Exam 4 (PDF pages 63-82) Flashcards
What are the 4 categories of arthritis?
1) degenerative
2) inflammatory
3) metabolic
4) infective
Which arthritis category is this?
-commonly exhibits a non-uniform loss of joint space, osteophytes, subchondral sclerosis and cysts and a predisposition for asymmetrical distribution
degenerative
What are some arthritis examples under the degenerative category?
-osteoarthritis/DDD/DJD
-erosive osteoarthritis
-diffuse idiopathic skeletal hyperostosis (DISH)
-neurotrophic arthropathy
-synoviochondrometaplasia
Which arthritis category is this?
-commonly exhibit soft tissue swelling/edema, uniform loss of joint space, bone erosions, juxta-articular osteoporosis
-when polyarticular, a symmetric pattern of distribution is more frequent
inflammatory
What are some arthritis examples under the inflammatory category?
-rheumatoid arthritis (RA)
-juvenile RA
-psoriatic arthritis
-ankylosing spondylitis (AS)
-reactive arthritis (reiter’s syndrome)
-systemic lupus erythmatosus (SLE)
-jaccoud’s arthritis
-scleroderma
-osteitis condensans IIIi
-osteitis pubis
Which arthritis category is this?
-commonly exhibit soft tissue masses, bone lesions
metabolic
What are some arthritis examples under the metabolic category?
-gout
-calcium pyrophosphate dihydrate crystal deposition disease
-ochronosis
-sarcoidosis
define enthesis
transition zone between bone and ligament or tendon
define enthesopathy
inflammatory cellular infiltrate at the bone-ligament or bone-tendon junction, usually seen in inflammatory arthritides
define erosion
loss of bone due to pressure atrophy or bone breakdown
define hyperostosis
ossification of a ligament or tendon, common in diffuse idiopathic skeletal hyperostosis (DISH)
define monoarticular
one joint involved
define pauciarticular
2-4 joints involved
define polyarticular
> 4 joints involved
define uniform arthritis
-entire joint space is decreased
-seen mostly in inflammatory arthritis
define non-uniform arthritis
-localized decrease in joint cavity
-usually at most stressed site
-seen in degenerative arthritis
define osteophyte
degenerative bony overgrowth continuous with underlying cortex, covered with a cartilaginous cap, occurring at the insertion of a ligament near a joint
define syndesmophyte
inflammatory ossification within a spinal ligament
define seronegative arthritis
inflammatory arthritis that lacks the presence of rheumatoid factor (AS, psoriatic arthritis, and reactive arthritis)
The name ___________________ is used more when all signs of degeneration are in the extremity. Also called ________, which is used when signs of degeneration are in the facet region, and _________ is used when there are signs of degeneration in the disc region
osteoarthritis, DJD, DDD
What is the most common arthritis characterized by changes in articular cartilage and its related components?
test q
osteoarthritis/DJD/DDD
What are the most common sites of involvement for osteoarthritis/DJD/DDD?
-weight bearing articulations of the spine
-hips
-knees
-AC joint
-1st MCP joint
-1st metacarpal-trapezium joint
-DIP joints of hand
Spinal involvement of osteoarthritis/DJD/DDD would have what symptoms?
-nerve root entrapment
-spinal stenosis
-vertebral artery stenosis
-esophageal compression
This is the pathophysiology of which arthritis?
-physical or chemical forces trigger a change/loss of chondrotin sulfate (found in the ground substance of normal cartilage), thus interfering with normal chondrocyte function
-this altered ground substance undergoes destruction of the cartilage surface and subchondral bone
-the cartilage degradation is the radiographic visual of loss of joint space
-osteophytes develop from a combination of cartilage degradation and increase capsular insertion stress
osteoarthritis/DJD/DDD
What are the 3 radiographic features that need to be there to diagnose osteoarthritis/DJD/DDD?
“LEO”
L= non-uniform loss of joint space
E= eburnation (subchondral sclerosis, increased radiopacity)
O= osteophyte formation (bony overgrowths)
What are the other radiographic features of osteoarthritis/DJD/DDD besides “LEO”?
-asymmetric distribution
-subchondral cysts (geodes, ovoid/round loss of bone density with a sclerotic rim, close to the joint surface, it is the escape of synovial fluid into subchondral bone, can cause fractures and deformity in weight bearing joints
-intraarticular loose bodies (fragmentation of degenerated cartilage and subchondral bone)
-articular deformity (degeneration causes altered joint mechanics with redistribution of forces)
-joint subluxation (deformation, ligament laxity can cause instability and eventual displacement)
Which part of the cervical spine most commonly has DJD?
C5-C6
What are the radiographic features of DJD in the cervical spine?
-most commonly ay C5-C6
-apophyseal joints (facet arthrosis) will have osteophytes and/or sclerosis
-von luschka (uncovertebral) joints will have osteophytes and IVF encroachment
-IVDs will have decreased height, vacuum phenomenon, osteophytes, and canal stenosis
What is the vacuum phenomenon?
lucent vacuum cleft adjacent to end plate, aka knuttsen’s sign (nitrogen gas build up in IVD, cannot dissipate)
Which part of the thoracic spine most commonly has DJD?
T6-T12
What are the radiographic features of DJD in the thoracic spine?
-costovertebral joints have osteophytes
-IVDs have decreased height, osteophytes, and kyphosis
Which part of the lumbar spine most commonly has DJD?
L4/L5
What are the radiographic features of DJD in the thoracic spine?
-apophyseal joints (facet arthrosis) will have decreased space, sclerosis, osteophytes, and subluxation
-IVDs will have decreased height, vacuum phenomenon, osteophytes, canal stenosis, and body sclerosis
What are the radiographic features of DJD in the sacroiliac area?
-loss of joint space
-subchondral sclerosis
-osteophytes
What are some associated degenerative syndromes with osteoarthritis/DJD/DDD?
-degenerative spondylolisthesis (occurs in conjunction with loss of joint space and disc height, remodeling of the facet surfaces (more sagittally), common at L4 and C7)
-instability (increased intersegmental movement)
-synovial (ganglion, juxta-articular) cysts (occur in conjunction with degenerative facet hypertrophy, common at L4/L5)
-hemispheric spondylosclerosis (HSS, significant subchondral sclerosis adjacent to the endplate, common at L4/L5)
-baastrup’s syndrome (kissing spine syndrome, impingement between SPs due to excessive lordosis from interspinous osteoarthritis (basically SPs jam together))
-hip may have femur migration superiorly and laterally
-hip may have osteophyte formation, sclerosis, or cysts
-knee will most commonly have the medial compartment affected
-wrist primarily affects the 1st metacarpal-trapezium joint
-wrist may have sclerosis or osteophytes
-hand may have visible enlargement of DIP joints (Heberden’s nodes) and PIP joints (Bouchard’s nodes)
Where is degenerative spondylolisthesis common?
L5 and C7
Where are synovial (ganglion, juxta-articular) cysts common in the spine?
L4/L5
Where is hemispheric spondylosclerosis (HSS) common?
L4/L5
What are heberden’s nodes?
visible enlargement of DIP joints
What are bouchard’s nodes?
visible enlargement of PIP joints
Which arthritis types have heberden and bouchard nodes?
1) osteoarthritis/DJD/DDD
2) RA also has haygarths which is at MCP joints)
3)
Which arthritis is a variant of DJD?
erosive osteoarthritis (also called inflammatory osteoarthritis)
Which arthritis is this?
-characterized by episodic and acute inflammation of the DIP and PIP joints
-inflammation includes pain, edema, redness, nodules, and restricted motion
-may also be occasionally involve the thumb at the MCP and CMC joint, and between the trapezium and scaphoid articulations
-osteophytes
-loss of joint space
-sclerosis
-superimposed changes of erosions, periostitis, and ankylosis on the above degenerative features
-bone erosions are centrally located on the proximal articular surface and more peripheral at the distal articular surface -> resultant articular surface is termed “gull wing sign”****
erosive osteoarthritis (also called inflammatory osteoarthritis)
Which degenerative arthritis is ligamentous, not joint related?
diffuse idiopathic skeletal hyperostosis (DISH) also called forrestier’s disease
Which arthritis is a spinal and extraspinal disorder characterized by ligamentous calcification and ossification, commonly ALL, but can also be PLL
diffuse idiopathic skeletal hyperostosis (DISH) also called forrestier’s disease
Patients with DISH may have _____________ due to anterior hyperostosis
dysphagia
DISH is associated with what disorder in 50% of cases?
diabetes
What are the 3 definitive criteria for diagnosis of DISH?
1) flowing ossification/calcification of the anterior aspect of at least 4 contiguous vertebral bodies (dripping candle wax, flame shaped osteophytes, or candle flame hyperostosis appearance)
2) relative preservation of disc height of involved segments
3) absence of apophyseal joint ankylosis and sacroiliac joint erosion (ROM relatively unaffected
Which part of the cervical spine most commonly has DISH?
C4-C7
What are the cervical spine presentations of DISH?
-presents with a flowing, bumpy anterior contour
-loss of cervical lordosis
-can affect PLL and cause canal stenosis/myelopathy
What is the most common site of spinal involvement for DISH?
thoracic spine, usually T7-T11
Which part of the lumbar spine most commonly has DISH?
L1-L3
A destructive articular disorder occurring secondarily to a loss of impairment in joint proprioception. Involved joint undergoes traumatic degeneration -> destruction and instability
neurotrophic arthropathy, also called charcot joint, neurogenic arthropathy, or neuroarthropathy
What is the most common cause of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy)?
diabetes
What are the causes of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy)?
-congenital (congenital indifferences to pain, meningocele)
-acquired (alcoholism, amyloidosis, CMT disease, leprosy, MS, neurosyphilis, syringomyelia, tumor)
-iatrogenic (drug induced)
What is the most common cause of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy)?
charcot marie tooth (CMT) disease
What are the 2 radiographic patterns of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy)?
hypertrophic and atrophic
One of the radiographic patterns of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy is hypertrophic pattern which is characterized by the 6 D’s. What are the 6 D’s?
1) distension
2) density
3) debris
4) dislocation
5) disorganization
6) destruction
Which radiographic pattern of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy) is more common- hypertrophic or atrophic?
hypertrophic
Where is the hypertrophic pattern of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy) seen?
weight bearing joints of the lumbar spine, knees, and ankles
Where is the atrophic pattern of neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy) seen?
non-weight bearing joints of the UE, especially the shoulder, elbow, and wrist
also seen in the hip and foot
What are the radiographic features of atrophic pattern in neurotrophic arthropathy (also called charcot joint, neurogenic arthropathy, or neuroarthropathy)?
appears as a surgical amputation of the articular end of a bone or the bone will gradually taper resembling a licked candy stick
Arthropathy, characterized by synovial tissue producing cartilaginous loose bodies within a joint, sometimes referred to as joint mice
synoviochondrometaplasia
What is the most common sight for synoviochondrometaplasia?
knee
Which arthritis is this?
-predominantly males 3:1 ratio around 30-50 y/o
-joint space will appear normal if loose bodies are not calcified
-once calcified, appear as round or ovoid, with laminated and stippled radiolucencies within an opaque matrix
synoviochondrometaplasia
Inflammatory connective tissue disorder which target synovial tissue, especially the peripheral joints of the hand/feet, as well as larger joints and the cervical spine, also exhibits systemic symptoms. Affected progressively BILATERALLY and SYMMETRICALLY
rheumatoid arthritis (RA)
What is the pathophysiology of RA?
-begins with synovial inflammation within joints, bursae, and tendon sheaths, with cellular infiltrate, hyperemia, edema
-synovium becomes hypertrophied to form granulation tissue (pannus)
-pannus infiltrates cartilage surfaces, and at bare areas, infiltrates bone, causing erosions and deformities
Which arthritis is this?
-palpable rheumatoid nodules (soft accumulation of inflammatory cells with outer zone of fibrosis) found on forearms, knees, ankles, hands, and over the sacrum
-soft tissue swellings adjacent to the MCP joints are called haygarth’s nodes (also at PIP joints which is called bouchard’s nodes)
RA
Which arthritis has these radiographic features?
-periarticular soft tissue swelling called baker’s cyst
-juxta-articular osteoporosis
-marginal erosions called rat bite erosions at the ulnar styloid process, carpal bones, tibial condyles, and humerus
-joint deformity causing ulnar deviation, boutonniere (flexion of PIP and extension of DIP joints), and hitch hiker’s thumb
-swan neck (flexion of DIP, extension of PIP)
-lanois deformity (dorsal subluxation of MTP joints with fibular deviation)
-AO joint will show loss of joint space, erosions, ankylosis, and upward odontoid translocation
-AA joint will show apophyseal joint erosions and ankylosis, atlas instability, laxity of transverse ligament (increased ADI >3mm), odontoid erosions
-C3-C7 will show apophyseal joint erosions, sclerosis, decreased neck length with narrowed IVDs, tapered erosions to spinous, osteoporotic vertebral bodies
RA
Which arthritis would have these lab findings?
-elevated ESR (erythrocytes sedimentation rate)
-elevated C-RP (C reactive protein)
-positive rheumatoid factor (RA latex positive)
-normochromic, normocytic anemia
RA
What 2 syndromes are associated with RA?
Felty’s syndrome and Caplan’s syndrome
What is Felty’s syndrome?
combo of leukopenia, splenomegaly, and RA
What is Caplan’s syndrome?
combo of pneumoconiosis and RA
Which arthritis is this?
-chronic polyarthritis
-usually begins before 16 y/o
-lower degree of inflammatory changes but affects bone growth
-absence of rheumatoid factor(seronegative) is a characteristic finding
juvenile RA (also known as Still’s disease)
What are the 3 subtypes of juvenile RA (also known as Still’s disease)?
1) classic systemic
2) pauciarticular-monoarticular
3) polyarticular (most common subtype)
Which subtype of juvenile RA (also known as Still’s disease) is this?
-systemic involvement of organ systems- high acute, intermittent fever, lymphadenopathy, hepatosplenomegaly, carditis, leukocytosis, anemia
-rash over trunk, face, and/or extremities
-joint manifestations are generally mild
classic systemic
Which subtype of juvenile RA (also known as Still’s disease) is this?
-affecting 4 or less joints in females 3x more frequently
-insidious onset with mild swelling, stiffness, and pain
-systemic manifestations are infrequent
-most common joints affected are the knee, ankle, hip, elbow, and wrist
-knee is the most common monoarticular onset along with iridocyclitis
pauciarticular-monoarticular
Which subtype of juvenile RA (also known as Still’s disease) is this?
-bilateral symmetrical involvement (pain, swelling) of MCP, wrist, foot, ankle, and knee articulations, also cervical spine
-may present with systemic symptoms but generally mild to moderate in severity
-osteoporosis
-uniform loss of joint space
-articular erosions
-growth distrubances
-ankylosis (especially cervical apophyseal joints)
-epiphyseal fractures
-AA joint instability
polyarticular (most common subtype)
Which arthritis is this?
-an erosive, seronegative arthopathy associated with psoriasis, a common skin disorder
-characterized by peripheral joint (hands/feet) destruction/deformity, bilateral, asymmetric sacroilitis and lower thoracic/upper lumbar involvement
psoriatic arthritis
Which arthritis has a high correlation with the presences of psoriatic nail involvement and articular changes?
psoriatic arthritis
Which arthritis has early changes with DIP joint redness, swelling and pain known as “sausage digits”?
psoriatic arthritis
What are the most common joints involved in psoriatic arthritis?
DIP and PIP
If MCP, PIP, and DIP joints are all involved in psoriatic arthritis, then what is this pattern called?
ray pattern
Which arthritis has erosions with fluffy periostitis “mouse ear” sign, which progresses into a tapering effect of the distal articular end of the phalanx known as pencil in cup deformity
psoriatic arthritis
Which arthritis would have these lab findings?
-elevated ESR
-negative rheumatoid factor
-+HLA-B27 antigen especially with spine involvement
psoriatic arthritis
A chronic, inflammatory disorder involving primarily the axial skeleton affecting mostly males 15-40 y/o, progresses to bony ankylosis, ligamentous ossification- bilaterally and symmetrically
ankylosing spondylitis
Which arthritis has these clinical features?
-pain, aching, stiffness typically begin in the low back (sacrum, buttocks into thighs)
-sciatica bilateral or alternates side to side
-reduced mobility
-paraspinal muscle spasm
-diminished chest expansion
-peripheral sites may include hips, shoulders, knees and heels with pain, limited ROM, muscle atrophy
-iritis (visual impairment)
-tachycardia
-aortic aneurysms
-lung fibrosis
-ulcerative colitis
-crohn’s disease
-prostatitis
-with increased ESR during active phase and HLA-B27 lab findings
ankylosing spondylitis
Where is ankylosing spondylitis in the sacrum most prominent?
lower 2/3
What are the 3 stages of ankylosing spondylitis in the sacrum?
1) pseudowidening of the SI joint space
2) erosions and sclerotic changes
3) ankylosis
Where is ankylosing spondylitis most evident in the spine?
thoracolumbar and lumbosacral regions and then ascends with the process of syndesmophytosis
Which arthritis would have calcification that occurs at the enthesis (bone/ligament of bone/tendon junction) and is known as a shiny corner sign at the corners of vertebra?
ankylosing spondylitis
Which arthritis would have ossification of outer annulus fibers known as bamboo spine?
ankylosing spondylitis
Which arthritis would have ossification of the joint capsule, ligamentum flavum and interspinous ligaments known as trolley track sign?
ankylosing spondylitis
Which arthritis would have ossification of interspinous and supraspinous ligaments known as dagger sign?
ankylosing spondylitis
Arthritis characterized by urethritis, conjunctivitis, uveitis, and polyarthritis, may of may not all be present simultaneously
reactive arthritis (also known as reiter’s syndrome)
What are the 2 causes of reactive arthritis (also known as reiter’s syndrome)?
1) venereal (chlamydia)
2) dysentric (shigella, salmonella)
What is the most common cause of reactive arthritis?
venereal (chlamydia)
Which arthritis has pain at the achilles calcaneal attachment known as lovers heels?
reactive arthritis (also known as reiter’s syndrome)
Which arthritis would have these radiographic and lab findings?
-swelling
-osteoporosis
-loss of joint space
-erosions and fluffy periostitis
-anemia
-elevated ESR
-HLA-B27
reactive arthritis (also known as reiter’s syndrome)
A chronic autoimmune disorder is which a person’s WBCs attack their moisture producing glands
sjogren’s syndrome
characterized by dry mouth, dry eyes, organ dysfunction, fatigue, and joint pain
sjogren’s syndrome
Which syndrome has an increased incidence of developing lymphoma?
sjogren’s syndrome
What would have these lab findings?
-positive ANA (anti-nuclear antibody)
-postive rheumatoid factor
-positive schirmer test (measures tear production/eye dryness)
-salivary gland function test (spit test)
sjogren’s syndrome
Chronic connective tissue disorder involving many organ systems, butterfly rash on face, RA like joint pain, deformities such as swan neck, boutonniere, and ulnar deviation
SLE
What would have these lab and radiographic findings?
-+ANA antinuclear antibodies
-elevated ESR
-anti-DNA antibodies
-bilateral, symmetrical deformities (usually reversible)
-osteoporosis
-minimal arthropathy
-deformities ulnar deviation
-boutonniere
-swan neck
-AA instability (increased ADI)
SLE
Which arthritis is a rare consequence of rheumatic fever?
test q
jaccoud’s arthritis
Systemic, inflammatory connective tissue disease involving the skin, lungs, GI tract, heart, kidneys, and MSK (appendicular skeleton)
progressive systemic sclerosis (PSS) also known as scleroderma
What would have these clinical features?
-begins as edema (especially painful swelling of the extremities) and then progresses with induration (thickening) and then atrophy of underlying tissues
-telangiectasia
-vitiligo
-hyperpigmentation
-face may be described as mouse like or mask like
-fingers may be described as claw like
progressive systemic sclerosis (PSS) also known as scleroderma
What is associated with CREST syndrome?
progressive systemic sclerosis (PSS) also known as scleroderma
What is CREST syndrome?
C= calcinosis
R= raynaud’s phenomenon
E= esophageal dysfunction
S= sclerodactyly (tapering deformity of the fingers)
T= telangiectasia
Non-progressive, self limiting arthritis with bilateral, symmetrical sacroiliac arthropathy, triangular shaped area of sclerosis at the lower half of the ilium
osteitis condensans IIii (OCI)
Painful condition characterized by bony resorption and reossification of the pubic symphysis. Frequently follows surgery of the prostate, uterus, or bladder, pregnancy, or trauma
osteitis pubis
Which condition has these clinical and radiographic features?
-pain at pubic symphysis
-may have antalgic gait with trunk flexion and waddling to prevent symphyseal stress
-may require arthrodesis
-may minic local infection
-bilateral and usually symmetric subchondral sclerosis of the pubic symphysis with widening of the joint space
osteitis pubis
Disorder of purine metabolism in which hyperuricemia leads to the deposition of sodium monourate crystals into synovial tissue, cartilage, periarticular and subcutaneous tissues
gout
Gout most commonly involves the….
LE
What are the 4 stages of gout?
1) asymptomatic (hyperuricemia present)
2) acute gout arthritis (prevalent at 1st MTP joint (podagra)
3) polyarticular gouty arthritis (may also affect hand, wrist, and elbow)
4) chronic tophaceous gout (soft tissue accumulations of sodium monourate (tophi))
Which arthritis would have these radiographic features?
-soft tissue tophi
-bone erosions (marginal, periarticular) known as overhanging margin sign
-intraosseous erosions (radiolucent or punched out areas in subchondral bone near involved joint
gout
Sometimes called pseudogout, an inflammatory joint disorder characterized by the deposition of calcium pyrophosphate dehydrate (CPPD) into the synovial fluid and articular cartilage
calcium pyrophosphate dihydrate (CPPD) crystal deposition disease
What would have these clinical features?
-symptoms mimic osteoarthritis with progressive joint pain, intermittent swelling, decreased ROM and crepitus
-predominantly involves peripheral joints, especially the knees
-may be associated with other conditions like diabetes, gout, hyperparathyroidism, hemochromatosis, and wilson’s disease
calcium pyrophosphate dihydrate (CPPD) crystal deposition disease
What condition would show chondrocalcinosis on an xray (calcification of hyaline (articular) or fibrocartilage (menisci)?
Test q
calcium pyrophosphate dihydrate (CPPD) crystal deposition disease
A rare, hereditary metabolic disorder of AA metabolism characterized by an absence of homogentisic acid oxidase (disorder in tyrosine metabolism)
ochronosis
What condition would have these clinical features?
-insidious onset of back pain and joint stiffness
-alkaptonuria (homogentisic acid excreted in urine turns black when exposed to air)
-deposition of homogentisic acid into body tissues, especially cartilage of the ears and nose
-sclerae and skin produces a yellow, black, or blue discoloration due to acid build up
ochronosis
What condition would have these radiographic features?
-mostly seen in spine (lumbar, thoracic, and then cervical)
-loss of disc height
-vacuum phenomenon
-distal calcifications
-osteoporosis
-loss of lumbar lordosis
-increased thoracic kyphosis
ochronosis
Systemic disease affecting multiple organ systems characterized by the formation of disseminated noncaseating (no necrosis) granulomas
sarcoidosis
What condition would have these clinical and radiographic features?
-lymphadenopathy
-hepatosplenomegaly
-ocular abnormalities
-nodular skin rash (especially on face, neck, shoulders, and anterior tibia)
-phalanges may have a diffuse reticular pattern known as “lace like” trabecula
sarcoidosis
Which syndrome is associated with sarcoidosis?
lofgrens
What is lofgrens syndrome?
acute onset of sarcoidosis, fever, arthralgia, lymphadenopathy, and erythema nodosum (rash on legs)
What is infective arthritis/septic arthritis?
-joint destruction (most commonly monoarticular) due to joint contamination with a micro-organism
-2 common sources are blood borne pathogens and post traumatic directed implantation
-secondary septic arthritis can also be a result of joint replacement surgery
What is the most common micro-organism that causes infective arthritis/septic arthritis?
S. aureus
What condition would have these clinical and radiographic features?
-severe pain and edema
-decreased ROM
-erythema
-fever
-knee and hip are most involved
-rapid loss of joint space
-loss of cortical white line progressing with medullary metaphyseal “motheaten” destruction
infective arthritis/septic arthritis
Arthritis disorders are similar, how can you determine disorder type?
understanding joint anatomy and key radiographic signs
The transition zone between bone and ligament
enthesis
Which of the following is non-uniform loss of joint space, eburnation, and osteophytes?
A) arthritis
B) osteoarthritis
C) gout
D) none of the above
B) osteoarthritis
Which term is used when all signs of degeneration are in the extremity?
osteoarthritis
Which of the following is a hereditary metabolic disorder of AA metabolism?
ochronosis
Which arthritis category has soft tissue swelling, uniform loss of joint space and is symmetric?
inflammatory
Which of the following presents with swan neck (flexion of DIP or extension of PIP)?
A) juvenile RA
B) psoriatic arthritis
C) ankylosing spondylitis
D) RA
D) RA
In which arthritis do you have to be aware of AA joint instability?
A) RA
B) psoriatic arthritis
C) ankylosing spondylitis
D) all of the above
D) all of the above
In this syndrome, the body’s moisture producing glands are attacked?
sjogren’s
A disorder of tyrosine metabolism is seen in this hereditary disorder?
ochronosis
in which condition is the radiographic feature of a triangular shaped area of sclerosis at the lower half of the ilium?
osteitis condensans illi
Who has the highest risk for osteitis condensans illi?
multiparous females
Acute gout arthritis of the first MTP joint is called?
podagra
Which deformity has a dorsal subluxation of MTP joints with fibular deviation?
lanois
Which has flexion of PIP and extension of DIP?
A) ulnar deviation
B) boutonniere
C) swan neck
D) lanois
B) boutonniere
This arthropathy is characterized by loose bodies or joint mice within a joint (knee common)?
synoviochondrometaplasia
Neurotrophic arthropathy is caused by
diabetes
The face has been described as mouse like, mask like, and has claw like fingers?
scleroderma
Which of the following is a degenerative disorder arthritis?
A) juvenile
B) reiter’s
C) ochronosis
D) erosive
D) erosive
All of the following are metabolic disorder arthritis except?
A) jaccoud’s
B) gout
C) ochronosis
D) sarcoidosis
A) jaccoud’s
All of the following are inflammatory disorder arthritis except?
A) psoriatic
B) scleroderma
C) osteitis pubis
D) neurotrophic
D) neurotrophic
In a pauciarticular disorder, how many joints are involved?
2-4
Osteoarthritis is nearly universal by age:
80
A degenerative bony overgrowth continuous with underlying cortex?
osteophyte
A lucent cleft adjacent to an endplate
vacuum phenomenon
Which of the following is a chronic connective tissue disorder?
A) SLE
B) sjogren’s
C) reiter’s
D) ankylosing spondylitis
A) SLE
Which of the following can mimic a local infection?
A) sarcoidosis
B) osteitis pubis
C) gout
D) sjogren’s
B) osteitis pubis
blood vessel dilated on face:
telangiectasia
Which is an autoimmune disorder?
A) SLE
B) sjogren’s
C) gout
D) RA
B) sjogren’s
In the hand, enlargement of PIP joints
bouchards node
A chronic inflammatory disorder involving the axial skeleton
ankylosing spondylitis
Which of the following is also called charcot’s joint?
A) erosive osteoarthritis
B) neurotrophic arthropathy
C) synoviochondrometaplasia
D) RA
B) neurotrophic arthropathy
Which of the following can be acquired with alcoholism?
A) neurotrophic arthropathy
B) RA
C) DISH
D) infective arthritis
A) neurotrophic arthropathy
Most common inflammatory disorder
RA
The impingement between SPs due to excessive lordosis
baastrup’s syndrome (kissing spine)
In the hand, enlargment of DIP joints:
heberdens nodes
Where is the gull wings sign?
A) RA
B) juvenille RA
C) erosive osteoarthritis
D) DISH
C) erosive osteoarthritis
Which of the following is characterized by ligamentous calcification and ossification in ALL and PLL?
A) osteoarthritis
B) DISH
C) neurotrophic arthropathy
D) synoviochondrometaplasia
B) DISH
What is the most common cause of charcot’s joint?
diabetes
Non-weight bearing joints of UE, appears a “surgical amputation, that gradually taper resembling a “licked candy stick”?
atrophic pattern
Soft tissue swellings adjacent to the MCP are called:
haygarth’s node
In psoriatic arthritis, the erosions with fluffy periostitis are called?
mouse ears
What is found in lab test especially with spine involvement?
HLA-B27
Which of the following presents “lovers heels”?
A) reiter’s syndrome
B) ankylosing spondylitis
C) psoriatic arthritis
D) sjogren’s syndrome
A) reiter’s syndrome
Which of the following have deposition of sodium monourate crystals into synovial tissue?
A) reiter’s
B) sjogren’s
C) gout
D) ochronosis
C) gout
The acute gout arthritis is prevalent at
1st MTP (podagra)
chondrocalcinosis
calcification of hyaline or fibrocartilage
