RA, Juvenile arthritis, SLE, Scleroderma Flashcards
what is the target of rheumatoid arthritis
Synobial tissue + jts
What is the most common inflammatory arthritide
Rheumatoid athritis
Age of onset, gender RA
20-60
Higher prevelence in women (evens out after 40)
What is considered juvenil idioathic arthritis
before 16
S+S of RA
fusiform swelling
stiffness in morning
bilateral bursitis
eventual deformities
What are the 2 abnormal blood markers you will see in RA
Rheumatoid factor- 70-95%
Anti CCP
What is Anti CCP
measures levels of specific antibodies against CCP
-more specific than RA factor
What is the pathological progression of RA (3)
- acute synovitis
- synovial effusion + hyperemia
- Synovial proliferation/grandulation tissues (pannus formation)
What is the bare area
intracapsular bone not protected by articular cartilage
-inflammatory process (pannus formation) erodes unprotected bone
Target sites in hands/wrist and hallmark finding
MCPs
PIPs
Carpals
(spares DIPs)
Bilaterally symmetrical!!
what is a good hand vew to visualize RA
ballcatchers
What are the signs of RA in the hand (6)
- Uniform jt space loss
- Marginal erossions
- fusiform swelling
- periarticular osteopenia
- subchondral cysts
- subluxations
What is periarticular osteopenia
osteopenia in the jt capsul
abrupt density change
what causes ulnar styloid erosions
RA that originally in the extensor carpi ulnaris will start to eat at ulnar syloid
What are the types of hand deformities seen in RA
- Ulnar deviation
- Swan neck defomities
- Zig zag deformity (ulnar dev of MCPs and radial dev of radiocarpal)
- athritis mutilans
What is swan neck def
flex of dip
ext of pip
flex of mcp
What is boutonnieres deformity
ext of dip
flex of pip
ext of mcp
What are some imaging signs in the carpals in RA
- Spotty carpal sign
- Squashed carpal sign
- Terry thomas sign (scapholunate dissociation)
- bony ankylosis
What are the imaging findings for RA in the foot
same findings as hand
uniform loss of jt space, marginal erosions, swelling, periarticular osteopenia, subluxations
what are the xray signs of RA in the hip
Uniform loss of jt space
erosions
femoral head destruction
bilateral acetabular protrusion
what causes bilateral protrusio acetabuli compared to unilateral
bilateral- RA (mc)
Unilat- Pagets, trauma, idiopathic females
X ray signs of RA in the cervical spine (5)
- Dens erosions
- Occipital condyle/lat mass erosions (causes basilar impression)
- Tepered spinous process (triangle shape)
- eroded and fused factets
- disc space narrowing
DDx of bilateral osteolysis of distal clavicle
Slceroderma
hyperparathyrodism
RA
Tx of RA and mc
Methotrexate Mc
NSAIDs
Corticosteroids
Jt replacements
Differences bw osteoarthritis and RA
RA- symetrical, morning stiff >30, spares dips
OA- asymetrical, morning stiff <30, spares MCPs
What is SLE- age, gender
chronic autoimmune disease
7:1 F:M
childbearing age
SLE clinical features (5)
- Constitutional Symptoms
- Polyarthralgia (jt pains)
- Skin rash (malar rash)
- Renal Failure
- Raynauds
Imaging features of SLE (sides, S+S)
- bilateral + symetric
- Reversible hand deformities **
- increased incidence of AVN
ERROSIONS NOT COMMON (differentiator from RA)
What are the abnormal lab tests in SLE (3)
- Le cells
- Antinuclear antibodies
- Abnormal plasma proteins
Scleroderma ratio, age of onset
F:M 3:1
onse age 30-50
overall scleroderma clinical features
- Skin changes mc
- raynauds phenomenon
- Telangiectasia (spider veins)
- dysphagia (esophageal probs common)
Scleroderma of the hands findings (3)
- loss of skin folds
- rigidity
- tapering of finger tips
Scleroderma imaging findings
- Acro-osteolysis (distal erosion)
- atrophy of soft tissue/skin retraction
- Soft tissue calcifications
- well preserved jt spaces
