On the right in T Spine (T7-T11)

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32
Q

DISH: Additional Features

A

1) bumpy ant. Spinal contour
2) discal extensions
3) vertical shadow between ossified ligament & vertebral body

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33
Q

DISH: MC other Skeletal Sites

A

Pelvis
Patella
Calcaneus
Foot
Elbow

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34
Q

DISH is associated w/…

A

OPLL

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35
Q

OPLL: a.k.a.

A

Japanese Disease

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36
Q

OPLL: MC Location

A

C2-C4 (cervical spine)

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37
Q

OPLL: Signs

A

May have neuro or Myelopathy signs

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38
Q

Signs of Myelopathy in OPLL

A

[Insidious motor & sensory disturbances]
- Heavy legs
- inability to walk at a brisk pace
- deterioration of fine motor skills
- (I) shooting pains in arms/legs
[Pathological Reflex Findings]

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39
Q

OPLL: Radiographic features

A
  • Dense, linear radiopaque strip 1-5mm thick
  • parallel to vertebral body margins
  • radiolucent zone between ligament & vertebral body may be seen
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40
Q

Ossification of _________ in OPLL Patients

A

Ligamenta Flava (7%)

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41
Q

Synovial Chondromatosis (SCM/SOC): What is it?

A

Meta plasma of synovial tissue into cartilage nodules that may calcify or ossify

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42
Q

Synovial Chondromatosis (SCM/SOC): Populations affected

A

20-50 year olds
Male 3:1
(Precipitated by trauma)

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43
Q

Synovial Chondromatosis (SCM/SOC): Clinical Presentation

A
  • Insidious onset of pain
  • Pain increase over time
  • swelling
  • Crepitus
  • Joint locking
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44
Q

Synovial Chondromatosis (SCM/SOC): MC Locations

A

70% Knee
20% Hip
Elbow
Ankle
Shoulder
Wrist

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45
Q

Primary Synovial Chondromatosis (SCM/SOC): Cause

A

[Idiopathic]
- Spontaneous
- Maybe Microtrauma??

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46
Q

Secondary Synovial Chondromatosis (SCM/SOC): Cause

A

1) DJD
2) Neuropathic Joint Disease
3) Osteochondritis Dessicans
4) Osteochondral Fractures
5) Joint Dislocations

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47
Q

Synovial Chondromatosis (SCM/SOC): Pressure

A

Extrinsic pressure may cause bone erosions

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48
Q

Synovial Chondromatosis (SCM/SOC): Deformity

A

Apple Core deformity (femoral neck)

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49
Q

Diff Dx for Synovial Chondromatosis (SCM/SOC):

A

Pigmented Villonodular Synovitis

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50
Q

What is Pigmented Villonodular Synovitis?

A

[Mass-like synovial proliferation]
- can cause pressure erosions
[No loose body calcification/ossification]

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51
Q

Synovial Chondromatosis (SCM/SOC): Referral

A

Orthopedic

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52
Q

Synovial Chondromatosis (SCM/SOC): Further Imaging

A

MRI (to determine extent of loose body formation)

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53
Q

Synovial Chondromatosis (SCM/SOC): Contraindication to Adjust?

A

Absolute

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54
Q

What is Neuropathic Arthropathy?

A

Destructive Articular disease occurring secondary to a loss of joint proprioception & loss of pain sensation

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55
Q

What happens to the involved joint in Neuropathic Arthropathy

A

undergoes premature and excessive traumatic degeneration that leads to severe destruction and instability

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56
Q

Neuropathic Arthropathy: a.k.a.

A

Charcot Joint

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57
Q

Neuropathic Arthropathy: Secondary conditions

A

[may cause neurological deficits]
1) MC: Diabetes 35% (lower extremities)
2) Syringomyelia 25% (upper extremities)
3) Tabes Dorsalis 20% (L spine & lower ext.)

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58
Q

Causes of Neuropathic Arthropathy (9)

A

1) DM ( alcoholism)
2) Syringomyelia (uremia)
3) Tabes Dorsalis (amyloidosis)
4) spinal cord tumors (steroid injections)
5) meningomyelocele (pernicious anemia)
6) spinal cord compression (congenital insensitivity to pain)
7) peripheral nerve tumors (familial dysautonomia)
8) MS (hereditary neuropathy)
9) poliomyelitis (leprosy)

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59
Q

French Theory for Pathogenesis of Neuropathic Arthropathy

A

Joint changes are result of CNS trophic centers damage which control nutrition of bones & joints (vasomotor dysregulation)

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60
Q

German Theory for Pathogenesis of Neuropathic Arthropathy

A

Joint changes are cumulative effects of multiple unprotected mechanical micro traumatic events

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61
Q

What leads to disintegration in Neuropathic Arthropathy

A

Loss of Normal Neurological Function rendering a joint susceptible to pathological alterations

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62
Q

Six “D’s” of Hypertrophic Pattern in Neuropathic Arthropathy

A

Distended Joints
Dislocation
Disorganization
Density Increases
Debris Production
Destruction

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63
Q

Characteristics of Atrophic Neuropathic Arthropathy

A
  • Lack’s the D’s
  • Reabsorbed articular surface
  • Tapered bone ends (licked candy stick)
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64
Q

Diff Dx & Treatment for Neuropathic Arthropathy

A

[Infection vs. aggressive neoplasm]
- immobilization/casting may slow healing
- managing underlying condition is crucial

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65
Q

Clinical presentation of Neuropathic Arthropathy

A
  • Painless swelling
  • deformity
  • weakness
  • instability
  • crepitus
  • “bag of bones”
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66
Q

What is Erosive Osteoarthritis (EOA)?

A
  • Inflammatory variant of osteoarthropathy (DJD)
  • Possible familial tendency
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67
Q

Clinical features of Erosive Osteoarthritis (EOA)

A
  • Middle-aged Females (30s-40s)
  • Pain, swelling & redness of joints
  • chronic disease progression
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68
Q

Radiographic features of Erosive Osteoarthritis (EOA)

A

DJD changes w, osseous erosions, periostitis and ankylosis
(Spares ulnar aspect of the wrist)

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69
Q

Located MCly affected by Erosive Osteoarthritis (EOA)

A

1) DIPs & PIPs
2) MCPs & 1st carpometacarpal joint

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70
Q

Sign seen in Erosive Osteoarthritis (EOA)

A

Gull-Wing

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71
Q

Erosive Osteoarthritis (EOA): Referral

A

Rheumatology for NSAIDS & Physical Therapy

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72
Q

Target tissue in RA

A

Synovium

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73
Q

RA is the result of…

A

Abnormal cellular immune response to antigen in synovial membrane

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74
Q

RA immune response leads to..

A

Erosive Pannus

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75
Q

RA: Lab Analysis

A

RF: not sensitive or specific for RA
(Not a requirement)
Anti-CCP (cyclic citrullinated peptide) antibody
ACCP: not sensitive for RA
ACCP: SPECIFIC for RA

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76
Q

Diagnosis of RA

A

Established by the constellation of findings observed over a period of time
(NOT BY LABS OR IMAGING FINDINGS)

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77
Q

RA: Population Affected

A

Females 3:1 before 40 years old
20-60 year olds

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78
Q

JIA: Onset

A

Before 16 years old

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79
Q

RA: Onset

A
  • Insidious
  • may follow physical/emotional stress
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80
Q

RA: Symptoms

A
  • Joint pain (tenderness, swelling, stiffness)
  • Fusiform ST swelling
  • Stiffness in the morning lasting > 2 hrs
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81
Q

MC Articular symptoms in RA

A

Begin in proximal interphalangeal joints & MCPs -> progress proximal

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82
Q

Clinical features of RA

A

Fatigue
Malaise
Generalized Muscle Weakness
Fever
Sjogren Syndrome: Xerostomia, Xerophthalamia, Xeroderma
(Dry mouth, dry eyes, dry skin)
Haygarth Nodes
Carpal Tunnel Syndroem

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83
Q

Xerophthalmia (dry eyes) condition seen in RA

A

Keratoconjunctivitis Sicca

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84
Q

RA Radiographic Features

A
  • Bilateral & Symmetrical
  • Periarticular Swelling
  • Uniform Loss of Joint Space
  • Marginal Erosions
  • Juxta-Articular Osteopenia
  • Large Pseudocysts
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85
Q

What is typically the 1st radiographic sign of RA?

A

Periarticular swelling

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86
Q

Deformities Seen in RA

A

Boutonnière Deformity
Hitchhiker Thumb

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87
Q

What is Boutenierre deformity?

A

Extension @ DIP, Flexion @ PIP

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88
Q

What is Hitchhiker Thumb?

A

Boutonnière of the thumb
Flexion of MCP, Extension of IP

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89
Q

RA: Target site of the wrist

A

Ulnar Styloid process

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90
Q

How much time before radiographic manifestations occur in RA?

A

3-6 months from onset

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91
Q

MC Location of Marginal Erosions in Hand RA

A

Radial aspect of 2nd & 3rd metacarpal heads and radial margins of proximal phalanges ends

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92
Q

Deformity in Foot RA

A

Lanois Deformity

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93
Q

X-Rays of RA Patients must include:

A

Standard series with Flexion View

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94
Q

Cervical Spine RA is associated w/

A

Pseudo-Basilar Invagination

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95
Q

Ligamentous Instability in Cervical Spine RA

A
  • Atlantoaxial joint from destruction of transverse ligament
  • widened ADI
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96
Q

MC alignment changes in Cervical Spine RA

A

C2-C4 Anterior Translation

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97
Q

Cervical Spine RA Lateral Cervical Appearance

A

Stepladder/Doorstep Appearance (multiple anterolisthesis)

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98
Q

Endplate erosions in Cervical Spine RA are MCly where?

A

Posterior 2/3rds of endplate

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99
Q

Consequences of Cervical Spine RA

A
  • Osteopenia w/ 5+ yrs of corticosteroid use
  • compression fractures
  • “sharpened pencil” spinous processes
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100
Q

Hip RA: Features

A
  • Axial migration
  • Protrusio Acetabuli
  • Erosions, Pseudocysts, Osteoporosis, ostenecrosis
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101
Q

RA is the MC cause of…

A

Bilateral Protusio Acetabuli

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102
Q

Elbow RA: Radiographic features

A

-Posterior Fat Pad in the absence of trauma should suspect RA or Infection

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103
Q

Heart RA

A
  • Cardiomegaly
  • Pericarditis
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104
Q

Lung RA

A
  • Nodular Densities
  • Diffuse basilar interstitial pattern
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105
Q

RA + Pneumoconiosis =

A

Caplan Syndrome

106
Q

RA + leukopenia and splenomegaly =

A

Felty Syndrome

107
Q

RA: Referral

A

Rheumatology

108
Q

RA: Treatment

A
  • DMARDs: anti-rheumatic drug
  • MC: Mathotrexate
  • Anti-inflammatory Diet
  • PACE exercise
109
Q

Juvenile Idiopathic Arthritis (JIA): Clinical Features

A
  • Females
  • Peak @ 2-5 and 9-12 years old
  • Fever, Rash, Lymphadenopathy, Iridocyclitis, Hypoplastic Mandible
110
Q

Juvenile Idiopathic Arthritis (JIA): Target Sites

A
  • C Spine
  • Hands/Wrists
  • Feet
  • Knees
  • Hips
111
Q

Juvenile Idiopathic Arthritis (JIA): Referral, Labs to run, Contraindication?

A

Rheumatology
CBC w/ differential & arthritis panel
Contraindication of involved joints

112
Q

What does “Seronegative Spondyloarthropathies” Mean?

A

“Seronegative”: rheumatoid factor negative
“Spondyloarthropathies”: affect joints, especially the spine

113
Q

Seronegative Spondyloarthropathies:

A

[PEAR]
1) Psoriatic Arthritis
2) Enteropathic Arthritis
3) Ankylosing Spondylitis
4) Reactive Arthritis

114
Q

Ankylosing Spondylitis (AS): what is it?

A

Chronic INFLAMMATORY disorder of unknown cause

115
Q

Ankylosing Spondylitis (AS): a.k.a.

A

Marie-Strumpell’s disease

116
Q

Ankylosing Spondylitis (AS): Pathogenesis***

A
  • Inflammatory
  • Autoimmune
  • HLA-B27 (90% test +)
117
Q

Ankylosing Spondylitis (AS): Target Sites

A

[Sharpey’s Fibers]

118
Q

Ankylosing Spondylitis (AS): Pathological Features in Synovial Joints

A

Synovial Joint proliferation -> Pannus -> Subchondral Bone Erosions -> Cartilage & Bone transformation -> osseous ankylosis

119
Q

Ankylosing Spondylitis (AS): Pathological Features in Fibrous Joints

A

Subchondral bone inflammation & granulation -> erosions -> fibrous ossification -> bony ankylosis

120
Q

Ankylosing Spondylitis (AS): Pathological Features in Entheses Joints

A

Erosive changes @ bone-ligament junction (Sharpey’s fibers) -> repair by bony deposition -> bony spicules (spur-like)

121
Q

Ankylosing Spondylitis (AS): Population Affected

A

15-35 years old
Males
White (4) to Black (1)

122
Q

When to consider Ankylosing Spondylitis (AS)

A
  • insidious back pain & stiffness
  • younger than 40
  • symptoms for > 3 months
  • increased symptoms in morning/inactivity
  • improvement w/ exercise
  • presence of iritis
123
Q

Ankylosing Spondylitis (AS): Symptoms

A

Local pain/tenderness of SI Joints
Sciatica Pain

124
Q

Ankylosing Spondylitis (AS): Extraskeletal Features

A
  • Unilateral Iritis
  • Heart & Lung changes
125
Q

Ankylosing Spondylitis (AS): Hallmark Joint Involved

A

SI Joints (bilateral & Symmetric)

126
Q

Stage 1 Ankylosing Spondylitis (AS)

A

Pseudo-widening of joint space

127
Q

Stage 2 Ankylosing Spondylitis (AS)

A

[Erosive & sclerotic changes]
- Rosary bead appearance/postage stamp
- triangular sclerosis

128
Q

Stage 3 Ankylosing Spondylitis (AS)

A

[Ankylosis]
- Ghost Joint (synovial)
- Star Sign (fibrous/syndesmotic)

129
Q

Important Early feature of Ankylosing Spondylitis (AS)

A

Osteitis

130
Q

What is Osteitis?

A

[Romanus Lesion the “shiny corner” sign]
Focal destructive areas along anterior margin of discovertebral junction @ superior and inferior vertebral bodies

131
Q

What comes secondary to remodeling a Romanus Lesion in Ankylosing Spondylitis (AS)?

A

Barrel-Shaped vertebra

132
Q

Radiographic feature of Spinal Ankylosing Spondylitis (AS)

A

Thin Marginal Syndesmophytes

133
Q

Bamboo Spine in Ankylosing Spondylitis (AS)

A

Fusion from marginal Syndesmophytes

134
Q

Railroad sign in Ankylosing Spondylitis (AS):

A

Ossification in facet joint capsules

135
Q

Dagger sign in Ankylosing Spondylitis (AS):

A

Isolated ossification of supraspinous & interspinous ligaments

136
Q

Trolley track sign in Ankylosing Spondylitis (AS):

A

Ossification within facet joint capsules, ligamentum flavum, interspinous ligaments

137
Q

Anderson lesion in Ankylosing Spondylitis (AS):

A

Poorly defined endplate secondary to fracture through a previously ankylosed segment

138
Q

Ankylosing Spondylitis (AS): Lab Findings

A

RF(-): Seronegative
Elevated ESR and CRP
HLA B27 (-): not specific, but sensitive

139
Q

Ankylosing Spondylitis (AS): Referral

A

Rheumatology

140
Q

Ankylosing Spondylitis (AS): Treatment

A
  • DMARDs, NSAIDS, Analgesics
  • Maintian joint mobility
  • Anti Inflammatory diet/ supplements
141
Q

What is Enteropathic Arthritis (EOA)?

A

Disease of GI origin w/ articular abnormalities

142
Q

2 MC GI Diseases in Enteropathic Arthritis (EOA)

A

Ulcerative Colitis & Regional Enteritis (Crohn’s)

143
Q

Other Related Conditions to Enteropathic Arthritis (EOA)

A

1) Whipple Disease
2) Salmonella, Shingella, Yersinia
3) Intestinal By-Pass
4) Hepatitis
5) Pacreatic Disease

144
Q

Enteropathic Arthritis (EOA): Clinical Features w/ Ulcerative Colitis

A

1) Malaise
2) Anorexia
3) Weight Loss
4) Abdominal Pain
5) Change in Stool

145
Q

Enteropathic Arthritis (EOA): Radiographic Changes

A

Same as AS

146
Q

When findings of AS/Enteropathic are seen…

A

(In the absence of clinical Hx)
The diff Dx is: (in this order)
1) AS
2) Enteropathic Arthritis

147
Q

Psoriatic Arthritis: What is it?

A

Skin disorder associated w/ erosive arthropathy

148
Q

Psoriatic Arthritis: Population Affected

A

20-50 years old
Male = Female

149
Q

Most significant Physical Correlation in Psoriatic Arthritis:

A

Nail Involvement (Nail Changes)

150
Q

Psoriatic Arthritis: Location

A
  • Interphalangeal Joints
  • MCP & MTP Joints
  • Calcaneus
  • SI Joints
  • Spine
151
Q

Psoriatic Arthritis: Early Involvement characterized by…

A

DIP Joint: redness, swelling & pain
Whole digit = Sausage digit

152
Q

Earliest Radiographic sign of Psoriatic Arthritis

A

Soft Tissue Swelling

153
Q

Immune reaction in Psoriatic Arthritis

A

[similar to RA]
Proliferation Synovitis -> Pannus -> cartilage & bone erosions -> narrowed joints

154
Q

Psoriatic Arthritis: Periosteal Reaction

A

Periostitis adjacent to erosions (not seen in RA)

155
Q

Psoriatic Arthritis: Radiographic Features

A
  • Asymmetric
  • Uniform loss of joint space (large joints)
  • widened joint space from erosions & fibrous deposition (small joints)
  • Complete ankylosis common
156
Q

What helps differentiate an RA diagnosis from a Psoriatic Arthritis diagnosis?

A

Lack of Osteopenia

157
Q

Sign seen in Periostitis with Psoriatic Arthritis

A

Mouse ear Sign

158
Q

Deformities seen in Psoriatic Arthritis:

A
  • Pencil in Cup
  • Opera Glass Hand
  • Arthritis Multilans
  • Ray Pattern
  • Acro-Osteolysis
  • Calcaneal Erosions
  • Ivory Phalanx
159
Q

MC Joints affected by Psoriatic Arthritis:

A

DIP & PIP
(MCP & wrists are usually spared)

160
Q

What is “Ray Pattern”

A

DIP, PIP and MCP involvement of the same digit
(Diagnostic sign of Psoriatic Arthritis)

161
Q

Psoriatic Arthritis: Calcaneal Effects

A

Calcaneal erosions & Periostitis at the Achilles and Plantar Ligament Insertions

162
Q

Calcaneal erosions & Periostitis at the Achilles and Plantar Ligament Insertions in Psoriatic Arthritis is due to

A

Infection of Clamydia

163
Q

Sacroiliac Psoriatic Arthritis:

A

MC: Bilateral asymmetric
30-50% of patients w/ Psoriatic Arthritis:

164
Q

Spinal Psoriatic Arthritis: Features

A

1) Non-Marginal Syndesmophytes
2) Atlantoaxial Subluxation
3) Discovertebral Erosions
4) Sparing of Facets

165
Q

MC Location & Involvement of Non-Marginal Syndesmophytes in Psoriatic Arthritis:

A

(T11-L3)
- Ossification initially lateral & separate from vertebral body
- eventually involves adjacent vertebral body & annulus fibers

166
Q

Cervical Spine Psoriatic Arthritis: Features

A
  • C-Spine involved in 35-75% of psoriatic arthritis patients
  • Narrowing/fusion of facets
167
Q

Psoriatic Arthritis: Referral

A

Rheumatology

168
Q

Psoriatic Arthritis: Skin Disease Treatments

A

Topical emollients & keratolytic agents

169
Q

Psoriatic Arthritis: Joint Disease Treatments

A

NSAIDS, DMARDs, Methotrexate, corticosteroid injections, Surgery

170
Q

Psoriatic Arthritis: general treatments

A
  • Anti-inflammatory diet
  • exercise
171
Q

Reactive Arthritis: formerly known as

A

Reiter’s Syndrome

172
Q

Reactive Arthritis: Clinical Triad

A

1) Conjunctivitis (cant see)
2) Urethritis (cant pee)
3) polyarthritis (cant dance with me)

173
Q

Reactive Arthritis: Population Affected

A

MC INflammatory Polyarthritis affecting Young Men
MALES
18-40 years old

174
Q

Reactive Arthritis: 2 Modes of Onset

A

MC: Venereal (Chlamydia Trachomatis)
Enteric (shigella, salmonella, yersinia)

175
Q

Reactive Arthritis: Location of skin lesions

A

MC on soles of feet & palms

176
Q

Up to 30% of Reactive Arthritis patients may develop:

A

Keratoderma Blennorrhagia

177
Q

Other lesions seen in Reactive Arthritis:

A
  • Genitals
  • Oral mucosa
  • Tongue
  • Hard Palate
178
Q

Reactive Arthritis: Clinical Features

A
  • asymmetrical in the lower extremity
  • shows up 1-3 weeks after urethritis or diarrhea
179
Q

Reactive Arthritis: MC Location

A
  • MTP Joints
  • IP Joints of the foot
  • Calcaneus
  • Ankle & Knee
180
Q

Reactive Arthritis: Foot & Ankle Radiographic Features

A
  • ST Swelling
  • Mariginal Erosions
  • Osteoporosis & Linear or Fluffy Periostitis
181
Q

What is Lanois Deformity?

A

Dorsal subluxation of the MTP joints and Fibular Deviation of the digits

182
Q

Pain in Reactive Arthritis:

A
  • Heel Pain & tenderness
  • Located posteriorly in the retro Calcaneal bursa or Achilles
  • Located Inferiorly at attachment of aponeurosis on plantar surface
183
Q

Calcaneal Sign in Reactive Arthritis:

A

Lover’s Heel

184
Q

Other Radiographic Features of Reactive Arthritis:

A

[Similar to AS & PsA]
- Periostitis & Spine changes mimic (PsA)
- Enthesis changes mimic all seronegative spondyloarthropathies

185
Q

Where are changes most apparent in Reactive Arthritis?

A

Lower Extremity & are Asymmetrical

186
Q

SIJ Reactive Arthritis: Features

A

MC: Sacroilitis
MC: Bilateral, asymmetrical

187
Q

Spine Reactive Arthritis: Features

A
  • Isolated to lower T spine and upper L spine
  • 15% non-marginal syndesmophytes
  • Atlantoaxial instability in < 2% of cases
188
Q

Reactive Arthritis: Referral

A

Rheumatology

189
Q

Reactive Arthritis: Treatment

A
  • NSAIDs, DMARDS
  • anti inflammatory diet
  • exercise
190
Q

What is Gout?

A

Painful arthropathy associated w/ hyperuricemia and secondary precipitation of sodium mono rate crystals in and around articulations

191
Q

Gout: Population Affected

A

Males
> 40 years old

192
Q

In Primary Gout, Hyperuricemia results from:

A
  • Overproduction
  • lack of excretion (enzyme defect)
193
Q

In Secondary Gout, Hyperuricemia results from:

A
  • Other disorders/diseases
  • drug interactions

(Causing overproduction/under excretion)
(Renal dysfunction os a common cause)

194
Q

Acute Gouty Arthritis

A
  • 60% on 1st MTP Joint
  • swollen, red, hot BUT DRY
  • responds immediately to colchicine treatment
195
Q

Polyarticular Gouty Arthiritis

A
  • Multiple attacks leads to poly articular involvement
  • radiographic changes are now visible
  • eventually, recovery becomes incomplete
196
Q

Chronic Tophaceous Gout

A
  • Follows numerous attacks (10-12 years)
  • Urate crystals deposit in several locations
  • Tophi contents have consistency of thick toothpaste
197
Q

Urate Crystal Deposition in Gout Occurs in:

A
  • Articular Cartilage
  • Subchondral Bone
  • Synovial membrane
  • Capsular/Periarticular tissues
198
Q

Pathological Features in Articular Tissues with Gout:

A

Crystal deposition -> inflammatory response -> Pannus -> cartilage breakdown & erosions

199
Q

Pathological Features in Periarticular Tissues with Gout:

A

Develop Tophi -> non-marginal pressure -> bone erosions

200
Q

Periarticular tissue affected by Gout

A

Bursae
Tendon Sheaths
Ligaments
Subcutaneous Tissues

201
Q

Radiographic features of Gout:

A
  • ST changes
  • Preservation of joint spaces
  • Uniform loss of Joint Space (in late disease)
  • Erosions
  • Periosteal new bone formation
  • secondary DJD
  • Chondrocalcinosis (5%)
202
Q

3 types of Bone Erosions in Gout:

A

1) Marginal
2) Periarticular
3) Intraosseous

203
Q

Marginal Erosions in GHout:

A

Due to pannus within joint

204
Q

Periarticular Erosions in Gout:

A

[Due to pressure erosions (tophus)]
- Eccentric
- Metaphyseal/Diaphyseal
- Sclerotic margin w/ protruding lip of bone (overhanging margin)

205
Q

Intraosseous Erosions in Gout:

A

Due to Tophi build up within bone

206
Q

Lab findings in Gout

A
  • Hyperuricemia (absolute finding)
  • Should be performed prior to imaging
207
Q

Gout: Treatment

A
  • Moist Heat
  • NSAIDs
  • Colchicine
  • Allopurinol
208
Q

How does Allopurinol work in treating Gout?

A

Decreases Uric acid formation & purine synthesis through xanthine oxidase

209
Q

How does Colchicine work in treating Gout?

A

Inhibits Uric acid deposition

210
Q

What is Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD)?

A

Articular disease characterized by production of gout like symptoms (pseudo-gout) in the presence of CPPD crystals

211
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD): Main Radiographic Finding

A

Chondrocalcinosis (involves hyaline and/or Fibrocartilage)

212
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD): Lab Findings

A

Normal except Increased ESR

213
Q

What reveals CPPD Crystals?

A

Joint Aspiration

214
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) may occur secondary to…

A
  • Hyperparathyroidism
  • Hemochromatosis
  • DM
  • Gout
  • etc.
215
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) triggers what?

A

Acute Synovitis (pain, swelling, redness of joint)

216
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) DOES NOT Trigger what?

A

Pannus formation or Tophi

217
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) Leads to…

A

Rapid & Extensive degradation of cartilage -> DJD

218
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD): Common Locations

A
  • Knee Meniscus
  • Symphysis Pubis
  • Triangular Fibrocartilage of wrist
  • annulus fibrosis
219
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD): Associated w/ what syndrome

A

Crowned Dens Syndrome

220
Q

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD): Radiographic Features

A
  • Unusual articular/intra-articular distribution
  • Prominent Subchondral cysts
  • Subchondral bone changes
  • may have osteophytes
221
Q

Hydroxyapatite Deposition Disease (HADD): What is it?

A

Deposition of calcium hydroxyapatite within tendon, bursa or other Periarticular ST’s

222
Q

Hydroxyapatite Deposition Disease (HADD): May cause…

A

Tendinitis
Bursitis
Joint Pain

223
Q

Hydroxyapatite Deposition Disease (HADD): Population affected

A

40-70 year olds
M = F

224
Q

Hydroxyapatite Deposition Disease (HADD): Symptoms

A

Pain
Tenderness
Localized Swelling
Decreased ROM

225
Q

Hydroxyapatite Deposition Disease (HADD): Radiographic Features

A
  • Tendon calcification
  • round/oval with clear margins (globular)
  • “veil-like”
226
Q

Hydroxyapatite Deposition Disease (HADD): MC Location

A

Shoulder

227
Q

Hydroxyapatite Deposition Disease (HADD): Other Locations

A

Hip or Longus Colli Muscle Tendon

228
Q

Hydroxyapatite Deposition Disease (HADD): Effect of Physiotherapy

A

Calcification may dissapear

229
Q

Progressive Systemic Sclerosis (PSS): a.k.a.’s

A

Scleroderma
Systemic Sclerosis

230
Q

What is Progressive Systemic Sclerosis (PSS)?

A

Systemic Inflammatory collagen vascular disorder (skin, lungs, GIT, Heart, kidneys & MSK)

231
Q

Progressive Systemic Sclerosis (PSS): Population Affected

A

30-50 year old Females

232
Q

Progressive Systemic Sclerosis (PSS): Most Unique Features

A

Edema -> Induration -> Atrophy

233
Q

Progressive Systemic Sclerosis (PSS): Symptoms

A
  • Peripheral Pain & Swelling
  • Raynaud Phenomenon
  • Thickening of Skin
  • Mouse-Like Fascies
  • Esophagus Dilation (GERD)
  • Decreased Bowel Function
  • Pleural/Pericardial Effusion
234
Q

Progressive Systemic Sclerosis (PSS): Crest Syndrome

A
  • Calcinosis
  • Raynaud Phenomenon
  • Esophageal Motility Issues
  • Skin/Subcutaneous Calcification
  • Telangiectasia
235
Q

Progressive Systemic Sclerosis (PSS): Pathological Changes

A
  • ST Changes (atrophy or calcifications)
  • Osseous changes (acro-osteolysis)
236
Q

Progressive Systemic Sclerosis (PSS): MC Site & Features

A

[Hand]
- ST retraction, tapered fingers
- acro-osteolysis
- calcinosis cutis

237
Q

Progressive Systemic Sclerosis (PSS): Referrals

A

[Rheumatology]
- Dermatologist, Pulmonologist, Nephrologist, astroenterologist, Cardiologist, Orthopedic Surgeon

238
Q

Progressive Systemic Sclerosis (PSS): Medications

A

Corticosteroids and DMARDs

239
Q

Systemic Lupus Erythematous (SLE): What is it?

A
  • CT disorder with multi-organ involvement
  • chronic w/ acute exacerbations
240
Q

Systemic Lupus Erythematous (SLE): Population Affected

A

20-40 year old Females

241
Q

Systemic Lupus Erythematous (SLE): Clinical Features

A
  • Fever & Malaise
  • Anorexia, Weight loss
  • Skin Rash
  • Arthralgia (pain, swelling, stiffness)
  • Hypermobility
242
Q

Systemic Lupus Erythematous (SLE): Lab Findings

A

Elevated ESR
+ ANA
LE Cell

243
Q

Rash seen in Systemic Lupus Erythematous (SLE)

A

Malar Rash on Face (40%)

244
Q

Systemic Lupus Erythematous (SLE): Systemic features

A

Kidney: renal failure
Heart: pericarditis
Lungs: interstitial disease
Raynaud phenomenon
Arthropathy** (up to 90%)

245
Q

Systemic Lupus Erythematous (SLE): Radiographic features

A
  • Bilateral, symmetric
  • reversible deformities
  • no joint space loss/erosions
  • Tuft reabsorption
  • ST atrophy & calcifications
246
Q

Systemic Lupus Erythematous (SLE): Complications of Steroid Treatments

A

1) Osteoporosis
2) Osteonecrosis
3) Spinal fracture

247
Q

Systemic Lupus Erythematous (SLE): Referral

A

[Rheumatologist]
- cardiologist, pulmonologist, nephrologist, PCP

248
Q

Systemic Lupus Erythematous (SLE): Treatment

A

Immunosuppressants & Corticosteroids

249
Q

Osteitis Condensans Ilii (OCI): What is it?

A

Isolated, Non-erosive sacroiliac arthropathy that mimics features of stress fracture

250
Q

Osteitis Condensans Ilii (OCI): Population affected & Cause

A

20-40 year old women
Unknown cause

251
Q

Osteitis Condensans Ilii (OCI): Theory for cause

A

Hormonal & secondary mechanical stresses related to pregnancy or menstrual cycle

252
Q

Osteitis Condensans Ilii (OCI): Radiographic features

A
  • Bilateral & symmetrical triangular sclerosis of iliac portion of SI Joints
253
Q

Osteitis Condensans Ilii (OCI): If reaction is suspected treat with…

A

[as appropriate]
- Adjustment
- PT
- Exercise
- Nutrition
- Education

254
Q

Osteitis Pubis: What is it?

A

Painful condition of the pubic symphysis

255
Q

Causes of Osteitis Pubis

A
  • Childbirth
  • Pelvic Surgeries
  • Athletic Injuries
256
Q

Osteitis Pubis: Clinical Features

A
  • Local pain/tenderness
  • Muscle spasms
  • Unstable gait
  • “groin-burning”
  • Audible “click” w/ some activities
257
Q

Osteitis Pubis: Radiographic features

A
  • bilateral & symmetrical
  • irregular bone margins
  • Subchondral sclerosis
  • moth-eaten type of osteoporosis
  • widening of joint space
258
Q

Osteitis Pubis: Looks identical to…

A

Infection

259
Q

Osteitis Pubis: May lead to…

A

Long term joint irregularity, instability & ankylosis

260
Q

Osteitis Pubis: Treatment Options

A
  • Adjustment
  • Referral if needed
  • remove from sport (if related)
  • strengthen & condition are a must
  • focus on balance & core strength exercises
261
Q

Osteitis Pubis: Must rule out what?

A

Infection

DXI II (8 decks)

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