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65 Cards in this Set
- Front
- Back
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3 Types of DJD
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Primary- Female weight bearing
secondary- joint stress/trauma erosive- female finger inflammation |
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DJD most common sites
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DIPS, HIPS, PIPS, thumb, knee, spine
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DJD general features
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most common form or arthritis.
stiffness with rest, improves with activity. normal lab results. caused by inactivity more than wear and tear. |
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DJD radiologic features.
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Loss of joint space, subchondral sclerosis, osteophytes, subchondral cysts. Asymmetric distribution and joint mice present.
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DJD most common areas
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Lower spine sections.
C5-7 (C7 anterolisthesis) T6-L1 (Z-jt, costal jt., IVD) L4-S1 (L4 anterolisthesis) SI synovial portion (lower 2/3) |
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Hip DJD
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Femur migration superiorly and medially.
Widened medially (Waldentrom's Sign)- difference of 3+ from side to side or 11+ on one side. Buttressing- thickening of inferior medial part of femoral head/neck from stress. |
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Knee DJD
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medial compartment first.
patellofemoral least common. chondromalacia patellae- cartilage softening (young variant of DJD) |
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shoulder DJD
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AC most affected, GH usually from trauma.
supraspinatus calcifying tendinitis. often B/L. |
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Wrist/Hand DJD
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Thumb articulations.
DIP- Heberdens PIP- Bouchards |
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Feet DJD
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First metatarsal phalangeal joint.
Hallux ridgidus. |
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Degenerative Spondylisthesis
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anterior slippage of one vertebrae on another.
combination of loss of joint space, disc height, and remodeling of facet surfaces to saggital plane. most common at L4 and C7. |
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HSS
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Hemispheric Spondylosclerosis
semicircle of sclerosis in lateral view from anterior stress. commonly mistaken for blastic metastasis. |
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EOA
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inflammatory DJD in DIPS and PIPS.
Gullwing sign present in DIPS non uniform loss in joint space and symetric periostitis occurs (fluffy on xray) |
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DISH
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aka forrester's ds.
ALL ossification most common at T/L juntion, then cervical and lumbar dysphagia caused by esophageal obstruction HLA B8 positive can occur with OPLL |
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DISH radiologic features
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ossification of 4+ segments
dripping candle wax, flame shaped osteophytes. IVD height preserved SI- only after spine involvement and doesnt affect synovial portion. |
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OPLL
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Associated with DISH
can cause myelopathy- problems with walking dense linear strip in the posterior part of spine on lateral film |
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Neurotrophic Arthropathy
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secondary to lack of jt. innervation
severe instability and jt dysfunction |
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NA hypertrophic phase
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6 D's:
Distended joint: earliest finding Density increase (subchondral sclerosis) debris production in jt. (joint mice) dislocation (from instability) disorganization of joint elements (bag of bones) destruction of bone |
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NA atrophic phase
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increased blood flow stimulates bone resorption
non weight bearing jts. but may be in hip/foot tapered bone:licked candy stick at joint space amputated bone appearance |
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NA locations
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spine- lumbar most common, hypertrophic vertebral fragmentation (jigsaw vertebrae)
knee- medial compartment first, joint debris is prominent feature, articular surface destruction foot- subtalar jt. gets hypertrophic and forefoot becomes atrophic |
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RA
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B/L SYMMETRIC peripheral joints with uniform jt. space loss
jelling phenomenon- symptoms worse in morning synovitis- synovial fluid causes edema and congestion in synovial membrane pannus formation ADI instability (decalcifies ligament attachments) |
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Pannus formation
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vascular granulation tissue
erodes cortex in "bare area" intrudes into marrow making subchondral cysts pannus replaces hyaline cartilage |
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RA lab results
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+ Rheumatoid factor
normochromic, normocytic anemia elevated CRP (checks for inflammation) and ESR |
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RA radiologic features
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B/L symmetric periarticular ST swelling
periarticular osteoporosis (dot-dash interruption in articular cortex) rat bite erosions |
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RA in the hand
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DIP spared
radial margins of 2-3 MC heads Boutonniere deformity- PIP flexed, DIP extended swan neck deformity- opposite haygarth nodes at MCP ULNAR DEVIATION arthritis mutilans- complete disorganization of anatomic relationships |
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RA in the wrist
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spotty carpal sign
terry thomas sign- scapholunate separation |
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RA in the feet
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great toe
fifth MTP has no fibular deviation, all the rest do |
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C/S RA
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Atlanto axial instability from transverse ligament disruption
uniform loss of disc height no sclerosis or osteophytes SP tapering (sharpened pencil) |
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Hip RA
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axial migration
protrusio acetabulae |
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SI RA
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U/L symmetric
synovial portion little/no sclerosis |
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Knee RA
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Bakers cyst (synovial fluid)
uniform bicompartmental loss of joint space (HALLMARK) |
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Shoulder RA
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B/L symmetric
pencil tapering of distal clavicle humeral head resorption |
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JRA
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sero+ - similar to adult RA
sero- - stills disease (could be U/L) less inflammation and pannus |
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JRA lab findings
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RF negative (90%)
elevated ESR and CRP positive HLA-B27 when in spine (related to stills) |
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Ankylosing Spondylitis
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starts in SI, skips to T/S costal articulations (likes axial skeleton)
pannus formation w/ synovial proliferation- destroys articular cartilage and erodes subchondral bone enthesopathy- inflammatory changes at ligament attachments |
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AS lab findings
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Increased ESR
mild anemia positive HLA B-27 negative RF (obviously) |
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AS radiologic features
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B/L SYMMETRIC
axial skeleton SI- B/L symmetric w/ ghost jt. spine- marginal syndesmophyte (ossification of outer annulus) |
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AS specific radiologic signs
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Anderson lesion, Romanus lesion (erosions at anterior VB), shiny corner sign (erosions surrounded by sclerosis), squared vertebrae, barrel vertebrae, bamboo spine (marginal syndesmophytes), trolly track (facet sclerosis and ligament ossification), dagger sign (interspinous lig. ossification), discal ballooning (decreased imbibitions)
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AS enthesopathy
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bone attachment pathology
most common at iliac crest, ischial tuberosity, and trochanters can occur at achilles and plantar insertion (fluffy compared to smooth look in OA) |
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Enteropathic Arthritis (EA)
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twin to AS in spine
associated with GI diseases (ulcerative colitis, crohn's disease) Lab- increased HLA B-27 |
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Psoriatic Arthritis
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assoc. w/ skin disorder
peripheral jt. distruction/deformity NON marginal syndesmophytes similar to RA but pannus affects less cartilage, erosions are smaller and develop slower |
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Psoriatic Arthritis lab findings
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normal ESR (except in acute)
Negative RF (obviously) +HLA B-27 (75% of patients w/ SI and 30% patients w/ peripheral) |
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Psoriatic Arthritis radiologic features
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ST swelling- sausage digit
normal mineralization tapered bone ends |
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Psoriatic Arthritis in hands/feet
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DIPS most common
asymmetric mouse ear sign pencil in cup appearance NO ulnar deviation |
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Paravertebral ossification
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flowing exuberant ossification (candle wax, DISH)
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Reactive arthritis (Reiter's)
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Non-marginal, comma shaped, stuck on, floating
triad: conjunctivitis, urethritis, polyarticular arthritis (cant see, cant pee, cant dance with me) mostly lower extremity +HLA B-27 in 75% Twin with Psoriatic in spine |
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SLE
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CT disorder involving multiple organ systems
chief complaint is myalgia, comes with fever and malar butterfly rash lab- elevated ESR, ANF and lupus erythematous cell |
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SLE radiologic findings
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RA type alterations
reversible subluxations, dislocations, and deformities calcifications normal bone density most prominent features seen in hands ADI |
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Jaccoud's arthritis
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after Rheumatic fever (vegetative lesions on mitral valve)
affects hands and feet can cause deformities/deviations normal bone density |
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Scleroderma
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systemic inflammation
lack of blood to tips of fingers CREST syndrome Raynaud's phenomenon thick skin on face and hands dysphagia (tongue and esophagus) |
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Scleroderma radiologic findings
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most common in hand
ST retraction and calcification bone resorption- acroosteolysis (DIP- caused by scleroderma, pyknodysostosis, or hyperparathyroidism) |
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Osteoitis Condensaans Ilii
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SI- B/L symmetric sclerosis in multiparous females
no positive lab results increased ligament laxity not painful or pathologic |
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osteoitis condensaans Ilii radiologic features
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B/L dense triangle of sclerosis in lower half of SI jt.
normal jt space can be confused with AS |
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CPPD
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inflammatory jt. disease causesd by deposition of Calcium Pyrophosphate Dihydrate crystals into synovial fluid, linings, and articular cartilage
aka pseudogout |
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CPPD clinical features
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joint hurts in passive and AROM
crepitus and stiffness calcium deposits in jt. is CPPD until proven otherwise |
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CPPD radiologic features
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most common in knee- deposits in the meniscus (chondrocalcinosis)
shoulder also common jt space should be black, cartilage calcification in joint space appears white |
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Hydroxyapatite Deposition Disorder
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calcification in a tendon, bursa, or other periarticular ST
aka calcifying tendonitis dystrophic calcification |
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HDD radiologic features
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most common in shoulder (supraspinatus tendon or subscap on internal rot.), hip (glut max tendon), and spine (longus coli)
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HDD DDX
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os peronei- not tender
calcific tendonitis of peroneus brevis tendon- tender |
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Onchronosis
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aka alkaptonuria
hereditary degenerative arthritis affecting large jts and spine disorder of tyrosine metabolism |
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Onchronosis radiologic findings
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advanced premature DJD (wrong place, wrong age)
chondrocalcinosis ligament calcification spine- discal calcification, increased kyphosis and lordosis, begins in L/S and ascends |
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Sarcoidosis
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large potato sized pulmonary nodules in hilar area or lung
lace like trabecular pattern in bone (bigger and rounder than normal) most common in hands, wrists, and feet (after chest) |
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Pigmented Villonodular Synovitis
PVS |
idiopathic inflammatory synovial lesions
lower extremity especially knee large intraarticular ST masses w/ capsule distension apple core deformity of proximal femur |
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PVS DDX
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osteosarcoma- break out lesion
PVS- break IN lesion |
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Crystal deposition
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HADD- hydroxyapatite
Gout- sodium monourate CPPD- CPPD crystals onchronosis- homogentisic acid, calcification |
