Rheumatology Flashcards
Findings/Hand X-ray in Rheumatoid arthritis
- Symmetrical
- *PIP and MCP joints involved, DIPs spared.
- loss of joint space
- *juxta-articular osteoporosis
- subchondral cysts
- erosions
- soft tissue swelling
- *ulnar deviation at MCP, radial deviation at wrist
- boutonniere, hitchhikers thumb and swan neck deformity
- erosion of medial distal radius
Other - atlantoaxial subluxation
Findings/Hand X-ray in gout
- Podagra - 1st metatarsophalangeal joint
- usually a oligoarthropathy
- joint effusion
- punched out erosions with over-hanging edge
- tophi
- double halo sign on US
Note- there is NO osteopenia
Findings/Hand X-ray in pseudogout
- involves knee, wrist, elbow, shoulder
- if hand - wrists and MCPs only
- features of osteoarthritis in non-weight bearing joints
- chondrocalcinosis
- subchondral cysts
Single halo on US as calcifications are within the cartilage itself
Findings/Hand X-ray in psoriatic arthritis
- distal joint predominance
- symmetric polyarthropathy
- asymmetric oligoarthroapthy
- enthesitis
- *pencil in cup erosions
- joint subluxation
- *periostitis - new bone formation/ thickening
- dactylitis - sausage finger
- athritis mutilans - telescoping fingers
Other:
- nail involvement- discolouration, ridging, pitting, hyperkeratosis, onycholysis
- skin psoriasis
- uveitis/ conjunctivitis
- IBD
- plantar fasciitis
- enthesitis
- prostatitis
Findings/ Hand X-ray in reactive arthritis
Reiters Triad - arthritis, conjunctivitis, urethritis (cervicitis in women)
- HLAB27 positive
- lower limbs > upper limbs
- asymmetric
- Enthesitis
- floating osteophytes
- *juxta-articular osteoporosis
- *periostitis - new bone formation/ thickening
Findings/ Hand X-ray in Osteoarthritis
X-ray:
- Loss of joint space
- Osteophytes
- Subchondral sclerosis
- subchondral cysts
- erosions
- synovitis
Findings:
- PIP, DIP and 1st CMC joint involvement
- Bouchards nodes (PIP), Herberden’s nodes (DIP)
- “Squaring of hands” due to 1st MCP subluxation
- Generally no severe deformity, no nodules
Findings/ Hand X-ray in Lupus
- correctable ulnar subluxation
- no erosions
Also called Jaccoud’s arthropathy
Rheumatoid arthritis exam
HANDS
● Inspection: wasting of dorsal interossei, fixed flexion deformity, swelling of MCP, PIP, Swan neck deformity, Boutonniere deformity, Z Thumb deformity, Nail fold infarct, Palmar erythema, Radial/Ulnar deviation, Elbow nodules
● Palpation: active synovitis, subluxation at ulnar and MCP joints
● Passive movement: flexion weakness due to tendon rupture, non-correctability of ulnar deviation
● Active movement: fixed flexion deformity, poor fist/wrist movements, trigger finger
● Carpal tunnel syndrome
● Functional assessment
ARMS ● Subcutaneous nodules ● Elbow joint ● Shoulder joint FACE ● Eyes – dry eyes (Sjogren’s), scleritis, episcleritis, anaemia, cataracts ● Mouth – ulcers (methotrexate) NECK ● Cervical spine tenderness, muscle spasm, reduction of rotational movement CHEST ● Heart – pericarditis, valve lesions (aortic regurgitation) ● Lungs – effusion, fibrosis ABDOMEN ● Splenomegaly LOWER LIMBS ● Knee/ankle/foot involvement, peripheral neuropathy, ulcers URINE: protein, blood
Scleroderma Hand X-ray findings
- No erosions
- distal osteo-acrolysis
- calcinosis
Psoriatic arthritis nail changes
- Pitting
- Ridging
- Onycholysis
- Discolouration
- hyperkeratosis
Causes of arthritis mutilans
- Psoriatic arthritis
2. RA
