PPT 8 Flashcards
HADD is calcifying
tendinitis and bursitis
HADD characteristics
- 40-70 yoa
- M=F
HADD MC in _____ specifically _____ but also affects elbow, wrist, fingers, hip, knee, foot, spine
single joint, shoulder (rotator cuff, hip, upper C spine)
What is the most definitive method of Dx for HADD
xray
HADD etiology
unknown
HADD the area of degeneration is ____ and you see what type of deposition?
focal, crystal deposition
HADD tendon calcification
- At insertion site
- Does not blend into cortex of adjacent bone
- Ovoid calcifications, sharp margins
- Disappear with U/S and active mobilization
HADD bursal calcification
- Impossible differentiation from tendon Ca++ radiographically
- MC subacromial, subdeltoid and ischial bursae
CPPD is a what type of disease
crystal deposition disease
What produces gout like symptoms?
pseudo-gout
CPPD characteristics
- > 30 yoa
- Chronic progressive joint pain
- Peripheral joints (Knees, wrists, hands, ankles, hips, elbows)
CPPD crystal deposition into which cartilage?
hyaline and fibrous types
CPPD is in and around which joints
- knee
- wrist
CPPD radiologic features: Chondrocalcinosis - Hyaline Cartilage
- thin, linear, parallel to articular cortex
- MC – wrist, knee, elbow, hip and shoulder
CPPD radiologic features: Chondrocalcinosis - Fibrocartilage
- thick, irregular, shaggy poorly defined margin
- MC – periphery of the meniscus of the knee, triangular fibrocartilage of wrist, symphysis pubis, annulus fibrosus
CPPD - Pyrophosphate arthropathy chracteristics
- Structural joint changes occurring due to CPPD crystals within a joint
- Similar DJD changes
Erosive OA is known as
inflammatory OA
Erosive OA is an episodic and acute inflammation of which joints?
DIP and PIP
Erosive OA is unilateral or bilateral?
bilateral
Erosive OA is symmetric or asymmetric
symmetric
Erosive OA characteristics
- Middle-aged females
- Pain, edema, redness, nodules, ROM
- 15% develop RA after >12 yrs
- Familial?
EOA radiologic changes
- DJD changes WITH bone erosions
- –*DIP joints
- CENTRAL EROSIONS
- –“GULL WINGS SIGN”
EOA main DDX for RA
rarely involves the DIP joints, has +’ve lab results
EOA main DDX for PA
marginal erosions with adjacent periostitis
EOA main DDX for non-inflammatory DJD
no erosions, identical to EOA
RA is what type of tissue disorder?
CT
RA etiology
unknown
RA attacks which tissues
synovial
RA characteristics
20-60 yoa Female, 3:1 (in 20-40 yoa group) 1:1 (>40 yoa) Pain, tenderness, stiffness, swelling “Jelling phenomenon”
RA is unilateral or bilateral
bilateral
In RA, what is the joint involvement?
peripheral
RA begins at ___ and ___ joints
IP & MCP
RA progresses proximally or distally?
proximally
RA - firm non-tender rheumatoid nodules characteristics
- Accumulation of inflammatory cells
- In 20% of patients
- severe cases
- 5mm to 3cm
- On extensor surfaces
RA: Haygarth’s nodes
- soft tissue swelling
- MCP joints
RA - Lab Values
- ↑ ESR and ↑ C-reactive protein
- Presence of rheumatoid factor (not specific for RA)
Felty’s syndrome which conditions combined?
Rheumatoid arthritis + Leukopenia + Splenomegaly
In RA you have a poor prognosis if
- Presence of subcutaneous nodules and high levels of rheumatoid factor
- Exacerbation of disease for more that 1 year
- Onset earlier than 30 yoa
- Extra-articular manifestations
RA Pathology
- acute synovitis with edema
- periarticular edema
- juxta-articular hyperemia
In RA, synovial proliferation forms
pannus
Pannus is ___ tissue that spreads over what surface of bone and cartilage?
vascular tissue, intra-articular
In RA Bare Area, where intra-articular bone is in direct contact with synovium there are _____ erosions
marginal
In RA, there are ____ cavities because ___ enters marrow space of the ____ bone
cyst-like, pannus, subchondral
In RA, the joint fills with pannus and leads to
progressive fibrous ankylosis
RA MC sites
- Hand
- Wrist
- Foot
- Knee
- Hip
- Cervical spine
RA of the hands which joint is NOT involved?
DIP
In RA of the hands there are ____ changes
irreversible
In RA of the hands there are _____ erosions, MC at
- marginal
- radial margins of 2nd and 3rd metacarpal heads
- Radial margins of the distal and proximal ends of the proximal phalanges
In RA of the hands you see
Boutonniere deformity
Swan-neck deformity
Digital ulnar deviation (zig zag deformity)
Carpal radial deviation