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Arthritis Imaging Atlas

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Ankylosing Spondylitis ankylosing.jpg

Arthritis Common Joints Involved Arthritis.jpg

CPPD Knee lateral.jpg

Erosive Arthritis Wrist Wrist_Erosions_T1_2.jpg

Gout Gout1.jpg

Juvenile Rheumatoid Arthritis JRA1.jpg

Rheumatoid Arthritis shoulder.jpg

SLE hands Lupus.jpg

  • Arthritis
    1. Monoarticular Arthritis
      1. SoS GPS
        1. Secondary Osteoarthritis
        2. Septic arthritis
        3. Gout
        4. PVNS
        5. Synovial osteochondromatosis
    2. Rheumatoid Arthritis: ST edema, osteoporosis, joint space narrowing, marginal erosions
      1. Marginal erosions
      2. Juxta-articular osteoporosis progressing to generalized osteoporosis
      3. Still Disease
        1. Fever, hepatosplenomegaly, pleuritis, pericarditis
      4. Distribution: hands, feet, knees, hips, cervical spine, shoulders, elbows
    3. Juvenile chronic arthritis
      1. Juxta-articular osteoporosis
      2. Metaphyseal lucent bands
      3. Periostitis
      4. Epiphyseal overgrowth due to hyperemia
      5. Widening of femoral intracondylar notch
      6. Antegonial notching in the mandible
      7. Premature fusion of physis
      8. Late joint space loss and erosive disease
      9. Maybe symmetric or sporadic
      10. Distribution: hand, wrist, foot, knee, ankle, hip, cervical spine, mandible
    4. Osteoarthritis: joint space narrowing, sclerosis, osteophytosis
      1. Neuropathic ostearthritis
        1. Hypertrophic changes in weight bearing joints
        2. Atrophic (lytic) changes in non-weightbearing joints
        3. Tabes dorsalis => knee, hip, (spine)
        4. DM => foot, ankle, (spine)
        5. Syringomyelia => shoulder and elbow
        6. Hip may demonstrate lytic changes in paraplegic patients
      2. Distribution: hands, feet, knees, hips
    5. DISH (Forestier disease)
      1. Not a true arthropathy - ossification of ligaments
      2. Four levels have to be involved for diagnosis
      3. Facet joints are maintained
      4. Lucent line can be seen between ligamentous ossification and vertebral body
      5. Pelvis is always involved if there is extraspinal involvement
      6. Flowing osteophytes with preserved disk heights
        1. Usually in thoracic spine (as opposed to OPLL and retinoic arthropathy in the cervical spine)
        2. Diff Dx (FOR): fluorosis, OPLL, retinoic arthropathy,
      7. Superior SI joints bridged by ligamentous calcification
      8. Enthesophytes
        1. Pelvis
        2. Calcaneus
        3. Anterior surface of patella
      9. Sacrotuberous and sacrospinous ligament ossification
    6. AS and Spondylitis of IBD
      1. Erosive disease in inferior SI joints and enthesitis in the superior SI joints eventually progressing to fusion
      2. Enthesitis with reactive sclerosis (osteitis, "shiny corner," "squared vertebra") followed by edema and erosions in the anterior superior and inferior vertebral  body corners
      3. Symmetric thin (marginal) syndesmophytes form along annulus fibrosus in thoracolumaber and lumbosacral spine
      4. Ankylosis can involve facet joints
      5. Distribution: SI joints, spine (lumbar, thoracic, cervical), hips, shoulders, knees, hands, feet
    7. Ochronosis
      1. Absence of homogentisic acid
      2. Multilevel disk degeneration with vacuum phenomena
      3. Symmetric
      4. If spine becomes ankylosed, the disk spaces are lost
      5. No erosions
      6. Relative lack of osteophytosis
      7. Distribution: spine, SI joints, knee, hip, shoulder
    8. PsA
      1. Tuft resorption or reactive sclerosis ("ivory phalanx")
      2. Pencil-in-cup deformity
      3. Asymmetric sacroilitis
        1. Involves inferior synovial portion
      4. Spine
        1. Asymmetric bulky (non-marginal or paramarginal) syndesmophytes
      5. Foot: IP and MTP
      6. Distribution: hands, feet, SI joints, spine
    9. Reiters syndrome
      1. Conjunctivites, urethrtis, arthritis
      2. SI joints
      3. Spine
      4. Calcaneal erosions and spurring
      5. Distribution: feet, ankles, knees, SI joints, hands, hips, spine
    10.  SAPHO
      1. Synovitis, ACNE, pustulosis, hyperostosis, osteitis
      2. Thickened medial clavicles and fusion of the sternoclavicular joints
    11. SLE
      1. Reversible subluxations
      2. Juxtaarticular osteoprosis
      3. Absence of erosions
      4. Osteonecrossis
      5. Distribution: hand, wrist, hip, knee, shoulder
    12. Scleroderma
      1. Acro-osteolysis
      2. Soft-tissue calcification
      3. Resorption of soft tissues of the fingertip
    13. Polymyositis/Dermatomyositis
      1. Fatty atrophy and soft tissue calcifications
    14. Gout
      1. Punched out erosions with sclerosing borders and overhanging edges
    15. CPPD
      1. Patellofemoral compartment involvement and scalloping of distal femur from abutment by patella
      2. If severe, may mimick neuropathic joint
      3. MCP joints may be involved
      4. May result in atlanto-axial instability
      5. Association: Hyperparathyroidism, gout, hemochromatosis
      6. Distribution of chondrocalcinosis: knee, TFC, symphysis pubis
      7. Distribution of arthropathy sites: shoulder, radiocarpal joint, patellofemoral joint, elbow
    16. Calcium HADD
      1. Amorphous calcifications
      2. Distribution: shoulder, hip, wrist, elbow, neck
    17. Hemochromatosis arthropathy
      1. Medial beak-like osteophytes at the 2nd and 3rd MCP joints
      2. Chondrocalcinosis
      3. Distribution: hand, wrist, knee, hip
        1. Concentric joint space narrowing in the hip
    18. Alcaptonuria (Ochronosis)
      1. Disk calcifications in osteoporotic spine
    19. Amyloidosis
      1. Bulky soft tissue nodules
      2. Joint widening
      3. Diskitis in the spine
    20. Hemophillia
      1. Radiodense soft tissue swelling
      2. Osteoporosis
      3. Epiphyseal overgrowth
      4. Widening of femoral intracondylar notch
      5. Enlargement of olecranon fossa
      6. Osseous pseudotumors due to periosteal or soft tissue hematomas
      7. Tibiotalar slant with tibial epiphyseal overgrowth
      8. Subchondral cysts
      9. Late osteoarthritic changes
      10. Joint space widening in non-weight bearing joint
      11. Distribution: knee, elbow, ankle, hip, shoulder
    21. Signs
      1. Overhanging edges => gout
      2. Pencil-in-Cup => PsA
      3. Mouse ears => PsA
      4. Seagull wing => ErOA
      5. Enthesitis and periosteal new bone formation => SpA (PsA & Reiter)
  • Joints
    1. Calcification around joints
      1. Hyperparathyroidism
      2. Tumoral calcinosis
      3. Hypervitaminosis D
    2. Calcifications within the joint space
      1. Synovial osteochondromatosis
    3. Charcot's joints
      1. Shoulder => syringohydromyelia
      2. Knee => syphillis
      3. Foot => diabetes
    4. Chondrocalcinosis
      1. CPPD (and Calcium HADD)
      2. Hyperparathyroidism
      3. Hemochromatosis
      4. Wilson's disease
    5. Erosions
      1. Pencil in cup - PsA
      2. Overhanging edges - Gout
      3. Central (Gull-wing) - Erosive OA
      4. Marginal - RA