Rheumatology Flashcards
Radiological Pattern of Rheumatoid Arthritis
Soft tissue swelling
Juxta-articular osteopenia
Uniform joint space narrowing
Marginal erosions.
Radiological Pattern of Gout
Asymmetric soft tissue swelling
Punched out periarticular erosions
Radiological Pattern of Psoriatic Arthritis
Soft tissue swelling Periosteal reaction Marginal erosions Exuberant periarticular new bone formation "Pencil in cup" asymmetrical sacro-ilitis
Radiological Pattern of Ankylosing Spondylitis
Lumbar and sacral spine:
Syndesmophytes.
Romanous lesion
Sacroiliac Joint:
Indistinctness of sacroiliac joint –> subchondral bony erosions of iliac bone –> subchondral sclerosis –> bony proliferation.
Late stages: transverse fractures of lumbojcolumnar and cervicothoracic junction.
Radiological Pattern of Systemic Lupus Erythematosus
Soft tissue swelling
Joint space narrowing
No erosions
Radiological Pattern of Osteoarthritis
Focal joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes
Signs of Limited Scleroderma
CREST babes! Calcinosis Raynauds Eoesophageal dysmotility Sclerodactyly Telangiectasia
Signs of Ankylosing Spondylitis
decreased spinal movement in all planes
- Schober’s test (
X-ray changes in Ankylosing Spondylitis
sacroiliac joints:
- cortical outline loss
- juxta-articular osteosclerosis
- erosions
- joint ankylosis
Lumbar spine:
- loss of lordosis
- squaring of vertebrae
- syndesmophytes
- bamboo spine
- apophyseal joint fusion
Clinical signs of psoriatic arthritis
typical patterns:
- predominantly DIPs
- Rheumatoid-like pattern (with negative RhF)
- Asymmetrical oligoarthritis
- arthritis with spondylitis
- Severely deforming (arthritis mutilans)
- Osseous - SAPHO syndrome
skin: search carefully for psoriasis
nails: pitting, onycholysis, ridging, sublingual hyperkeratosis
Dactylics (sausage digits)
Enthesitis
30% have a FH
Signs of rheumatoid arthritis
Symmetrical deforming inflammatory arthritis affecting predominantly the small joints (sparing DIPs) Swan neck/boutonnières deformity Rheumatoid nodules Nerve entrapment Tendon rupture/tenosynovitis Sicca symptoms Scleritis/episcleritis Neck range of movement Chest - intersitial fibrosis - pleural effusion - pericarditis Splenomegaly (Feltys) Vasculitis
Signs of osteoarthritis
Typical large joint oligoarrhritis
Heberdans (DIP) and bouchards nodules (PIP)
Squaring of the CMC joint
Tenderness, joint effusions, crepitus with limited range of movement
Palpable osteophytes
Varus deformity at knees
Signs of SLE
Arthropathy Non-erosive, correctable, symmetrical small joint arthritis (Jaccouds) - affects PIPs + MCPs, ulnar devation, swan neck deformity Malar rash Photosensitive rash in sun exposed areas Alopecia Discoid lupus Scleritis Mouth ulcers Raynauds Vasculitis Pleural effusion/pericarditis/pleuritis/interstital fibrosis Proximal myopathy Vasculitis Mononeuritis multiplex
Signs of diffuse systemic sclerosis
Skin thickening and tightening involving above elbows, trunk and face Loss of wrinking of face Sicca symptoms Fish mouth (microstomia) Raynauds Dilated capillary loops Small joint arthropathy Vasculitis in legs and ulceration Atrophy of distal tissue pulp (finger tapering) Scelerodactyly Nail pitting Telangiectasia Hypertensive Interstital fibrosis and cor pulmonale CREST
