Radiology of Inflammatory Disorders Flashcards
aka for Osteitis Condensans Ilii
Osteitis Triangularis Ilii
AS involves 2 extremities
- MC = hip
- 2nd = GH joint
Which side of the SI joint does AS affect with the majority of changes?
Iliac side
RA knee
- frequent involvement
- bilateral often
- swelling prominent
RA Target site of Hip - an obvious finding could be
Acetabulae protrusio
AS posture changes
- Lumbar - hypolordosis
- Thoracic - hyperkyphosis
- Cervical - hypolordosis
- Anterior weight bearing
Everything that keeps you bent forward
RA (also Psoriatic) - advanced joint destruction, dislocation, flexion deformity & fibular deviation. This is called ______
Lanois deformity
Psoriatic of SI joint is most commonly:
a) bilateral or unilateral?
b) symmetric or asymetric?
a) Bilateral
b) Asymetric
Note: According to Medscape, SI involvement may also entail SI widening and sclerosis
AS radiographic “signs”
- Shiny Corner sign
- Ghost joint
- Star sign
- Bamboo spine
- Trolley track sign
- Railroad track sign
- Dagger sign
AKA for Ankylosing Spondylitis (AS)
Marie-Strumpell disease
Triad of Reiters
- Urethritis
- Conjunctivitis
- polyarthritis (lower extremity predominance) - plantar fascia or Achilles attachment
“Can’t see, can’t pee, can’t dance with me.”
Labs associated with Reiter’s
- HLA B27 +
- high ESR
AS initial site of involvement
SI joint
Which gender is more affected by AS?
Males (10/1)
AS radiographic hallmarks
- O = Osteopenia
- M = Marginal Syndesmophytes
- A = Ankylosis
- R = Romanus Lesions
- S = Shiny Corner Sign
- B = Barrel vertebra
- A = Anterior Squaring of Vertebra
- R = Rosary Bead sign
- P = pseudo widening (iliac side of SI)
O MARS BARP (think of Mars Bar - candy bar)
Seronegative Spondyloarthropathies
- Psoriatic
- Enteric
- AS
- Reiters
Labs of Psoriatic Arthritis
- high ESR
- HLA B27 (75% + with spine only, 35% with peripheral arthritis)
Psoriatic Arthritis of the Spine - radiographic feature:
- Asymmetric, non marginal syndesmophytes - Unilateral
Labs - AS
- high ESR
- HLA B27+
Predominant area of infection associated with Psoriatc Arthritis
- hands and feet @ DIPS = primary
- spine and pelvis = secondary
Complications of Enteric Spondyloarthropathy
- Chron’s
- UC
Psoriatic radiographic features
- Asymetric
- Feet = usually DIPS
- Mouse Ears = adj to marginal erosions. Fluffy periosteal new bone formation.
- Pencil in Cup = whittling of the articular ends of phalanges at the PIP or DIP articulation that fit together.
- Pestle and mortar
- Mushroom & stem
- balancing Pagoda
- Cup & Saucer
5, 6, 7, 8 = same as 4.
RA labs
- Rheumatoid Factor +
- high ESR
- high CRP (acute)
Radiologic Hallmarks of RA
GettinN RA is a “BUMO”
- B = bilateral (in extremities)
- U = uniform joint space narrowing
- M = marginal erosions due to pannus formations
- O = osteoporosis
- N = nodules (pathologic diagnosis)
Radiographic Features of OCI are:
- Bilateral
- Symmetric
- Trianglular shaped areas of sclerosis involving the Ilium at SI
- Jt spacing & margins = normal
Note: I can remember a lab xray with this feature.
A common skin disorder associated with an erosive arthropathy
Psoriasis
Note: According to Medscape, patients rarely have Psoriatic Arthritis (PA) before any skin lesions appear.
Name of the healed lesion in AS disc
Andersson Lesion
RA spine
- C-spine only
- possible Atlas instability
MC causes of Osteitis Pubis
- Over use in sports
- post surgical - prostate, bladder
Bony resorption & spontaneous reossification @ pubic symphasis = OP
Note: Scuderi: OP is very, very rare.
Psoriatic (also RA) - fibular deviation with severe joint destruction. This is called _____.
Lanois deformity
Osteitis Pubis location
Pubic Symphasis
Target sites of Reiter’s - bones
Foot & Ankle
- MTP joints
- IP joints
- +/- Achilles attachment
- +/- Plantar fascia insertion
- +/- erosions, osteoporosis, & fluffy periostitis and Achilles or Plantar Fascia insertion.
aka for Reither’s Syndrome
Reactive Arthritis
SI Joint - RA
- not common involvement here
- Unilateral involvement
A spondyloarthropathy that is radiographically indistinguishable from AS due to its inflammatory bowel diseases
Enteric Spondyloarthropathy
SI joints, pattern - Reiters
Unilateral, asymetric
7 Main Inflammatory Disorders
- Psoriatic
- Enteric
- AS
- Reiters
- RA
- OCI (Osteitis Condensans Ilii)
- OP (Osteitis Pubis)
RA target sites - MC joints affected in foot
MTP joints 4 & 5
IP joint #1
Typical patient with OCI is ____
Multiparous female
Age 20-40
Chronic LBP
Spine involvement - Reiters
syndesmophytes:
non-marginal
thick
Asymetric
Unilateral
Or not involved at all.
Name the disease
Osteitis Condensans Ilii
(aka = Osteitis Triangularis Ilii)
Name the disease at red arrows
Osteitis Triangularis Ilii
(aka = osteitis condensans Ilii)
Name the disease
Osteitis Condensans Ilii
Name the disease of this child
JRA
- periarticular osteopenia
- diffuse joint space narrowing
- epiphyseal deformities and overgrowth
- osteopenia and fusion of the carpals
True or False
JRA is always seronegative
False
15% are seropositive = more females
85% are seronegative = both sexes are equal
When JRA is systemic it is called _______ disease
Still’s disease
Name the disease - patient age is over 40 years
RA
Name the disease. Patient age > 40 years
RA
(O=anterior edge of Odontoid
A=posterior margin of anterior arch)
if > 3 mm is unstable
Name the disease. Patient age > 40 years. Seropositive
RA of foot
Name the disease
RA
Name the disease
RA
Bilateral involvement (greater at L than R)
Uniform Narrowing of hip joints
No Spurs (characteristic of RA)
Name the disease
RA
ulnar styloid erosion
Name the disease on R knee
RA
uniform joint space loss
erosion of tibial plateau
AKA for ankylosing spondylitis
Marie Stumpel’s disease
Name the Disease
AS
Name the disease
AS
Name the disease
AS
AS - Radiographic features of SI
P.E.A.
Pseudowidening
Erosive & sclerotic
Ankylosis (stiffened joint)
Name the sign at the arrows & disease associated
Shiny Corner Sign - Ankylosing Spondylitis
Black arrows are pointing at _____ associated with ___.
Syndesmophytes, AS
Name the signs in A & B, and disease associated.
A) Trolley Track sign
B) saber sheath / dagger sign
disease = AS
A ragged vertebral body endplate may indicate _____ mobility of the adjacent body and is termed a _____ lesion in ankylosing spondylitis.
Ragged appearance of entire endplate is due to HYPER mobility - a fracture through a previously ankylosed joint.
Termed an ANDERSSON LESION
A fracture line through an ankylosed IVD is termed _____ in Ankylosing Spondylitis
a Carrot Stick fracture
