Inflammatory arthritis - Radiology Flashcards
What are the features of an inflammatory disease?
Loss of joinst spaces
Erosions (juxta-articular)
Soft bone (osteopenia) / Periarticular osteoporosis
Soft tissue swelling
What are the features of a degenerative disease?
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral scelerosis
Describe the distribution of osteoarthritis
- Distal (DIP and PIP) and symmetrical (affects same joints on both hands)
Describe the distrbution of psoriatic arthritis
Distal and asymemtrical (same joints affected but one side is predominately affected/different joints are affected one either side)
Describe the distribution of rheumatoid arthritis
Proximal (MTP, PIP and wrists) and symmetrical/asymmetrical
What is scelerosis? What is it a feature of?
- Sclerorsis = increase in bone density
- A feature of degeneration
What is juxtaarticular osteoporosis?
Loss of bone density proximal to the joint but a preservation of bone density distal from the joint
a) What are erosions
b) What condition are they a feature of?
c) What is an active and healed erosion?
d) What should you do if it’s hard to distingish between an erosion and cyst
a) A hole in bone, adjacent to a joint, with no roof due to synovium becoming inflamed and eating into bone where it’s attached
b) Inflammatory arthritis
c) Active erosion - ill defined
Healed erosion - less ill defined
d) An oblique view can be take if hard to distinguish between erosion and cyst
a) What is a subchondral cyst
b) What is it a feature off?
c) What is a geode?
a) A hole in bone, adjacent to a joint, with a roof. It occurs more centrally than marginally (unlike erosions)
b) Features of degeneration
c) Geode - large subchondral cyst
a) What are osteophytes?
b) Which type of bone formation do they typically develop by?
c) What type of condition is it a feature of?
d) It can be confused with entheseal proliferation. What is the difference between osteophyes and entheseal proliferation
a) Areas of new bone formation that occurs at the peripheral of joints
b) Typically develop by endochondral formation
c) Features of degenerative joint disease
d) Entheseal proliferation are found further away from the joint, fluffier and more ill defines
a) Describe this radiograph
b) What is the likey diagnosis
a)
- Proximal – affects MTP, wrists
- Sparing of DIP and relative sparing of PIP
- Slightly symmetrical
- Erosions in MTP and wrists
- Loss of joint space
- No osteophytes
b) Points towards inflammatory disease - rheumatoid arthritis
a) Describe this radiograph?
b) What is the likely diagnosis?
a)
- Distal and symmetrical – affects PIP and DIP joints
- Scelerosis
- Subchondral cysts
- Osteophytes at DIP and MTP of thumb
b) Points towards a degenerative disease - osteoarthritis
a) Describe this radiograph
b) What is the most liekly diagnosis?
a)
- Soft tissue swelling involving DIP
- Asymmetrical involvement
- Distal – DIP joints affected
- New bone formation- less well defined so enthesitis
b) Point towards inflammatory - psoriatic arthritis
