Sianny Suryawati SpRad Departemen Radiologi FK UWKS Arthritis or Not DJD AVN PVNS DJD Classification HYPERTROPHIC Hallmarks Bone production Sclerosis INFECTIOUS Hallmark Destruction of ID: 775439
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Slide1
APPROACH TO ARTHRITIS
dr.
Sianny
Suryawati
,
Sp.Rad
Departemen
Radiologi
FK UWKS
Slide2Arthritis or Not
DJD
AVN
Slide3PVNS
DJD
Slide4Classification
HYPERTROPHIC
Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of
articular
cortex
EROSIVE
Hallmark : Erosion
Slide5Normal joint
Normal knee joint
Slide6HYPERTROPHIC ARTHRITIS
DEGENERATIVE ARTHRITIS
Primary
Secondary
CHARCOT ARTHROPATHY
Slide71° DEGENERATIVE ARTHRITIS
Intrinsic degeneration of
articular
cartilage
Excessive wear and tear
Osteoarthritis (OA) is more common in the weight-bearing joints (the knee, hip, and spine)
Non-weight-bearing joints, such as the
shoulder and elbow,
can undergo the same degenerative process
.
Slide81° DEGENERATIVE ARTHRITIS
The
most common form of
arthritis
Primary
(idiopathic)
form
a
affects
individuals age 50 and
older
Secondary form
a
may
be seen in a much younger age
group
Patients
in the latter group have clearly defined underlying conditions leading to the development of degenerative joint disease
Slide9OA Pathology
Slide10Degenerative changes of the joint
NARROWING
joint space
OSTEOPHYTES
at bone margin
CYSTS
formation at
subchondral
bone
SCLEROSIS
at
subchondral
bone plate
Slide111° DEGENERATIVE ARTHRITIS
X-ray findings :
Narrowing of joint space
Subchondral
sclerosis
Marginal
osteophyte
formation
Subchondral
cysts
Slide12Joint narrowing
Slide13Osteoarthritis : Joint narrowing + Osteophyte/”lipping”
Slide14Osteoarthritis
Subchondral cyst
Subchondral
sclerosis
Slide152° DEGENERATIVE ARTHRITIS
Another process destroys
articular
cartilage
Degenerative changes supervene
How to recognize
Atypical locations (CPPD and knee)
Atypical appearance (marked DJD of 1 hip)
Atypical age (DJD in 20 year-old)
Slide16Causes :
TraumaInfectionAvascular necrosisCPPDRAHemophilia HemochromatosisAcromegalyOchronosisWilson’s disease
Bottom line
: Any arthritis can end as DJD
Slide17HYPERTROPHIC ARTHRITIS
DEGENERATIVE ARTHRITIS
Primary
Secondary
CHARCOT ARTHROPATHY
Slide18Charcot arthropathy
Disturbance in sensation leads to multiple microfracturesPain sensation intact from muscles and soft tissueCauses :Shoulders – syrinx, spinal tumorHips – tertiary syphilis, diabetesFeet – diabetes
General
Slide19Charcot arthropathy
FragmentationSoft tissue swellingDestruction of jointsSclerosisOsteophytosis
Findings :
Slide20Charcot Arthropathy
Complete disorganization of the jointFragmentationSubluxation The absence of osteoporosis is a characteristic feature of the neuropathic joint
Slide21Charcot Arthropathy
A 59-year-old woman with long-standing diabetes mellitus presented with neuropathic changes of left ankle joint
Slide22Classification
HYPERTROPHIC
Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of
articular
cortex
EROSIVE
Hallmark : Erosion
Slide23INFECTIOUS ARTHRITIS
More common in adults
Usually from local trauma – surgery or accident
Children get
osteomyelitis
Destruction of
articular
cartilage and cortex
Tends to affect one joint (
DDx
from gout)
Fingers from human bites
Feet from diabetes
Hips from THRs
Slide24Causes
Usually staph – “early” destruction of
articular
cortex
Rapid course (unlike most
arthritides
)
TB spreads via bloodstream from lung
More protracted course
In children, spine most common; in adults, knee
Severe osteoporosis
Healing with
ankylosis
common in both
Slide25Septic arthritis of toe
Slide26Classification
HYPERTROPHIC
Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of
articular
cortex
EROSIVE
Hallmark : Erosion
Slide27EROSIVE ARTHRITIS
Synovial proliferation (pannus formation)InflammationErosions seen in small joints (hands) better than large joints (hips)Destroy portion of cortex
General
Slide28Inflammatory Arthritis
Slide29Slide30EROSIVE ARTHRITIS
Bilaterally symmetrical
Earliest change : STS MCP, PIP,
ulnar
styloid
Radiocarpal
joint most commonly narrowed
Periarticular
demineralization
Begins MCP joints of 1
st
and 2
nd
fingers
Large joints usually no erosions
Slide31EROSIVE ARTHRITIS
Can lead to 2 DJD
Marked narrowing of joint space with intact
articular
cortex, think of RA
Little or no sclerosis
Especially, hips and knees
Slide32Normal
articular
cortex
Erosive Arthritis
Slide33GOUT : General
Long latent period between onset of symptoms and bone changes
Asymmetric and
monoarticular
More common in males
Most common at 1
st
MT-P joint
Tophi
rarely calcify
Olecranon
bursitis is common
Slide34GOUT : Findings
Juxta-articular
erosions
Sharply
marginated
with sclerotic rims
Overhanging edges (rat-bites)
No joint space narrowing until later
Little or no osteoporosis
Soft tissue swelling
Tophi
not calcified
Slide35Gouty Arthritis
Slide36Gouty Arthritis
Slide37EROSIVE OSTEOATHRITIS
Post menopausal females
Changes like DJD but with marked inflammation and erosions
IP joint of hands and carpal-MCP joint of thumb
DDx
: Psoriasis (skin changes)
Slide38Progression of erosive OA into rheumatoid arthritis
Slide39PSORIATIC ARTHRITIS
Almost always accompanies skin disease, especially nail changes
Involves DIP joints of hands > feet
Cup-in-pencil deformity
Resorption
of terminal phalanges
No osteoporosis
Slide40REITER’S SYNDROME
Urethritis
, arthritis (50%) and conjunctivitis
Periostitis
at sites of
tendinous
insertion
Whiskering
Like DISH,
ankylosing
spondylitis
Affects feet more than hands; also SI joints
Resembles RA
Reiter’s also has osteoporosis
Slide41ANKYLOSING SPONDYLITIS
HLA-B27 positive
B/L SI arthritis
Squaring of vertebral bodies
Bamboo-spine from continuous
syndesmophytes
Peripheral large joint erosive
arhtritis
Slide42Overview
HYPERTROPHIC
Degenerative arthritis
Primary
Secondary
Charcot
arthropathy
INFECTIOUS
Pyogenic
Tuberculous
Slide43EROSIVE
RA
Gout
Erosive osteoarthritis
Psoriatic arthritis
Reiter’s syndrome
Ankylosing
spondylitis
Slide44THE END