Rheumatology Radiology

Question 1

imaging modality choices for arthritis

Answer 1

1. plain films (X-rays) = gold standard
2. MR imaging may be used for evaluation of early disease or for disease complications
3. sometimes CT or ultrasound are used

Question 2

general imaging findings associated with arthritis

Answer 2

*osteophytes
*joint space narrowing
*erosions: marginal vs. subchondral
*ankylosis
*periostitis
*soft tissue swelling:
-fusiform (around joint)
-diffuse (sausage digits)
-lumpy bumpy

Question 3

osteophyte (radiology)

Answer 3

*an outgrowth of bones, usually near joints
*develop over time in patients with arthritis or joint damage
*feet, hands, knees, and spine often develop bone spurs
*associated with osteoarthritis

Question 4

marginal erosions (radiology)

Answer 4

*associated with rheumatoid arthritis
*erosions seen in the bare area

Question 5

subchondral erosions (radiology)

Answer 5

*associated with erosive osteoarthritis

Question 6

fusiform soft tissue swelling (radiology)

Answer 6

left = abnormal; right = normal

Question 7

sausage digit soft tissue swelling (radiology)

Answer 7

*associated with psoriatic arthritis
left = abnormal; right = normal

Question 8

lumpy bumpy soft tissue swelling (radiology)

Answer 8

*associated with gout
*gout is also associated with juxta-articular erosions

Question 9

periostitis (radiology)

Answer 9

*associated with psoriatic arthritis

Question 10

osteoarthritis - radiology findings

Answer 10

*distribution in hand: DIP & PIP joints, basal joint of thumb (first CMC joint, STT joint)
*osteophytes
*asymmetric joint space narrowing
*subchondral sclerosis
*erosive form OA: characteristic subchondral erosions (seagull shaped)

*NO marginal erosions or osteopenia

Question 11

inflammatory arthritis - 1 joint vs. multiple joints affected

Answer 11

*one joint affected: SEPTIC (or rule it out)
*many joints affected: rheumatoid arthritis or seronegatives

Question 12

septic arthritis - radiology findings

Answer 12

*orthopedic emergency
*plain film findings: joint effusion, erosions, soft tissue swelling
*MR is more sensitive for early disease

Question 13

rheumatoid arthritis - radiology findings

Answer 13

*distribution in the hands: proximal (wrist, MCP, PIP)
*marginal erosions (see image)
*osteopenia
*fusiform soft tissue swelling
*subluxations
*diffuse, symmetric joint space narrowing
*no osteophytes

Question 14

psoriatic arthritis - radiology findings

Answer 14

*sausage-digit soft tissue swelling
*marginal then subchondral erosions
*subluxations
*ankylosis
*periostitis
*buzz word = pencil-in-cup deformity

Question 15

gout - radiology findings

Answer 15

*lumpy-bumpy soft tissue swelling
*radiodense soft tissue deposits
*erosions with corticated margins (juxta-articular erosions)
*over-hanging edges