Rheumatoid Arthritis- Continued

Question 1

Pannus

Answer 1

Vascular Connective (Granulation) Tissue

Question 2

Where does Pannus Form?

What Forms it?

Answer 2

Within the Synovium, by proliferating fibroblasts and inflammatory cells

Question 3

Pannus Causes:

How?

Answer 3

Erosion of Bone and Cartilage
By producing more enzymes that destroy nearby cartilage, aggravating the area and attracting more inflammatory cells- perpetuates the process

Question 4

RA- Hand

End-Stage Deformity:

Answer 4

Arthritis Mutilans

Question 5

RA- Wrist

Answer 5

Usually 1st seen in the Wrist Radiographically

Question 6

RA of Wrist is ___% more severe than hand changes

___% of wrist cases show no hand changes

Answer 6

60%

20%

Question 7

RA Wrist Locations

Answer 7

Distal Ulna
Distal Radius
Carpus

Question 8

RA-Wrist

Distal Ulna

Answer 8

Soft Tissue Swelling Due to- Synovitis within joint or adjacent Tendon (Extensor Carpi Ulnaris)
Erosion of Ulnar Styloid Process

Question 9

Locations of Distal Ulnar Erosion? (3)

Answer 9

1) Extensor Carpi Ulnaris Attachment site
2) Prestyloid Recess
3) Radioulnar Articulation

Question 10

RA-Wrist

Distal Radius

Answer 10

Marginal Erosions at the Radial Styloid and Adjacent Scaphoid
Synovial Thickening on MRI

Question 11

RA-Wrist

Carpus (1/5)

Answer 11

“Spotty Carpal Sign” - multiple marginal erosions throughout Carpus

Question 12

What is Spotty Carpal Sign also seen in?

Answer 12

Gout
Tuberculous Arthritis
Sudeck’s Atrophy

Question 13

RA-Wrist

Carpus (2/5)

Answer 13

Midcarpal Joint Fusion

Spares Radiocarpal Joint

Question 14

RA-Wrist

Carpus (3/5)

Answer 14

Zigzag Deformity

Question 15

RA-Wrist

Carpus (4/5)

Answer 15

Terry Thomas Sign- Separation of Scaphoid and Lunate

Question 16

RA-Wrist

Carpus (5/5)

Answer 16

Caput Ulnae Syndrome- Diastasis at radioulnar joint, Ulna moves dorsally
May have extensor tendon rupture

Question 17

RA-Foot

MC site?

Answer 17

IP Joint of great Toe

MTP Joints- 5th to 1st in decreasing order of frequency

Question 18

In ____% of people, the foot is initial RA involvement

Answer 18

15%

Question 19

RA Foot- Radiographic Changes

Answer 19

Soft Tissue Swelling
Marginal Erosions
Juxta-Articular Osteoporosis
Uniform loss of Joint Space
Deformities

Question 20

Where are Marginal Erosions for Foot RA?

Answer 20

Medial Surface of each Metatarsal Head

EXCEPT- on 5th Metatarsal Head- Lateral Margin Erosion

Question 21

RA Foot-

What is Lanois Deformity?

Answer 21

Digital Fibular Deviation at MTP Joints (except 5th digit)
AND
Flexion Defomities, Dislocation of Toes, Advanced Joint Destruction

Question 22

RA- Hip

What happens?

Answer 22

Bilateral and Symmetrical:
Axial Migration of Femoral Head (superior and medial)
Small femoral Heads
Decreased Joint Space

Question 23

What is Protrusio Acetabuli?

Answer 23

Acetabulum is displaced medially

Question 24

Most Common Case of Bilateral Protrusio Acetabuli?

Answer 24

Rheumatoid Arthritis- Hip

Question 25

RA-Hip: Late Stages

Answer 25

Secondary Degenerative Changes | Eburnation, Ostephytes, Etc.

Question 26

What are the patterns of hip migration? | What are they seen with?

Answer 26

1) Superior Migration - DJD 2) Medial Migration - DJD - Paget's Disease 3) Axial Migration - RA - Infection

Question 27

RA- Shoulder What does it look like? Where is it?

Answer 27

Bilateral & Symmetrical | GH and AC Joints

Question 28

RA- Shoulder- Description

Answer 28

Pencil-Like Tapering of Distal Clavicle | Differential Dx- Lytic Mets, Multiple Myeloma, Hyperparathyroidism

Question 29

RA- Shoulder- GH Joint | What's happening?

Answer 29

Synovial Erosions at humeral head Early inflammatory rupture of rotator cuff tendons Humeral head elevates Space btw clavicle & humeral head is decreased

Question 30

RA-Elbow | Signs

Answer 30

Rheumatoid Nodules- Extensor Surface Fat-Pad Sign- seen in 90% RA elbows Supinator Notch Sign- Early erosion, Proximal Elbow, Opposing neck of adjacent radius

Question 31

RA-Knee | Signs

Answer 31

Soft-Tissue Swelling- Due to Synovial Effusion Marginal Erosions Uniform Bicompartmental Loss of Joint Space

Question 32

RA-Ribs | Seen in RA Patient >___ Year Prevalence

Answer 32

14 Years

Question 33

RA- Ribs | Signs

Answer 33

Asymptomatic Erosions Superior Margins of 3rd, 4th, 5th Posterior Ribs Can simulate Malignant Bone Destruction

Question 34

What else can RA affect?

Answer 34

Spine- C1/C2 Ankle Chest- Heart, Lungs, Pleura

Question 35

Juvenile RA

Answer 35

Most Frequent Autoimmune Inflammatory Disease Affecting Children Unknown Etiology

Question 36

AKA for Juvenile Chronic Arthritis

Answer 36

Still's Disease | Juvenile Rheumatoid Arthritis

Question 37

Is JRA/JCA Seronegative or Seropisitive?

Answer 37

Seronegative

Question 38

JRA-Adult-type RA

Answer 38

Juvenile Onset in 10% of individuals Seropositive Worst Prognosis

Question 39

3 Forms of JCA/JRA/Still's

Answer 39

Classic Systemic: 20% Polyarticular- 50% Pauciarticular-Monoarticular Disease- 30%

Question 40

JRA: Classic Systemic Disease Signs

Answer 40

``` M=F Fever Lymphadenopathy Hepatosplenomegaly Anemia Pale, Erythematous rash over trunk, face and extremities- migratory Mild Radiographic Joint Changes ```

Question 41

JRA: | Polyarticular Disease

Answer 41

2x more common in Females | Bilateral, symmetrical with pain & swelling at distal exremities and cervical spine

Question 42

What is the child's appearance with JRA: | Polyarticular Disease?

Answer 42

Bird-Like Features Frail, delicate features of limb & face Small Receded Jaw

Question 43

JRA: | Pauciarticular-Monoarticular Disease

Answer 43

3x more common in Females More Common in Larger Joints MC Monoarticular Site- Knee

Question 44

JRC- Monoarticular Type Complication?

Answer 44

Iridocyclitis: inflammation of the iris and ciliary body

Question 45

JRA Pathology

Answer 45

Less imflammatory changes than with Adult RA Less Pannus Growth Disturbance: accelerated growth plate activity or permature fusion

Question 46

JRA Radiology- Early

Answer 46

Soft Tissue Swelling Osteoporosis- Diffuse or Juxta articular Periostitis

Question 47

JRA Radiology- Late

Answer 47

``` Uniform loss of Joint Space Articular Erosions Growth Disturbances & Deformities Bone Ankylosis Epiphyseal Compression Fractures ```

Question 48

JRA- Hand & Foot | Signs

Answer 48

Tarsal & Carpal Involvement Spares Distal Joints Ankylosis- remains small in adult- "squashed carpi"

Question 49

JRA- Knee | Signs

Answer 49

Large Epiphysis- Balloon Epiphysis Inferior Pole of Patella is Squared Large Intercondylar Notch