Rheumatoid Arthritis- Continued Flashcards
Pannus
Vascular Connective (Granulation) Tissue
Where does Pannus Form?
What Forms it?
Within the Synovium, by proliferating fibroblasts and inflammatory cells
Pannus Causes:
How?
Erosion of Bone and Cartilage
By producing more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory cells- perpetuates the process
RA- Hand
End-Stage Deformity:
Arthritis Mutilans
RA- Wrist
Usually 1st seen in the Wrist Radiographically
RA of Wrist is ___% more severe than hand changes
___% of wrist cases show no hand changes
60%
20%
RA Wrist Locations
Distal Ulna
Distal Radius
Carpus
RA-Wrist
Distal Ulna
Soft Tissue Swelling Due to- Synovitis within joint or adjacent Tendon (Extensor Carpi Ulnaris)
Erosion of Ulnar Styloid Process
Locations of Distal Ulnar Erosion? (3)
1) Extensor Carpi Ulnaris Attachment site
2) Prestyloid Recess
3) Radioulnar Articulation
RA-Wrist
Distal Radius
Marginal Erosions at the Radial Styloid and Adjacent Scaphoid
Synovial Thickening on MRI
RA-Wrist
Carpus (1/5)
“Spotty Carpal Sign” - multiple marginal erosions throughout Carpus
What is Spotty Carpal Sign also seen in?
Gout
Tuberculous Arthritis
Sudeck’s Atrophy
RA-Wrist
Carpus (2/5)
Midcarpal Joint Fusion
Spares Radiocarpal Joint
RA-Wrist
Carpus (3/5)
Zigzag Deformity
RA-Wrist
Carpus (4/5)
Terry Thomas Sign- Separation of Scaphoid and Lunate
RA-Wrist
Carpus (5/5)
Caput Ulnae Syndrome- Diastasis at radioulnar joint, Ulna moves dorsally
May have extensor tendon rupture
RA-Foot
MC site?
IP Joint of great Toe
MTP Joints- 5th to 1st in decreasing order of frequency
In ____% of people, the foot is initial RA involvement
15%
RA Foot- Radiographic Changes
Soft Tissue Swelling Marginal Erosions Juxta-Articular Osteoporosis Uniform loss of Joint Space Deformities
Where are Marginal Erosions for Foot RA?
Medial Surface of each Metatarsal Head
EXCEPT- on 5th Metatarsal Head- Lateral Margin Erosion
RA Foot-
What is Lanois Deformity?
Digital Fibular Deviation at MTP Joints (except 5th digit)
AND
Flexion Defomities, Dislocation of Toes, Advanced Joint Destruction
RA- Hip
What happens?
Bilateral and Symmetrical:
Axial Migration of Femoral Head (superior and medial)
Small femoral Heads
Decreased Joint Space
What is Protrusio Acetabuli?
Acetabulum is displaced medially
Most Common Case of Bilateral Protrusio Acetabuli?
Rheumatoid Arthritis- Hip
RA-Hip: Late Stages
Secondary Degenerative Changes
Eburnation, Ostephytes, Etc.
What are the patterns of hip migration?
What are they seen with?
1) Superior Migration
- DJD
2) Medial Migration
- DJD
- Paget’s Disease
3) Axial Migration
- RA
- Infection
RA- Shoulder
What does it look like?
Where is it?
Bilateral & Symmetrical
GH and AC Joints
RA- Shoulder- Description
Pencil-Like Tapering of Distal Clavicle
Differential Dx- Lytic Mets, Multiple Myeloma, Hyperparathyroidism
RA- Shoulder- GH Joint
What’s happening?
Synovial Erosions at humeral head
Early inflammatory rupture of rotator cuff tendons
Humeral head elevates
Space btw clavicle & humeral head is decreased
RA-Elbow
Signs
Rheumatoid Nodules- Extensor Surface
Fat-Pad Sign- seen in 90% RA elbows
Supinator Notch Sign- Early erosion, Proximal Elbow, Opposing neck of adjacent radius
RA-Knee
Signs
Soft-Tissue Swelling- Due to Synovial Effusion
Marginal Erosions
Uniform Bicompartmental Loss of Joint Space
RA-Ribs
Seen in RA Patient >___ Year Prevalence
14 Years
RA- Ribs
Signs
Asymptomatic Erosions
Superior Margins of 3rd, 4th, 5th Posterior Ribs
Can simulate Malignant Bone Destruction
What else can RA affect?
Spine- C1/C2
Ankle
Chest- Heart, Lungs, Pleura
Juvenile RA
Most Frequent Autoimmune Inflammatory Disease Affecting Children
Unknown Etiology
AKA for Juvenile Chronic Arthritis
Still’s Disease
Juvenile Rheumatoid Arthritis
Is JRA/JCA Seronegative or Seropisitive?
Seronegative
JRA-Adult-type RA
Juvenile Onset in 10% of individuals
Seropositive
Worst Prognosis
3 Forms of JCA/JRA/Still’s
Classic Systemic: 20%
Polyarticular- 50%
Pauciarticular-Monoarticular Disease- 30%
JRA:
Classic Systemic Disease
Signs
M=F Fever Lymphadenopathy Hepatosplenomegaly Anemia Pale, Erythematous rash over trunk, face and extremities- migratory Mild Radiographic Joint Changes
JRA:
Polyarticular Disease
2x more common in Females
Bilateral, symmetrical with pain & swelling at distal exremities and cervical spine
What is the child’s appearance with JRA:
Polyarticular Disease?
Bird-Like Features
Frail, delicate features of limb & face
Small Receded Jaw
JRA:
Pauciarticular-Monoarticular Disease
3x more common in Females
More Common in Larger Joints
MC Monoarticular Site- Knee
JRC- Monoarticular Type Complication?
Iridocyclitis: inflammation of the iris and ciliary body
JRA Pathology
Less imflammatory changes than with Adult RA
Less Pannus
Growth Disturbance: accelerated growth plate activity or permature fusion
JRA Radiology- Early
Soft Tissue Swelling
Osteoporosis- Diffuse or Juxta articular
Periostitis
JRA Radiology- Late
Uniform loss of Joint Space Articular Erosions Growth Disturbances & Deformities Bone Ankylosis Epiphyseal Compression Fractures
JRA- Hand & Foot
Signs
Tarsal & Carpal Involvement
Spares Distal Joints
Ankylosis- remains small in adult- “squashed carpi”
JRA- Knee
Signs
Large Epiphysis- Balloon Epiphysis
Inferior Pole of Patella is Squared
Large Intercondylar Notch
