radiology 2- recognizing joint disease
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Disease that affects a joint and usually the bones on either side of the joint.
What are the 3 categories of arthritis?
What type of arthritis is characterized by bone formation (Fairbank's Signs), causing subchondral sclerosis, osteophytes, joint space narrowing and subchondral cysts?
What condition is also degenerative joint disease (DJD), is the most common form of arthritis, and is due to intrinsic degeneration and wear/tear in weight bearing joints?
primary osteoarthritis (symmetric)
This type of arthritis is due to an underlying predisposing condition, most commonly trauma, is atypical for the age it presents in, and shows up in unusual locations (elbow, non wt bearing).
secondary osteoarthritis (asymmetric)
Type of arthritis that causes severe inflammation and erosive changes, most often occurs in perimenopausal females, is symetrical and bilateral, and is typically centrally located.
Type of arthritis that causes sensory dysfunction or is neuropathic, leads to microfractures and autonomic imbalance, and causes hyperemia, bone resorption and fragmentation.
Charcot arthropathy (neuropathic joint)
What is a prominent feature in charcot arthropathy (neuropathic joint)? Which pt population is it most common in?
- Soft tissue sweeling
What are the hallmark findings in charcot arthropathy (neuropathic joint)?
- joint destruction
Deposits CPPD (calcium pyrophosphate dihydrate) crystals in hyaline cartilage and fibrocartilage. Also called pseudogout.
calcium pyrophosphate deposition disease
Where does calcium pyrophosphate deposition disease (pseudo gout) affect the wrist?
TFCC (triangular fibrocartilage complex)
Type of arthritis that results from hematogenous or direct seeding.
What are the two types of infectious arthritis?
- pyogenic (septic) arthritis: S. aureus
- nonpyogenic: mycobacterium tuberculosis (Pot's disease-TB infx in spine)
Where do children and adults typically get pyogenic infectious arthritis? What if the infection is in the hands? Where do diabetics typically get it?
- Hip & knee
- From human bites ("fight bites")
- Feet (diabetics)
What are the hallmark findings in infectious arthritis?
- destruction of articular cartilage
- very rapid
- soft tissue swelling
Type of infectious arthritis that causes destruction of articular cartilage, has an indolent and protracted course, monoarticular, and causes severe osteoporosis.
Where do children and adults typically get nonpyogenic infectious arthritis?
- Children: spine
- Adults: knee
Arthritis that describes a large number of arthritides like inflammation, synovial proliferation (pannus), and lytic lesions in or near the joint.
What are the causes for erosive arthritis?
- psoriatic arthritis
- ankylosing spondylitis
- Reiter's syndrome
Type of arthritis most common in females, affects the proximal joints of the hands and wrists, has a bilateral-symmetric pattern (esp knees & hips), and early x-rays reveal soft tissue swelling and osteopenia/osteoporosis.
Where in the hands and wrist do rheumatoid arthritis erosions tend to set in?
- Hands: involve the proximal joints (CMC, MCP, PIP)
- Wrists: carpals, ulnar styloid, and narrowing radiocarpal joint space
What are the typical late findings in hands of pts with rheumatoid arthritis?
- ulnar deviation and subluxatin at eh MCP joints
- Swan-neck deformities
- Boutonniere deformities
What are the typical findings in large joints with RA?
- marked uniform narrowing
- little to no subchondral sclerosis
What are the typical findings in the spine in a pt with RA?
atlantoaxial subluxation (also common in Down's syndrome kids)
Arthritis characterized by inflammatory changes incited by deposition of calcium urate crystals in the joint. Is monoarticular and asymmetrical.
Gout arthritis typically found in the great toe of males is referred to as what?
What are the hallmark findings in pts with gout arthritis?
- sharply marginated, juxta-articular erosion which tends to have a sclerotic border
- overhanging edges ("rat bite lesions"), inflammatory
- olecranon bursitis
Arthritis that is worse than gout and RA, causes skin and nail changes, and typically affects small joints of the hands, esp DIP joints.
What are the hallmark findings in a pt with psoriatic arthritis?
- juxta-articular erosions
- bony proliferation at sites of tendon insertions (enthesophytes)
- resorption of the terminal phalanges
- "pencil-in-cup" deformity
Bilateral S-I joint fusion (autofusion) occurring in young males (20s) positive for HLA-B27. Ascends the spine starting in the S-I joint.
ankylosing spondylitis ("bamboo spine")
What are the hallmark findings in a pt with ankylosing spondylitis?
- "bamboo spine" appearance
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