Lecture 10: Inflammatory : Reiters SLE Flashcards
Reiters Spine:
TL manifestations?
- *Spine:**
- Occasionally may result in AA instability or atlas dislocation
-TL manifestations:
- Coarse non-marginal syndesmophytes
- may be complete or incomplete
- May be floating type, but unattached to vertebral bodies
What condition is this?
CPPD
Radiology:
Major features:
-Calcification in and around the joint (Pyrophosphate Arthropathy)
- Chondroalcinosis: Calcification of cartilage
- Pyrophosphate athropathy
Calcium pyrophosphate dihydrate crystal
Radiology
Radiology:
Major features:
-Calcification in and around the joint (Pyrophosphate Arthropathy)
- Chondroalcinosis: Calcification of cartilage
- Pyrophosphate athropathy
What condition is this?
- *SLE in the hands**
- Flexible deformities caused by lax ligaments and tendons
- Boutinniere and swan neck
- *-Arthropathy:**
- Joint space normal, with no subchondral bone changes
- Generalised osteopenia
- *ST:
- **Muscle atrophy
- Sometimes punctuate or sheet like calcification in myofascial plans and subcutaneous tissue
- Peripheral vascular calcifications
Common Radiological findings in Reiters in the spine?
- non-marginal syndemophytes
- Thoracolumbar region
- Asymmetric
- “Skip” type of distribution
- Complete/incomplete
- Vertical
- Thick, tapered
- Fluffy or well define
SLE
JOINTS?
- *Hands:**
- Flexible deformities caused by lax ligaments and tendons
- Boutinniere and Swan Neck
- Arthropathy:*
- *-** Joints space normal, with no subchondral bone changes
- Generalised osteopenia
- Soft Tissue:*
- Muscle atrophy
- Sometimes punctuate or sheet like calcification
- -Peripheral vascular calcification*
- *Spine:**
- Unusual location
- May develop AA instability
- *Long bones:**
- Osteonecrosis, most commonly in femoral and humeral heads
- Effects are likely to be simultaneously bilateral.
- Other affected sites: femoral condyles, talus, wrist, tarsus, metacarpal heads, metatarsal heads
- Severe osteoporosis
- *Chest:**
- Small bilateral pleural effusions, and pleural thickening
- Cardiomegaly
- Pericardial effusion
Gout
Radiograph Clinical manifestations
- 75% of gout patients have back pain. x-ray signs rare. CX spine most commonly effected with odontoid erosion, atlantoaxial instability and endplate erosion.
- *Radiology:**
- Clinical manifestations may precede visible signs 5-10years.
- Soft Tissue: Effusion tophi (5mm to 5cm)
- Joint Spaces: Late loss of joint space, Very rare ankylosis
- Bone Erosions:
- -*Marginal plannus reaction with cortical loss
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis or diaphysis
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into Soft tissue.
-Interosseous well circumscribed, oval or round punched out tophi in medullary cavitiy.
- *Bone Density:** Usually remains normal but may see some subchondral osteopenia.
- *Periosteum:** occasional linear periosteal new bone
- *Chondrocalcinosis:** Uncommon, occurs in triangular cartilage of wrist, knee meniscus, symphysis pubis.
- *Avascular necrosis:** Medullary infarcts, epiphyseal necrosis. at femoral and humeral heads.
What condition is this?
Gout with ulna deviation
- Radiology:*
- Clinical manifestations may precede visible signs 5-10years.
- Soft Tissue: Effusion tophi (5mm to 5cm)
- Joint Spaces: Late loss of joint space, Very rare ankylosis
- Bone Erosions:
- Marginal plannus reaction with cortical loss
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis or diaphysis
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into Soft tissue.
-Interosseous well circumscribed, oval or round punched out tophi in medullary cavitiy.
Bone Density: Usually remains normal but may see some subchondral osteopenia.
Periosteum: occasional linear periosteal new bone
Chondrocalcinosis: Uncommon, occurs in triangular cartilage of wrist, knee meniscus, symphysis pubis.
Avascular necrosis: Medullary infarcts, epiphyseal necrosis. at femoral and humeral heads.
What condition is this?
Longstanding Gout
- Radiology:*
- Clinical manifestations may precede visible signs 5-10years.
- Soft Tissue: Effusion tophi (5mm to 5cm)
- Joint Spaces: Late loss of joint space, Very rare ankylosis
- Bone Erosions:
- Marginal plannus reaction with cortical loss
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis or diaphysis
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into Soft tissue.
-Interosseous well circumscribed, oval or round punched out tophi in medullary cavitiy.
Bone Density: Usually remains normal but may see some subchondral osteopenia.
Periosteum: occasional linear periosteal new bone
Chondrocalcinosis: Uncommon, occurs in triangular cartilage of wrist, knee meniscus, symphysis pubis.
Avascular necrosis: Medullary infarcts, epiphyseal necrosis. at femoral and humeral heads.
What condition is this?
Reiters finger“marginal erosion (arrows) linear periostitis (arrow heads) and soft tissue swelling (crossed arrows)”
Reiters
General?
Distribution?
- *General:**
- Articular and periarticular soft tissue swelling
- Osteoporosis
- Uniform loss of joint space
- Marginal eprsions
- Periostitis
- *Distribution:**
- MTP and interphalangeal foot joints
- Calcaneus
- Ankle
- Knee
- SIJ
Calcium pyrophosphate dihydrate crystal.
Clinical features
- Similar to DJD, chronic progressive joint pain, intermittent swelling, crepitus and decreased R.O.M.
- Chronic course interspersed with acute attacks.
- Peripheral joints most often involved in order; knees, wrists, hands, ankles, hips and elbows.
- Wrist involvement often includes carpal tunnel syndrome
Reiters Joints:
- *Knee:** -Usually only visible change is effusion
- With longstanding pelligrini stieda type of calcification may develp in medial collateral ligament (Avulsion injury of the medial collateral ligament at the medial femoral condyle). Calcification usually begins to form a few weeks after the initial injury)
- *Foot, ankles, and toes:**
- Prominent soft tissue swelling
- MTP and IP erosions
- Associated osteoporosis and linear fluffy periositis
- Lanois deformity: proximal phalnages dorsally subluxed, fibular deviation of digits.
- *Calcaneous:**
- Erosions
- Signs are achilles and platar insertions
- Soft tissue swelling
- *Ankle:**
- Swelling and periostitis and malleoli
- *SIJ:**
- Involved in up to 70% of Reiter’s patients
- May see erosions hazy joint margins, variable sclerosis, especially on iliac margins
- Altered joint space
- Can progress to ankylosis but not as common as AS
SLE
General
- Bilateral, symmetric, reversible hand /finger deformities
- Osteoporsis
- Soft tissue atrophy and calcification
- Minimal arthropathy
- Increased osteonecrosis
- Hands are most prominently affected
- Proximal long bones may be involved in up to 10% of adults, 40% adults
What is this condition?
- *Reiters:**
- Involved in up to 70% of reiters patients
- May see ersions hazy joint margins, variable sclerosis, especially on iliac margins
- Altered joint space
- Can progress to ankylosis but not as common as AS
What is this condition?
Spine:
“Occasionally may result in AA instability or atlas dislocation”
TL manifestations:
-Coarse non-marginal syndemophytes
-May be complete or incomplete
-May be floating type, but unattached to vertebral bodies
What condition is this?
Gout:
- Marginal pannus reaction to cortical loss.
- Periarticular pressure erosions especially with tophi with eccentric locations in metaphysis and diaphysis.
- Sclerotic margins gives “overhanging margin sign” where lip of bone protrudes into soft tissue.
-Erosion of bone around the tophis
