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PHTH 565 - Rheumatology > Radiology in the Management of OA > Flashcards

Radiology in the Management of OA Flashcards

1
Q

“People who have persistent, atraumatic movement-related joint pain or aching and/or morning stiffness lasting <30mins are diagnosed w/ OA based on clinical Ax.”

_________ _________ is NOT required to make a diagnosis in people aged 40 years or older if their symptoms are typical of OA

A

Radiological Imaging

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2
Q

Next to clinical diagnosis, are cost effective & quickly & readily obtained

Augment our understanding and stage OA

Ensure they are load bearing views; must be specified otherwise radiology techs assumer there is a #

Generally need at least 2 views:

  • Knee; AP weight bearing, lateral, skyline for PF joint
  • Hip; AP weight bearing, true lateral
A

X-Ray Advantages

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3
Q

Imaging used to differentiate OA from other inflammatory joint disorders or conditions mimicking OA, rule out red flag causes (sepsis, tumour, #, inflammatory conditions)

A

Differential Diagnosis

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4
Q

GOLD STANDARD

Helps w/ disease ownership, self management & validation

Improves clinician’s understanding of the client

Helps in designing exercise, activity prescription, walking aids, safety, bracing, assistive equipment

Convey meaningful info to other health care professionals

Differential Diagnosis: referred spinal pain, vascular or neurological compromise

Surgical Planning: Dysplasia, measurement of true LLD

Monitor slowly evolving conditions: AVN, Charcot Marie Tooth

A

X-Rays

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5
Q

Radiation; absorbed by structures in the body differently

Bone absorbs more radiation that soft tissues (creates white opaque image)

Background dose in environment: ~1-3mSV/year

Peripheral X-ray: 0.001-1 sSV or 3 hours to 10 days added exposure

Spine X-ray: 1.5 mSV or 6 months exposure

CAT 20mSV or 7 years exposure

A

X-Ray Disadvantages

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6
Q

Computed Tomography cross sectional x-rays

Rarely used but useful in surgical planning hip OA when hip dysplasia or structural abnormality a factor or w/ TJR failure

A

CAT Scan

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7
Q

Not necessary to diagnose OA or required in addition to plain X-ray image

Can visualize articular cartilage, bone edema, meniscal tears, ligament ruptures & effusions

Great cost, not timely, does not stage arthritis NWB reporting focuses on soft tissues. Little info about degree of cartilage invovlement

Clients fixated on menisectomies & arthroscopic solutions to manage OA

A

MRI

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8
Q

Checklist for pts 40 years or older referred.

One or more MUST apply in order to be eligible for MRI of the hip/knee:

  • MRI was recommended on a previous imaging report
  • Previous hip/knee surgery
  • Suspected infection
  • Suspected tumour
  • Osteonecrosis
  • Fixed locked knee
  • Pt has had a weight-bearing X-ray within the past 6 months and referring clinician has confirmed mild or no evidence of OA in the knee/hip
A

VCH MRI Criteria

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9
Q

Used for guided injections w/ fluoroscopy

Can be used to DDx calf embolus from a Baker’s Cyst

Used in the management of RA to monitor effectiveness of meds in reducing synovial pannus & for early detection synovitis

A

Ultrasound

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10
Q

Useful in detecting early hand OA

DDx osteomyelitis, bone metastases, metabolic bone disease, implant failure

A

Bone Scan

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11
Q

When you see symmetrical joint space loss = an _______ condition (can still lead to secondary OA)

A

Inflammatory

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12
Q

A: Alignment

B: Bone integrity & mineralization

C: Cartilage space

D: Distribution

S: Soft tissue changes

Additional info: Correct patient, correct knee, weigh bearing view?

A

ABCDS

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13
Q

Radiological descriptors:

  • Normal
  • Juxtaarticular osteopenia, diffuse osteopenia
  • Erosion: marginal aggressive, central aggressive, non aggressive
  • Whiskering, excrescence, periosteal reaction, osseous anklyosis overhanding edge
  • Osteophytes subcondral sclerosis
A

Bone Integrity & Mineralization

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14
Q

___ changes on plain x-ray reveal the FINAL COMMON PATHWAY where there is defective articular cartilage & underlying marginal bone changes which eventually lead to:

  • Joint space narrowing
  • Sclerosis
  • Osteophytes
  • Subchondral cysts
A

OA

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15
Q

Grade 0: Normal

Grade 1: Cartilage softening swelling

Grade 2: Partial thickness defect w/ fissures on surface that do not reach subchondral bone or exceed 1.5cm in diameter

Grade 3: Fissuring to a level of subchondral bone in an area w/ a diameter greater than 1.5cm

Grade 4: Exposed subchondral bone

A

Outerbridge Arthroscopy

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16
Q

Grade 1: Subtle CMC joint space widening

Grade 2: Slight CMC joint narrowing, sclerosis, and cystic changes w/ osteophytes or loose bodies <2mm

Grade 3: Advanced CMC joint narrowing, sclerosis, & cystic changes w/ osteophytes or loose bodies >2mm

Grade 4: Arthritic changes in CMC as for stage 3 w/ scaphotrapezial arthritis

A

Eaton-Littler Thumb OA Classification

17
Q

Dx of OA does NOT require radiological imagin: X-ray, MRI, or laboratory investigation

1) Symptoms do not always match visible findings on x-ray/MRI
2) Severe pain can reveal minimal changes on imaging
3) Minimal pain despite normal to severe structural joint changes is also possible

A

Summary

18
Q

Interval deterioration, joint space narrowing shows early bone on bone appearance

Heterogenous reactive sclerosis

Tricompartmental osteophyte lipping

Mild thinning

Interval moderate deterioration in degenerative changes

A

Pertinent OA Descriptors

19
Q

No osteochondral defect present

No chondrocalcinosis present

No local #

No subluxation

No avulsion

No acute or aggressive osseous lesion identified

A

Conditions Ruled Out

20
Q

When conservative management fails

Pain is affecting all aspects of daily life, mobility, and ability to manage other health issues

No further benefit from modifiable factors: weight loss, exercise, pacing, activity modification, weight bearing aids, bracing, PT or adjunct therapy

Non-narcotic medication, and or injections are no longer provide adequate pain relief

Decision making tools:
- Oxford hip/knee score <31 (surgical referral)

A

Surgery Consideration

21
Q

Grade 0: No radiographic features of OA

Grade 1: Doubtful joint space narrowing (JSN) & possible osteophytic lipping

Grade 2: Definite osteophytes possibleJSN on AP weight bearing radiograph

Grade 3: Multiple osteophytes, definite JSN, sclerosis, possible bone deformity

Grade 4: Large osteophytes, marked JSN, severe sclerosis & definite bone deformity

A

Kellgren Lawrence OA Classification System

PHTH 565 - Rheumatology (9 decks)

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