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70 Cards in this Set
- Front
- Back
What are the ABCD'S of arthropathy
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Alignment
Bone Integrity Cartilage/Joint Space Distribution Soft Tissue Changes |
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What does subluxation look like
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the bones are touching but not in normal alignment
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What are 4 arthropathies that may lead to subluxation
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RA
OA Lupus Jaccouds |
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What is the main condition that may lead to arthritis with dislocation
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severe neuropathic conditions
severe CPPD |
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Does OA typically have erosions
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no, helps differentiate from RA
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Does SLE and jacouds cause erosions
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almost never it is very rare for either
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What is a good example of an arthropathy that is non-erosive and has reducible subluxations
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SLE (jaccouds is non-reducible subluxations), but only in 3-8% of pts does this happen
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What is a bouttenier deformity
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PIP is flexed
DIP is extended (looks like a leg with the PIP being the foot) |
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Can SLE have boutteniets deformities
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yes
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When does jaccouds arthropathy occur
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after rheumatic fever
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What are some soft tissue changes that may occur with lupus
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-calcifications
-non-specific soft tissue swelling |
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Can SLE cause osteoporosis and acrosclerosis
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yes
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What are 5 plain film changes that occur in SLE (all are rare)
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These are all uncommon
-non-specific soft tissue welling -calcification -non-erosive reducible subluxation -ST calcification -Osteoporosis -Acrosclerosis or acro-osteolysis |
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What is acrosclerosis
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sclerosis of the distal tufts of fingers
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When analyzing bone integrity (the B of ABCDS) what are the 5 parameters that should be evaluated
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mineralization
destruction erosion sclerosis new bone production |
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Does Gout cause bony destruction
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yes
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What is the ddx of gout
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infection, sarcoid, mets
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When refering to the bone mineralization what is the preferred terminology
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osteopenic (usually looking at only a small part of the body so dont lable osteoporotic)
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Should osteopenia be used to describe bone commonly
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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
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What are 3 conditions that may have dense sclerosis around a joint
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OA, neuropathic, chronic inflammatory condition with secondary degenerative changes
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Does psoarasis cause new bone production
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yes
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What are some arthropathyes that have normal joint space width (Cartilage/Joint space the C of the ABCDS of arthropathy)
4 |
Gout
PVNS Primary synovial (osteo)chondromatosis SLE |
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What are some causes of uniform narrowing of the joint space
2 (non-specific) |
inflammatory
Infectious |
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What are causes of non-uniform narrowing of the joint space (3)
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OA
neuropathic CPPD crystal deposition disease |
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What is PVNS
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pigmented villonodular synovitis
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What joints does PVNS (pigmented villonodular synovitis) typically affect
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usually affects the hip or knee. It can also occur in the shoulder, ankle, elbow, hand or foot.
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What is the demographic of typical pts with PVNS
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PVNS predominantly affects adults in their second to fourth decade
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What part of the joint is typically affected by PVNS
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. PVNS can affect any joint, bursa, or tendon sheath
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What are the 2 types of PVNS
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diffuse (within the joint) and focal
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Can joint space narrowing occur in PVNS
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yes, but if it does narrowing can occur only late in its course
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Is PVNS erosive
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yes, erode into bone, creating large cystic cavities
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What are two classic radiographic features of primary synovial osteochondromatosis
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-one joint
-diffuse calcificaitons |
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What is the most common joint for synovial osteochondromatosis
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the knee joint
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What percent of primary synovial osteochondromatosis ossify
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2/3rds
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What is the treatment for synovial osteochondromatosis
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synovectomy
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What is the causes of synovial osteochondromatosis
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synovial metaplasia which forms cartilage
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What are secondary causes of synovial osteochondromatosis
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DJD, AVN, OCD
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What is it called when synovial osteochondromatosis does not ossify
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synovial chondromatosis
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What does OCD stand for
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osteochondrtitis dissicans
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Can synovial chondromatosis or osteochondromatosis causes large errosive areas like PVNS
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yes
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Does synovial osteochondromatoss or chondromatosis cause errosive changes
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yes, pressure erosions in a tight joint
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What typicaly has blooming artifact on GRE MRI; PVNS or synovial chondromatosis
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PVNS
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What does the D of the ABCDS of arthropathy stand for
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distribution
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Does psaoratic arthritis have a sporadic distribution in the joints of the hands
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yes
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What arthropathy is classically bilateral and symmetric
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rheumatoid
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What are the joints that are typically involved in CPPD
2 |
radio-carpal
metacarpal-phalangeal (may effect other joints but these are classic) |
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What may happen to the lunar triquetral ligament in CPPD
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calcifications
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What is a ddx for non-errosive involvement of the DIP and PIP
2 |
OA
CPPD (this has non-uniform narrowing so im not sure if this is correct) |
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What is the ddx for erosive arthropathy of the PIP and DIP
5 |
erosive OA
psoarisis multicentric histio (rare) gout RA |
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Does RA effect the DIP
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rarely usually PIP
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What is the classic distribution of OA in the hand
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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) |
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What is the classic distribution of psoaratic arthritis
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Carpal
1st interphalangeal joint DIP PIP |
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How can you differentiate erosive OA and psoariatic arthritis of the hand
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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.
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What are 7 radiographic features of psoriatic arthritis
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-normal mineralization
-asymmetry -sausage digit -uniform narrowing -erosions -pencil in cup deformity -new bone formation |
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What arthropathy does the 'mickey mouse' ears typically occur with
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psoriatic
(this is new bone formation at the Distal phalanx and looks like mickey mouse) |
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Where does the erosion occur in the joint in psoariasis and erosive OA
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psoaratic occurs laterally (contributes to the formation of the mickey mouse ears)
OA- central erosion |
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Does enthesopathy and periosteal reaction occur with psoaratic arthropathy
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yes
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What are two causes of sausage digits
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infections and psoarasis
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What does the sausage digit of psoriatic arthritis look like on MR
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bright signal on T2 and may look like a severe cellulitis with osteo
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Besides erosive OA and psoriasis what other erosive conditions may effect either the DIP and PIP joints or both
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multicentric reticulohistiocytosis, gout, and RA
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What are some features of multicentric reticulohistiocytosis
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unknown etiology
DIP erosion (not PIP) Women>men 25%have some time malignancy subluxation |
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What is the clinical presentation of multicentric reticulohistiocytosis
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arthritis and non-tender soft tissue nodules
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Can psoarasis occosional affect the MCP joints
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yes
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What is an enthesophyte
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an osteophyte at an insertion point of a tendon.
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What is the hallmark of osteoarthritis
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osteophytes
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What is the location of osteophytes in degenerative changes of the hips
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rim of the acetabulum
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What is pannus of rheumatoid arthritis
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the erosions follow the development of an inflammatory proliferation of the synovium, called pannu
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Where does erosions tend to occur first
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at the periarticular bare areas (areas not covered by articular cartilage)
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What is the most common finding of CPPD
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calcium pyrophosphate dyhidrate depostition (CPPD) disease, the most common site of radiographic calcifications is in fibrocartilage and hyaline articular cartilage (chondrocalcinosis).
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Does calcifications also occur in the joint capsule or synovial membrane in CPPD
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yes
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