Ucsf: Video E 49 Part 1 Msk Arthropathy (Hands)

Front 1

What are the ABCD'S of arthropathy

Back 1

Alignment
Bone Integrity
Cartilage/Joint Space
Distribution
Soft Tissue Changes

Front 2

What does subluxation look like

Back 2

the bones are touching but not in normal alignment

Front 3

What are 4 arthropathies that may lead to subluxation

Back 3

RA
OA
Lupus
Jaccouds

Front 4

What is the main condition that may lead to arthritis with dislocation

Back 4

severe neuropathic conditions
severe CPPD

Front 5

Does OA typically have erosions

Back 5

no, helps differentiate from RA

Front 6

Does SLE and jacouds cause erosions

Back 6

almost never it is very rare for either

Front 7

What is a good example of an arthropathy that is non-erosive and has reducible subluxations

Back 7

SLE (jaccouds is non-reducible subluxations), but only in 3-8% of pts does this happen

Front 8

What is a bouttenier deformity

Back 8

PIP is flexed
DIP is extended

(looks like a leg with the PIP being the foot)

Front 9

Can SLE have boutteniets deformities

Back 9

yes

Front 10

When does jaccouds arthropathy occur

Back 10

after rheumatic fever

Front 11

What are some soft tissue changes that may occur with lupus

Back 11

-calcifications
-non-specific soft tissue swelling

Front 12

Can SLE cause osteoporosis and acrosclerosis

Back 12

yes

Front 13

What are 5 plain film changes that occur in SLE (all are rare)

Back 13

These are all uncommon
-non-specific soft tissue welling
-calcification
-non-erosive reducible subluxation
-ST calcification
-Osteoporosis
-Acrosclerosis or acro-osteolysis

Front 14

What is acrosclerosis

Back 14

sclerosis of the distal tufts of fingers

Front 15

When analyzing bone integrity (the B of ABCDS) what are the 5 parameters that should be evaluated

Back 15

mineralization
destruction
erosion
sclerosis
new bone production

Front 16

Does Gout cause bony destruction

Back 16

yes

Front 17

What is the ddx of gout

Back 17

infection, sarcoid, mets

Front 18

When refering to the bone mineralization what is the preferred terminology

Back 18

osteopenic (usually looking at only a small part of the body so dont lable osteoporotic)

Front 19

Should osteopenia be used to describe bone commonly

Back 19

no, when evaluating bone arthritis this is often at sites of trabecula bone (spongy) and may appear osteopenic when it is completely normal. So only mention when it is absolutely obvious

Front 20

What are 3 conditions that may have dense sclerosis around a joint

Back 20

OA, neuropathic, chronic inflammatory condition with secondary degenerative changes

Front 21

Does psoarasis cause new bone production

Back 21

yes

Front 22

What are some arthropathyes that have normal joint space width (Cartilage/Joint space the C of the ABCDS of arthropathy)
4

Back 22

Gout
PVNS
Primary synovial (osteo)chondromatosis
SLE

Front 23

What are some causes of uniform narrowing of the joint space
2 (non-specific)

Back 23

inflammatory
Infectious

Front 24

What are causes of non-uniform narrowing of the joint space (3)

Back 24

OA
neuropathic
CPPD crystal deposition disease

Front 25

What is PVNS

Back 25

pigmented villonodular synovitis

Front 26

What joints does PVNS (pigmented villonodular synovitis) typically affect

Back 26

usually affects the hip or knee. It can also occur in the shoulder, ankle, elbow, hand or foot.

Front 27

What is the demographic of typical pts with PVNS

Back 27

PVNS predominantly affects adults in their second to fourth decade

Front 28

What part of the joint is typically affected by PVNS

Back 28

. PVNS can affect any joint, bursa, or tendon sheath

Front 29

What are the 2 types of PVNS

Back 29

diffuse (within the joint) and focal

Front 30

Can joint space narrowing occur in PVNS

Back 30

yes, but if it does narrowing can occur only late in its course

Front 31

Is PVNS erosive

Back 31

yes, erode into bone, creating large cystic cavities

Front 32

What are two classic radiographic features of primary synovial osteochondromatosis

Back 32

-one joint
-diffuse calcificaitons

Front 33

What is the most common joint for synovial osteochondromatosis

Back 33

the knee joint

Front 34

What percent of primary synovial osteochondromatosis ossify

Back 34

2/3rds

Front 35

What is the treatment for synovial osteochondromatosis

Back 35

synovectomy

Front 36

What is the causes of synovial osteochondromatosis

Back 36

synovial metaplasia which forms cartilage

Front 37

What are secondary causes of synovial osteochondromatosis

Back 37

DJD, AVN, OCD

Front 38

What is it called when synovial osteochondromatosis does not ossify

Back 38

synovial chondromatosis

Front 39

What does OCD stand for

Back 39

osteochondrtitis dissicans

Front 40

Can synovial chondromatosis or osteochondromatosis causes large errosive areas like PVNS

Back 40

yes

Front 41

Does synovial osteochondromatoss or chondromatosis cause errosive changes

Back 41

yes, pressure erosions in a tight joint

Front 42

What typicaly has blooming artifact on GRE MRI; PVNS or synovial chondromatosis

Back 42

PVNS

Front 43

What does the D of the ABCDS of arthropathy stand for

Back 43

distribution

Front 44

Does psaoratic arthritis have a sporadic distribution in the joints of the hands

Back 44

yes

Front 45

What arthropathy is classically bilateral and symmetric

Back 45

rheumatoid

Front 46

What are the joints that are typically involved in CPPD
2

Back 46

radio-carpal
metacarpal-phalangeal
(may effect other joints but these are classic)

Front 47

What may happen to the lunar triquetral ligament in CPPD

Back 47

calcifications

Front 48

What is a ddx for non-errosive involvement of the DIP and PIP
2

Back 48

OA
CPPD (this has non-uniform narrowing so im not sure if this is correct)

Front 49

What is the ddx for erosive arthropathy of the PIP and DIP
5

Back 49

erosive OA
psoarisis
multicentric histio (rare)
gout
RA

Front 50

Does RA effect the DIP

Back 50

rarely usually PIP

Front 51

What is the classic distribution of OA in the hand

Back 51

1st carpal-metacarpal (thumb)
1st metacarpal-phalangeal joint
all DIPs (interphalangeal joint of thumb)
(usually not PIP , but can be)
NOTE: there is no PIP and DIP in the 1st finger only (carpal-metacarpal, metacarpal-phalangeal joint, interphalangeal joint)

Front 52

What is the classic distribution of psoaratic arthritis

Back 52

Carpal
1st interphalangeal joint
DIP
PIP

Front 53

How can you differentiate erosive OA and psoariatic arthritis of the hand

Back 53

although erosive OA typically doesnt occur in the PIP it can and does OA (typically), however OA will never occur in the carpal bones and psoaratic arthritis classically does.

Front 54

What are 7 radiographic features of psoriatic arthritis

Back 54

-normal mineralization
-asymmetry
-sausage digit
-uniform narrowing
-erosions
-pencil in cup deformity
-new bone formation

Front 55

What arthropathy does the 'mickey mouse' ears typically occur with

Back 55

psoriatic
(this is new bone formation at the Distal phalanx and looks like mickey mouse)

Front 56

Where does the erosion occur in the joint in psoariasis and erosive OA

Back 56

psoaratic occurs laterally (contributes to the formation of the mickey mouse ears)

OA- central erosion

Front 57

Does enthesopathy and periosteal reaction occur with psoaratic arthropathy

Back 57

yes

Front 58

What are two causes of sausage digits

Back 58

infections and psoarasis

Front 59

What does the sausage digit of psoriatic arthritis look like on MR

Back 59

bright signal on T2 and may look like a severe cellulitis with osteo

Front 60

Besides erosive OA and psoriasis what other erosive conditions may effect either the DIP and PIP joints or both

Back 60

multicentric reticulohistiocytosis, gout, and RA

Front 61

What are some features of multicentric reticulohistiocytosis

Back 61

unknown etiology
DIP erosion (not PIP)
Women>men
25%have some time malignancy
subluxation

Front 62

What is the clinical presentation of multicentric reticulohistiocytosis

Back 62

arthritis and non-tender soft tissue nodules

Front 63

Can psoarasis occosional affect the MCP joints

Back 63

yes

Front 64

What is an enthesophyte

Back 64

an osteophyte at an insertion point of a tendon.

Front 65

What is the hallmark of osteoarthritis

Back 65

osteophytes

Front 66

What is the location of osteophytes in degenerative changes of the hips

Back 66

rim of the acetabulum

Front 67

What is pannus of rheumatoid arthritis

Back 67

the erosions follow the development of an inflammatory proliferation of the synovium, called pannu

Front 68

Where does erosions tend to occur first

Back 68

at the periarticular bare areas (areas not covered by articular cartilage)

Front 69

What is the most common finding of CPPD

Back 69

calcium pyrophosphate dyhidrate depostition (CPPD) disease, the most common site of radiographic calcifications is in fibrocartilage and hyaline articular cartilage (chondrocalcinosis).

Front 70

Does calcifications also occur in the joint capsule or synovial membrane in CPPD

Back 70

yes