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1
Q

This is a chonic, inflammatory arthritis primarily affecting the articulations & ligs of the spine & pelvis

A

Ankylosing Spondylitis

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2
Q

Ankylosing Spondylitis is AKA?

A

Marie-Strumpell, Bechterev, rhizomelic spondylitis

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3
Q

Ankylosing Spondylitis is a common cause of low back pain in what group of people?

A

Young males (15-35 yrs of age; 9:1 M-to-F)

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4
Q

Where is aching/stiffness M/C w/ Ankylosing Spondylitis?

A

In sacral region

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5
Q

What is the typical clinical presentation of Ankylosing Spondylitis?

A 
Pain at max in morning
Pain/tenderness over bony prominences
Chest pain (costochondral involvement)
Fatigue,low grade fever
Iritis, heart problems, upper lung fibrosis
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6
Q

What % of pt’s w/ Ankylosing Spondylitis have peripheral involvement?

A

up to 50%

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7
Q

What are typical lab findings w/ Ankylosing Spondylitis?

A

Positive HLA-B27 (90-95% of cases)
ESR
Negative for RF

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8
Q

What are the characteristic sites of involvement for Ankylosing Spondylitis?

A 
SI joints (M/C; hallmark)
Apophyseal joints
Costovertebral joints
Pubic symphysis
Discovertebral
Manubriosternal joints
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9
Q

What are basic features of Ankylosing Spondylitis radiographically in the SI joints?

A 
Reactive Sclerosis
Osteoporosis
Bony ankylosis
Erosions
Typically bilateral & symmetrical
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10
Q

What are the most diagnostic views for Ankylosing Spondylitis in the SI joints?

A

PA angulated spots or SI views

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11
Q

What are the stage 1 changes in SI joints w/ Ankylosing Spondylitis?

A

Pseudo-widening of joint

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12
Q

What are the stage 2 changes in SI joints w/ Ankylosing Spondylitis?

A

Erosive & sclerotic changes

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13
Q

What are the stage 3 changes in SI joints w/ Ankylosing Spondylitis?

A

Ankylosis 50% (7-23 years)

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14
Q

What radiographic signs are assoc. w/ ankylosing spondylitis in the SI?

A

Ghost joint margins

Star sign

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15
Q

Erosive changes w/ ankylosing spondylitis in the SI are seen more on what part of the joint?

A

Iliac side of the joint & lower 1/3rd of the joint

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16
Q

Where are the earliest spinal manifestations radiographically of ankylosing spondylitis?

A

Thoracolumbar region (M/C)

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17
Q

This is an erosion at the corner of a vert. body assoc. w/ ankylosing spondylitis

A

Romanus lesion

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18
Q

Vert. bodies become what shape w/ ankylosing spondylitis?

A

Squared contour, barrel shaped

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19
Q

This radiographic sign is d/t osteitis in the spine of a pt w/ ankylosing spondylitis

A

Shiny corner sign

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20
Q

Ossification of the outer edges of the disc in a pt w/ ankylosing spondylitis is called what?

A

Marginal syndesmophytes

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21
Q

Names assoc. w/ ankylosing spondylitis in the spine?

A

Bamboo spine, Trolley-track, dagger sign

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22
Q

Type of fx assoc. w/ ankylosing spondylitis in the spine?

A

Carrot-stick fx

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23
Q

Lesion that is assoc. w/ ankylosing spondylitis that looks like an infection & is M/C in the C-spine

A

Anderson lesion

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24
Q

This arthropathy is assoc. w/ ulcerative colits & crohn’s disease

A

Enteropathic arthropathy

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25
Q

Enteropathic Arthropathy affects what group of people?

A

Young adults

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26
Q

What is a typical clinical symptom of enteropathic arthropathy?

A

Peripheral arthralgias w/ rapid resolution (knee, ankle, elbow, wrist)

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27
Q

What % of time is there spinal involvement w/ enteropathic arthropathy?

A

5%

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28
Q

What lab test is positive w/ enteropathic arthropathy?

A

HLA-B27

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29
Q

How does enteropathic arthropathy appear radiographically?

A

Similar to ankylosing spondylitis (bilateral & symmetrical)

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30
Q

Common skin disorder assoc. w/ joint disease characterized by peripheral joint destruction & deformity, sacroiliitis, & non-marginal syndesmophytes

A

Psoriatic Arthritis

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31
Q

What is the pathophysiology of Psoriatic Arthritis?

A

Similar to RA
Pannus affects cartilage less &erosions are smaller & slower in development
Periostitis

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32
Q

What are the M/C joints affected by Psoriatic Arthritis?

A

DIP of hand & foot

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33
Q

What age group is M/C affected by Psoriatic Arthritis?

A

20-50 yrs of age

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34
Q

What are clinical features of Psoriatic Arthritis?

A

Skin lesions characteristic of psoriasis
Nail changes (incidence of arthritis increased)
Acute & chronic joint pain especially in DIP joints
Morning stiffness
Sausage digit

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35
Q

What are laboratory features seen w/ Psoriatic Arthritis?

A

Positive HLA-B27 (30%)
Hyperuricemia
Increased ESR

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36
Q

What is the M/C pattern of involvement w/ Psoriatic Arthritis?

A

Polyarthritis w/ DIP joint involvement

37
Q

What are some radiographic features seen w/ Psoriatic Arthritis?

A 
Soft tissue swelling (sausage digit)
Normal bone mineralization
Erosions & tapering of bone ends
Juxta-articular fluffy periostitis
Joint space may be wide
Non-marginal syndesmophytes
Sacroiliitis (bilateral asymmetrical)
Sparring of pos. joints except C-spine
38
Q

What is one radiographic feature seen w/ Psoriatic Arthritis but not RA?

A

Juxta-articular fluffy periostitis

39
Q

Fluffy periostitis is AKA?

A

Mouse Ears

40
Q

What radiographic feature is highly suggestive of Psoriatic Arthritis?

A

DIP & PIP ankylosis

41
Q

What is an uncommon radiographic finding w/ Psoriatic Arthritis?

A

SI ankylosis

42
Q

Type of deformity assoc. w/ Psoriatic Arthritis?

A

Pencil & cup deformity AKA mortar & pestal deformity

43
Q

What view can you see marginal syndesmophytes?

44
Q

This is AKA as Reactive arthritis?

A

Reiter’s Syndrome AKA Conjuctivo-urethro-synovial syndrome

45
Q

What triad is assoc. w/ Reiter’s?

A

arthritis, conjuctivitis, & non-specific urethritis (Can’t see, can’t pee, can’t dance w/ me)

46
Q

Reiter’s usually follows what?

A

Sexual intercourse or rarely certain types of dysentery

47
Q

What ratio does Reiter’s affect males to females?

A

50:1 M-to-F

48
Q

What age group is affected by Reiter’s?

A

20-40 yrs of age

49
Q

Where is arthritis M/C w/ Reiter’s?

A

Lower extremity

50
Q

Rash that is assoc w/ Reiter’s that appears on the palms of the hand & bottom of the feet?

A

Keratodermia blennorrhagica

51
Q

What is the M/C clinical presentation of Reiter’s?

A

Conjuctivitis

52
Q

What lab test is positive in 75% of cases of Reiter’s?

53
Q

What are radiographic features of Reiter’s?

A

Lower extremities (MTP, IP, calcaneus, knee, ankle)
SI (bilateral asymmetrical)
Spine (thoracolumbar)
Non marginal syndesmophytes, Soft tissue swelling, Osteoporosis, marginal erosions, uniform decrease of joint space, periosititis

54
Q

What is one radiographic feature common w/ Reiter’s but not psoriatic?

A

Osteoporosis

55
Q

Condition assoc. w/ Reiter’s where there is periostitis on calcaneous

A

Lover’s Heel

56
Q

Reiter’s & psoriatic involve more peripheral joints or more axial joints?

A

Peripheral

57
Q

Disorder of purine (adenine, guanine) metabolism that results in hyperuricemia which causes the deposition of monosodium urate crystals into joints & soft tissues

A

Gout (Gouty Arthritis)

58
Q

What are the pathomechanics of Gout?

A

Tophi irritates the synovium which leads to hyperplasia & formation of granulation tissue (pannus) which leads to erosions & cartilage destruction

59
Q

Which type of gout is caused by a metabolic disorder where hyper-uricemia is caused by uric acid overproduction

60
Q

Who is affected M/C from Gout?

A

Males 20:1 age 30-60

61
Q

Gout attacks are precipitated by what?

A 
Surgery
Trauma
Dietary or alcohol excess
Starvation
Drugs (salicylates)
62
Q

This particular group of women are prone to Gout?

A

Postmenopausal women on diuretics

63
Q

What are some clinical signs of Gout?

A 
Prodromal irritability 
Sudden onset of pain
20% develop renal calculi
Red, hot, dry, swollen, tender joint
Local edema
Sometimes fever
20% have tophi around joints & ear cartilage
64
Q

What is the clinical presentation of a pt w/ asymptomatic hyperuricemia?

A

No s/s
Predisposed to gouty arthritis
Renal calculi

65
Q

S/S of acute gouty arthritis

A

Affects 1st MTP joint (M/C location to see gout)
Swollen, hot, dry, joint
Rapid recovery

66
Q

Type of gout where radiographic changes are most frequently encountered

A

Polyarticular gouty arthritis

67
Q

Type of gout that is not common seen & lasts on avg. 10-12 years

A

Chronic tophaceous gout

68
Q

Hydroxyapapitite Deposition Disease (HADD) is M/C seen where?

A

Supraspinatus tendon (calcification about greater tuburosity of humerus

69
Q

What are lab findings w/ gouty arthritis?

A 
Elevated uric acid
Moderate leucocytosis
Increased ESR
Low grade proteinuria
Monosodium urate crystals in joint fluid
70
Q

What % of gout attacks are monoarticular?

71
Q

What % of gout attacks involve the big toe?

72
Q

What are radiographic findings assoc. w/ gout?

A

Asymmetrical w/ lower extremity predilection
Joint effusion
Uniform joint narrowing (late)
Bone erosions (marginal, periarticular, intraosseous)
Soft tissue masses

73
Q

What is a radiographic sign assoc. w/ gout?

A

Overhanging edge sign

74
Q

What are 2 radiographic presentations that differentiates gout from RA?

A

Periarticular bone erosions & a lack of juxta-articular osteoporosis

75
Q

What is a radiographic sign seen in RA & gout?

A

Spotty Carpal Sign

76
Q

Where is the M/C location to see CPPD?

77
Q

What is the key radiographic feature of CPPD?

A

Chondrocalcinosis (calcification in cartilage)

78
Q

What are 3 presentations of CPPD?

A

Acute-symptomatic (pseudogout)
Asymptomatic-chondrocalcinosis
Chronic-Pyrophosphate Arthropathy

79
Q

Which presentation of CPPD do you see bone changes in?

A

Chronic (Pyrophosphate Arthropathy)

80
Q

What would you see radiographically that would suggest a chronic presentation of CPPD?

A

Degenerative changes in a joint that is not a primary location of OA (MCPs, glenohumeral, radiocarpal joints)

81
Q

If you have degenerative changes in the knee & they’re localized to the ________ joint then CPPD/Pyrophosphate Arthropathy should be a consideration

A

Patellofemoral joint

82
Q

This is a bilateral symmetrical SI disorder predominately found in multiparous females

A

Osteitis Condensans ilii

83
Q

Osteitis Condensans Ilii is AKA?

A

Hyperostosis Triangularis ilii

84
Q

What causes Osteitis Condensans Ilii?

A

Combination of hormone-induced ligamentous laxity & increased mechanical joint stress that leads to low-grade inflammatory & sclerotic changes involving the iliac subchondral bone

85
Q

What is the typical clinical presentation of Osteitis Condensans Ilii?

A

A multiparous woman b/w 20-40 yrs of age w/ chronic LBP & stiffness

86
Q

What labs are typically seen w/ Osteitis Condensans Ilii?

A

Labs are typically normal

87
Q

Where is Osteitis Condensans Ilii seen in the SI joint on xray?

A

Seen on the lower 2/3rds or 1/3rd

88
Q

What differentiates Osteitis Condensans Ilii from sacroillitis?

A

Sclerosis but no marginal erosions

Skeletal Rad (5 decks)

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