Categories of Arthritis
inflammatory degenerative depositional/metabolic infectious neuropathic
Diffuse joint space narrowing
Marginal or central erosions
Absent or minimal subchondral sclerosis
Lack of osteophytes
Inflammatory Arthritis (RA)
Juxtaarticular osteoporosis
Periarticular soft tissue swelling
Soft tissue nodules
Articular deformities
Inflammatory Arthritis (RA)
Localized joint space narrowing (non-uniform)
Subchondral sclerosis
Osteophyte formation
Cyst or pseudocyst formation
Weight bearing side of the joint usually involved
Degenerative Arthritis (Osteoarthritis)
Marginal periarticular erosions
Overhanging edge
Lack of osteoporosis
Metabolic Arthritis (Gout)
Lobulated, asymmetric soft tissue mass
Spotty carpals
Relative preservation of articular spacing
Metabolic Arthritis (Gout)
Destruction of joint space
Joint effusion
Soft tissue swelling
Osteoporosis
Infectious Arthritis
hands:
DIPs and thumb affected
OA
hands:
MCPs, PIPs, and thumb affected
RA
hands:
proximal thumb and MCPs affected
CPPD
knee:
medial joint line and patella
OA
knee:
entire joint line and patella
RA
knee:
patella
CPPD
hip:
superior or inferior joint line
OA
hip:
entire joint line (2)
RA and CPPD
Asymmetric, non-uniform loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts, loose bodies and subluxation
Degenerative Joint Dz
Spondylophytes, loss of disc height, facet hypertrophy, uncinate hypertrophy, IVF encroachment, spondylolisthesis
cervical DJD
Spondylophytes
thoracic DJD
Spondylophytes, loss of disc height, facet hypertrophy, vacuum sign, spondylolisthesis
lumbar DJD
Occurs as a complication of loss of joint space, loss of disc height and remodeling of the facet surfaces to a more sagittal orientation
Degenerative spondylolisthesis
m/c at DIPs and PIPs of hands
Sclerosis, osteophytes, periostitis, ankylosis, non-uniform joint space narrowing
Erosive Osteoarthritis
Central joint erosions on proximal articular surface and peripheral joint erosions at distal articular surface = “gull wing” sign
Erosive Osteoarthritis
Flowing anterior ossification of ALL Disc height relatively preserved 50% have OPLL m/c in cervical spine Stenosis (must order CT)
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Neurotrophic Arthropathy:
Associated with diabetes
Six Ds: joint distention, increased subchondral density, debris, dislocation, disorganization, and bone destruction
Weight-bearing joints
Hypertrophic
Neurotrophic Arthropathy:
Syringohydromyelia
Simulates a sharp amputation of the articular end of the bone: resorption and tapered ends
Atrophic
Destruction of the joint with gross disorganization
Osseous debris
Joint instability, dislocation
Joint distention (effusion)
Lack of osteoporosis (usually)
Can have a “surgical amputation” appearance in the atrophic form (licked candy stick)
Neuropathic Arthropathy
charcot’s joint is a condition of
Neuropathic Arthropathy
Synovial membrane detaches and calcifies/ossifies
Multiple round/ovoid, smooth faceted, laminated loose bodies within the joint capsule
Associated extrinsic bone erosion or DJD
m/c joints: knee, hip, ankle, elbow, wrist
Synoviochondrometaplasia
These “bare areas” refer to portions of the bone within the synovial space that are not protected by articular cartilage
Rheumatoid Arthritis (RA)
Ulnar deviation of the MCP joints
Swan-neck deformity of the fingers
Rheumatoid Deformities
Inflammatory Arthritis: \_\_\_\_\_\_\_\_ arthropathies Ankylosing Spondylitis IBD Arthropathy (Enteropathic) Reiter’s (Reactive) Arthritis Psoriatic Arthritis
Seronegative arthropathies
Absence of osteoporosis Presence of bony proliferation Periostitis Intra-articular bony ankylosis HLA-B27 positive
Seronegative arthropathies
Fusiform soft tissue swelling (sausage digits)
Pencil in cup deformity
Fluffy periostitis with erosions at the interphalangeal joints can resemble “mouse ears”
Pitting of the nails
Bony ankylosis
Erosions of the spinous processes in the cervical spine (penciling)
Psoriatic Arthritis
Calcaneal enthesopathy
Parasyndesmophytes (non-marginal)
Unilateral or Bilateral asymmetrical sacroiliitis
Lower extremity involvement
Fluffy periostitis
Ray distribution of involvement (hands/feet)
Reiter’s Syndrome (Reactive Arthritis)
Bony ankylosis of SI joints & facets Marginal bridging syndesmophytes Bilateral SI joint involvement Favors “root joints” Disuse osteoporosis
Ankylosing Spondylitis
Crystal deposition into the synovial fluid, linings and articular cartilage
Soft tissue calcification, chondrocalcinosis
Common in knees, wrists, symphysis pubis, elbows and hips
DJD
Calcium Pyrophosphate Dihydrate Crystal Deposition Disease
Calcification within a tendon, bursa or other periarticular soft tissue Self limiting - rotator cuff, bursa - glut max - longus colli
Hydroxyapatite Deposition Disease