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Skel Rad A Final Material > Rheumatoid Arthritis- Continued > Flashcards

Rheumatoid Arthritis- Continued Flashcards

1
Q

Pannus

A

Vascular Connective (Granulation) Tissue

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2
Q

Where does Pannus Form?

What Forms it?

A

Within the Synovium, by proliferating fibroblasts and inflammatory cells

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3
Q

Pannus Causes:

How?

A

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

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4
Q

RA- Hand

End-Stage Deformity:

A

Arthritis Mutilans

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5
Q

RA- Wrist

A

Usually 1st seen in the Wrist Radiographically

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6
Q

RA of Wrist is ___% more severe than hand changes

___% of wrist cases show no hand changes

A

60%

20%

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7
Q

RA Wrist Locations

A

Distal Ulna
Distal Radius
Carpus

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8
Q

RA-Wrist

Distal Ulna

A

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

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9
Q

Locations of Distal Ulnar Erosion? (3)

A

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

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10
Q

RA-Wrist

Distal Radius

A

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

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11
Q

RA-Wrist

Carpus (1/5)

A

“Spotty Carpal Sign” - multiple marginal erosions throughout Carpus

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12
Q

What is Spotty Carpal Sign also seen in?

A

Gout
Tuberculous Arthritis
Sudeck’s Atrophy

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13
Q

RA-Wrist

Carpus (2/5)

A

Midcarpal Joint Fusion

Spares Radiocarpal Joint

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14
Q

RA-Wrist

Carpus (3/5)

A

Zigzag Deformity

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15
Q

RA-Wrist

Carpus (4/5)

A

Terry Thomas Sign- Separation of Scaphoid and Lunate

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16
Q

RA-Wrist

Carpus (5/5)

A

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

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17
Q

RA-Foot

MC site?

A

IP Joint of great Toe

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

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18
Q

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

A

15%

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19
Q

RA Foot- Radiographic Changes

A 
Soft Tissue Swelling
Marginal Erosions
Juxta-Articular Osteoporosis
Uniform loss of Joint Space
Deformities
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20
Q

Where are Marginal Erosions for Foot RA?

A

Medial Surface of each Metatarsal Head

EXCEPT- on 5th Metatarsal Head- Lateral Margin Erosion

21
Q

RA Foot-

What is Lanois Deformity?

A

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

22
Q

RA- Hip

What happens?

A

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

23
Q

What is Protrusio Acetabuli?

A

Acetabulum is displaced medially

24
Q

Most Common Case of Bilateral Protrusio Acetabuli?

A

Rheumatoid Arthritis- Hip

25
Q

RA-Hip: Late Stages

A

Secondary Degenerative Changes

Eburnation, Ostephytes, Etc.

26
Q

What are the patterns of hip migration?

What are they seen with?

A

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

27
Q

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

A

Bilateral & Symmetrical

GH and AC Joints

28
Q

RA- Shoulder- Description

A

Pencil-Like Tapering of Distal Clavicle

Differential Dx- Lytic Mets, Multiple Myeloma, Hyperparathyroidism

29
Q

RA- Shoulder- GH Joint

What’s happening?

A

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

30
Q

RA-Elbow

Signs

A

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

31
Q

RA-Knee

Signs

A

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

32
Q

RA-Ribs

Seen in RA Patient >___ Year Prevalence

A

14 Years

33
Q

RA- Ribs

Signs

A

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

34
Q

What else can RA affect?

A

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

35
Q

Juvenile RA

A

Most Frequent Autoimmune Inflammatory Disease Affecting Children
Unknown Etiology

36
Q

AKA for Juvenile Chronic Arthritis

A

Still’s Disease

Juvenile Rheumatoid Arthritis

37
Q

Is JRA/JCA Seronegative or Seropisitive?

A

Seronegative

38
Q

JRA-Adult-type RA

A

Juvenile Onset in 10% of individuals
Seropositive
Worst Prognosis

39
Q

3 Forms of JCA/JRA/Still’s

A

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

40
Q

JRA:
Classic Systemic Disease
Signs

A 
M=F
Fever
Lymphadenopathy
Hepatosplenomegaly
Anemia
Pale, Erythematous rash over trunk, face and extremities- migratory
Mild Radiographic Joint Changes
41
Q

JRA:

Polyarticular Disease

A

2x more common in Females

Bilateral, symmetrical with pain & swelling at distal exremities and cervical spine

42
Q

What is the child’s appearance with JRA:

Polyarticular Disease?

A

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

43
Q

JRA:

Pauciarticular-Monoarticular Disease

A

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

44
Q

JRC- Monoarticular Type Complication?

A

Iridocyclitis: inflammation of the iris and ciliary body

45
Q

JRA Pathology

A

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

46
Q

JRA Radiology- Early

A

Soft Tissue Swelling
Osteoporosis- Diffuse or Juxta articular
Periostitis

47
Q

JRA Radiology- Late

A 
Uniform loss of Joint Space
Articular Erosions
Growth Disturbances & Deformities
Bone Ankylosis
Epiphyseal Compression Fractures
48
Q

JRA- Hand & Foot

Signs

A

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

49
Q

JRA- Knee

Signs

A

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

Skel Rad A Final Material (6 decks)

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