Test #3 Flashcards
5 types of degenerative disorders?
OA (DJD), Erosive OA, DISH, Neurotropic Arthropathy, Synoviochondrometaplasia
4 types of inflammatory disorders?
RA, JRA, SLE, Scleroderma
4 types of Rheumatoid variants of inflammatory disorders?
Ankylosis Spondylitis, Enteropathic Arthropathy, Psoriatic Arthropathy, Reiter’s Syndrome
Rheumatoid variants will be positive for what & negative for what?
Positive for HLA-B27 & negative for RF
4 types of endocrine & metabolic related disorders?
Gout, CPPD crystal deposition disease (Pseudogout), calcium hydroxyapatite crystal deposition disease, ochronosis
2 types of primary synovial disorders?
Synoviochondrometaplasia & pigmented villonodular synovitis
2 types of infectious arthritis?
Pyogenic (septic) arthritis & non-pyogenic arthritis
Pyogenic arthritis is m/c caused by what organisms?
Staph. aureus
Non-pyogenic arthritis is m/c caused by what?
Tuberculosis
Motion at synarthrosis joint?
fixed or rigid
Motion at amphiarthrosis joint?
Slightly moveable
Motion at diarthrosis joint?
Freely moveable
Fibrous joints are composed of what type of tissue?
Interposed fibrous connective tissue
Cartilaginous joints are composed of what type of tissue?
Usually hyaline or fibrocartilage
Synovial joints are composed of what type of tissue?
Articular cavity is lined w/ synovial tissue
What is the procedure of choice for making diagnosis for arthritides?
Conventional Radiography
ABCDS of arthritis stands for what?
Alignment, Bony mineralization, Cartilage Space, Distribution, Soft Tissue
What type of imaging is used to evaluate degenerative & inflammatory changes in a joint & to document & assess spinal stenosis?
CT
What is bone scintigraphy used for?
Differentiate active disease from arthritis in remission
What is one use for MRI & arthritis?
Demonstrates rheumatoid nodules & synovial abnormalities
What is a negative for MRI & arthritis?
Can’t distinguish b/w inflammatory & non-inflammatory fluid
What are routine lab studies for arthritis?
Auto antibodies (RF, ANA) Uric acid, ESR, C-Reactive protein
What labs are not part of a routine study?
Histocompatability antigen (HLA-B27, HLA-DR4) & joint fluid aspiration
According to Resnick, radiographic diagnosis is based on what 2 fundamental parameters?
Morphology & distribution
Radiographic presentation is dependent upon what?
Type & stage of the disease
What type of changes occur when articular cartilage is site of original insult?
Degenerative changes
What type of changes occur when synovial membrane is site of original insult?
Inflammatory changes
What are 4 morphologic changes seen on xray?
Abnormalities of opposing joint margins
Changes in the radiographic joint space
Malalignment
Evidence of intra-articular disease
What is (Willy) Sutton’s Law?
When diagnosing, one should first consider the most obvious.
Types of appendicular arthritis from M/C to L/C?
OA RA CPPD Gout Septic artritis
Types of axial arthritis from M/C to L/C
OA DDD DISH RA Ankylosing spondylitis CPPD
Original site of injury for DJD is what?
Cartilage
DJD is AKA?
OA, OA spondylosis, DDD
What is the M/C form of arthritis?
DJD/OA
What are risk factors for DJD?
Heredity, gender, diet, obesity, age, physical activity
DISH is AKA
Forestier Disease
Senile Ankylosing hyperostosis
This is a generalized articular disorder w/ an axial predilection characterized by ligamentous ossification
DISH (Diffuse idiopathic skeletal hyperostosis
What is the etiology of DISH?
Unknown
What are some possible diseases assoc. w/ DISH?
Diabetes (30% of pts)
Dyslipidemia
Alcohol intake
Poor dietary habits postulated
Who does DISH M/C affect?
> 50yr old, caucasian males
What are some clinical manifestations of DISH?
Intermittent spinal stiffness Restricted ROM that's worse in morning, after activity, or cold weather Pain related to enthesitis, tendonitis Dysphagia Increased predisposition to fx
What is occasionally the initial presenting complaint of DISH?
Dysphagia
What occurs mainly in the C-spine of approx. 50% of pts w/ DISH that may lead to neural compromise?
Ossification of the PLL
What is the definitive criteria for the spine on a imaging study of DISH?
Calcification/ossification along anterolateral aspect of 4 contiguous vertebrae
Relative preservation of disc height
Absence of pos. joint & SI joint ankylosis
What differentiates DISH from ankylosing spondylitis?
Absence of pos. joint & SI joint ankylosis
Where is DISH M/C frequently seen in the C-spine?
C4-C7, anteroinferior margin, extending down
Horizontal radiolucent clefts on an xray in the C-spine of a pt w/ DISH may result from?
Ant. disc bulges
Fxs in a DISH pt M/C occur in what spinal region?
Cervical
What is the M/C site of involvement for DISH in the thoracic region?
T7-T11
DISH in the lumbar region?
Upper segments & extends upwards
This has a definite assoc. w/ DISH
OPLL
What ethnicity is predisposed to develop OPLL?
Japanese
What age group is OPLL M/C seen in?
> 50 yr old
What ratio does OPLL affect men vs. women?
Men 2:1
What is the M/C complaint w/ OPLL?
Difficulty in walking d/t cord compression
What are typical signs of an upper motor neuron lesion?
Spastic weakness
Hyperreflexia w/ clonus
Pathological reflexes
What is the typical sign of a lower motor neuron lesion?
Spasm
What is the best clue for OPLL on an xray?
Flowing multilevel ossification pos. to the vertebral bodies
What are two specific radiographic features of OPLL?
Minimal disc disease
Absent facet ankylosis
Where does OPLL M/C occur?
Cervical spine (C3-C5)
How is asymptomatic OPLL managed?
observation, non-operative
How is symptomatic OPLL managed?
Decompression laminectomy
What is a lab test that can tell if a pt has DISH?
HLA-B8
After what age does primary DJD occur?
age 50
What is the main clinical manifestation of OA in the spine?
Neural deficits
What are common causes of canal stenosis?
DDD & facet arthrosis
Where are the M/C locations in the skeleton for OA?
Hips & knees Spine 1st MTP joint AC joint 1st Metacarpal-trapezium DIP & PIP
What are hallmarks for DJD in the extremities?
Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Subchondral cysts
What are 4 hallmarks for DDD?
Reduced joint space (non-uniform)
Osteophyte formation
Subchondral sclerosis
Vacuum phenomena
What are the M/C radiographic features of DJD in the hip?
Sup. joint space compartment & subchondral cysts
What are subchondral cysts of the hip called?
Egger’s cysts
What are advanced changes in the hip for DJD?
Coxarthrosis
Malum coxae
Senilis
Narrowing of axial compartment is a red flag for what?
Inflammatory process, not degeneration
What is the primary etiology of DJD in the knee?
Chronic microtrauma
What are secondary joint disorders that cause DJD in the knee?
Previous trauma
Joint instability
AVN
What is the clinical profile for DJD in the knee?
Pain w/ utilization of joint
Variable joint swelling
Catching, locking, grinding in older pt
What is the M/C radiographic features of the knee w/ DJD?
Narrowing of med. femorotibial joint space
What are radiographic features of the knee w/ DJD?
Small osteophytes Mild subchondral sclerosis Subchondral cysts <10% Varus or valgus deformity Osteochondral bodies Patellar tooth sign
What is degenerative enthesopathy AKA?
Patellar tooth sign
If only the patellofemoral joint compartment is involved, it’s not which type of OA?
Not primary OA
What is indicated by patellofemoral joint pain & crepitus accentuated by knee flexion?
Chondromalacia patella
Chondromalacia patella may be idiopathic or secondary to what?
Patellar trauma
Chondromalacia patella occurs most often in who?
Adolescents & young adults
What conditions predispose people to chondromalacia patella?
Patella alta
Increased valgus angle
Femoral condyle hyperplasia
What is the best imaging procedure for chondromalacia patella?
MRI
DJD in the ankle is usually secondary to what?
Trauma
What joint in the foot is M/C affected by DJD?
1st MTP joint
Osteophytes of the MTP M/C grow where?
Dorsal & medial aspect
Is a valgus or varus deformity common in MTP joints w/ DJD
Valgus deformity
M/C joint for DJD in the shoulder?
AC joint
Ant. displacement of humeral head into the acromial process indicates what?
Rotator cuff injury, typically supraspinatus
M/C location for DJD in the hands?
DIPs
Heberden’s nodes are located by which joints?
DIPs
Bouchard’s nodes are located at which joints?
PIPs
Nodes are caused by what?
Osteophytes
M/C location for degenerative spine disease?
C5-C7
T6-T12
L4-S1
Degenerative changes may involve the spine at which sites?
Synovial joints Intervertebral disc Vertebral bodies & annulus fibrosus Fibrous articulation ligs. Sites of lig. attachment
Degenerative changes in the vert. bodies & annulus fibrous is called what?
Spondylosis deformans
Degenerative changes in the fibrous articulations, ligs, sites of lig. attachment is known as what?
DISH
If osteophyte is projecting off the endplate of a vert. body its called what?
Spondylophyte
Radiographic features of degenerative spine disease in synovial joints?
Decreased joint space
Eburnation
Osteophytes
Eburnation is AKA?
Subchondral sclerosis
Not common, but can cause occipitocervical pain?
Atlantoaxial arthrosis
Facet joint involvement is M/C in what part of the spine?
Mid & lower cervical & lower lumbar spine
Best views to see facet involvement in degenerative spine disease?
AP & oblique
M/C location for costovertebral involvement w/ degenerative spine disease?
Lower thoracic
Syndrome where a person w/ costovertebral degeneration that gives rise to symptoms suggesting pt has a GI disorder?
Robert’s Syndrome
Lower thoracic facet arthrosis that causes pain to be projected or radiated down into lower lumbar area?
Maigne’s syndrome
Nuclear vacuum is pathoneumonic to what?
DDD
Radiographic findings of DDD?
Loss of disc height Osteophytes Eburnation Vaccuum phenomena Subluxation
This is due to uncovertebral joint arthrosis & facet joint arthrosis at the same time
Hour glass appearance to IVF
Kissing spinouses is AKA?
Baastrup’s Syndrome
Degenerative spondylolisthesis is M/C in the C-spine at what level & M/C in the spine overall at what level?
C7; L4
Osteophytes that have turned up or down?
Claw osteophytes
Thought tot be caused by tears in Sharpey’s fibers?
Annular vacuum phenomena
Nuclear vacuum phenomena tells you what 3 things?
Pt has DDD, doesn’t have infection, & the segment moves
Ant. & lat. osteophytes d/t ant. & anterolateral disc herniation initiated by abnormalities of peripheral fibers of annulus & vert. body?
Spondylosis Deformans
Degeneration of innermost portion of annulus, dehydration of nucleus, breakdown of cartilage plate?
Intervertebral chondrosis/osteochondrosis
Where do osteophytes occur in SI joints that are degenerating?
Ant. aspect of synovial portion at sup. or inf. aspect
This is a clinical & radiographic variant of DJD that is AKA inflammatory osteoarthritis?
Erosive Osteoarthritis
Erosive osteoarthritis is M/C in who?
Middle aged females
What symptoms manifest clinically w/ erosive osteoarthritis?
Episodic acute inflammation of DIP & PIP
Symmetric
Pain, edema, redness, nodules, decreased ROM
What type of laboratory manifestations are encountered w/ erosive osteoarthritis?
Normal to slightly elevated ESR
Negative for rheumatoid factor
What are two pathological features of erosive osteoarthritis?
Cartilage degeneration
Synovial proliferation
What radiographic sign is assoc. w/ erosive osteoarthritis?
Gull wings sign
What is the Gull Wings Sign?
central erosion proximal & peripheral erosions distal
What are some radiographic manifestations of erosive osteoarthritis?
Osteophytes, loss of joint space, sclerosis
Erosions, periostitis, ankylosis
Destructive arthropathy which occurs when pain & proprioception are diminished & mobility maintained is known as what?
Neurotrophic Arthropathy
What is neurotrophic arthropathy AKA?
Charcot joint
What are some underlying conditions assoc w/ neurotrophic arthropathy?
Diabetes mellitus (M/C) Syphilis Syringomyelia Congential indifference to pain Spina bifida
What are clinical manifestations of Neurotrophic Arthropathy?
Recurrent painless effusions Relatively painless instability Enlargement, crepitus, "bag of bones" Gait disturbances Loss of DTRs, pain insensitivity
Where is neuortrophic arthropathy manifest in diabetes?
Ankle, subtalar joints, feet
Where does neuortrophic arthropathy manifest in syphilis?
Lumbar, knee, ankle
Where does neuortrophic arthropathy manifest in alcoholism?
Tarsals, metatarsals
Where does neuortrophic arthropathy manifest in syringomyelia?
Shoulder, elbow, wrist
What are two types of neuortrophic arthropathy seen on xrays?
Hypertrophic & atrophic
What are the 6 D’s of hypertrophic neuortrophic arthropathy?
Distention Density Debris Disorganization Dislocation Destruction
Where is hypertrophic neuortrophic arthropathy most pronounced?
In weight-bearing joints
What are terms assoc. w/ neuortrophic arthropathy?
Bag of bones Licked candy stick Tumbling building block spine Jigsaw spine Surgical amputation
What are the top DDx for neuortrophic arthropathy?
Pyogenic infections
Non-pyogenic infections
DDD
Hemophilia
This is a benign arthropathy where synovial tissue undergoes metaplastic transformation to produce foci of cartilage
Synoviochondrometaplasia
Where is the M/C location for Synoviochondrometaplasia?
Knee
Secondary Synoviochondrometaplasia is often seen in cases of what?
DJD
Who does Synoviochondrometaplasia affect more, males or females?
Males 3,2:1
What age group is most affected by Synoviochondrometaplasia?
third to fifth decade (20-40yrs)
What are some radiographic manifestations of Synoviochondrometaplasia?
Joint effusion (Hoffa's fat is obliterated) Many radiopaque joint bodies
What is the best imaging method to see Synoviochondrometaplasia?
CT
What are skeletal locations affected by Synoviochondrometaplasia?
Knee (M/C) Hip Elbow Ankle Shoulder Wrist
Chronic & progressive autoimmune system inflammatory disorder that primarily affects the synovium & characterized by destruction of bone & cartilage; M/C chronic inflammatory arthritide
RA
What is the most frequently assoc. human leukocyte antigen w/ the development of RA?
HLA-DR4
What is the ratio of males to females affected by RA?
3:1 females to males
What age group is M/C affected by RA?
20-60 yrs w/ a peak b/w 40-60 yrs
RA increases a pt’s risk of developing what diseases?
Cardiovascular disease, lymphoma, leukemia
What are some typical clinical symptoms assoc. w/ RA?
Stiffness in morning & at times of inactivity (Jelling Phenomenon)
Often bilateral & symmetric joint involvement
Joint deformity
Malaise, weakness, weight loss, myalgias, fever
Neuropathy median & ulnar nerve distribution
Non-tender rheumatoid nodules (20%)
In this syndrome a pt has RA, dry eyes, & dry mouth?
Sjogren’s syndrome
In this syndrome a pt has RA, leukopenia, & splenomegaly
Felty’s syndrome
In this syndrome, a pt has RA & pneumoconiosis
Caplan’s syndrome
MCP joint nodes are called what?
Hagar’s nodes
What lab results would a person w/ RA have?
\+RF test Normochromic, normocytic anemia Increased ESR \+ANA C-reactive protein
Acute synovitis in RA leads to what?
edema, effusion hyperemia
Synovial proliferation in RA leads to what?
Pannus that spreads over the articular surface
Pannus plus “bare areas” leads to what in RA?
Marginal erosions
In RA, articular cartilage breaks down d/t what?
Pannus enzymes & interference w/ nutrition
In RA, intraosseous pannus &/or synovial fluid leads to what?
Synovial cysts
Where is the M/C location to see early manifestations of RA?
Hand & wrist, specifically 2nd & 3rd MCP joints, 2nd & 3rd prox. phalangeal joints
Approx. 80% of pts w/ RA that shows up in the hands have involvement in what area of the spine?
C-spine
What is the M/C imaging procedure to assess suspected cases of RA?
X-ray
What are the earliest radiographic findings of RA?
Soft tissue swelling & osteopenia
What is MRI good for w/ RA?
Sensitive in detection of erosions & synovial proliferation
What is the main radiographic manifestation of RA?
bilateral symmetry (may by unilateral initially)
What are some radiographic manifestations of RA?
Periarticular soft tissue swelling Juxta-articular osteoporosis Uniform loss of joint space Marginal erosion (rat bite) Juxta-articular periostitis Subchondral cysts Deformity Ankylosis
Where is the earliest place to see marginal erosion?
bare areas, where synovium contacts bone
What is the M/C radiographic manifestations of RA in the C-spine?
Atlantoaxial instability (PADI less than 14mm)
This is d/t loss of disc height, apophyseal joint disease, & lig. laxity
Stepladder or doorstep deformity
This is bilateral protusion of acetabulum; M/C cause is RA
Otto’s pelvis
This deformity is caused by extension of the DIP joint & flex at the PIP joint; typically seen in thumb
Boutonniere Deformity
This deformity is caused by flexion at the DIP & extension at the PIP
Swan neck deformity
What is the main ddx for spotty carpal sign?
Gout
Seronegative chronic arthritis is AKA
Still’s disease
