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• Also:
- Sublaxation
- Malalignment
- Fibrous ankylosis
- Intraarticular bodies
• Pathogenesis:
Physical forces on joint
a. abnormal force
b. weak cartilage or subchondral
bone
↓
CLASSIFICATION OF ARTHRITIS Articular cartilage disruption
I. Degenerative Disease ↓
II. Rheumatoid Arthritis and related diseases Greater stress on subchondral bone
III. Crystal-induced and related diseases ↓
IV. Infectious Osseous degenerative changes
V. Neurogenic and Traumatic ↓
VI. Primary synovial disease Vicious cycle
VII. Miscellaneous
Overload
WHAT TO LOOK FOR: ↓
• Morphology of articular lesions Microfractures in subchondral bone
• Distribution in the body ↓
Repair resulting in “stiffness” of bone
ABCDs (reduced shock absorption)
↓
• Alignment Increased force to overlying cartilage
• Bone mineralization ↓
Vicious cycle
• Cartilage, also search for Erosions
• Distribution
• Soft tissues
Joint space
loss
Bone
sclerosis
OSTEOARTHRITIS - Usual sites:
Hand Distal interphalangeal
(DIP)
Proximal interphalangeal
(PIP)
Metacarpals (MCP)
Wrist 1st CMC,
trapezioscaphoid area
Should Acromioclavicular Osteophytosis
er Sternoclavicular
Hip Superolateral joint space
narrowing
Knee Medial > patellofemoral >
lateral
Foot TMT
1st MTP
Subchondral Cysts
INTERVERTEBRAL (OSTEO)CHONDROSIS
Joint space narrowing
• Dehydration
PRIMARY OSTEOARTHRITIS
• Unknown cause
• Familial
- Middle-aged female
- Hands: DIP, PIP, base of thumb
- Bilaterally symmetric
• Erosive osteoarthritis
- Very painful and debilitating
SECONDARY OSTEOARTHRITIS
• Trauma or microtrauma over the years
DEGENERATIVE DISEASE OF THE SPINE Schmorl’s nodes = elevated pressure on disc causes
• Osteoarthritis prolapse
• Intervertebral (osteo)chondrosis
- Dehydration of intervertebral disc
• Spondylosis deformans
- Osteophyte formation after degeneration of
outer fibers of anulus fibrosus
• Ligamentous degeneration
- Calcification and ossification
FORESTIER’S DISEASE
• Cervical spine
Marginal erosions
• Erosions
• Joint space Pathophysiology
narrowing Acute synovitis
ARTHRITIS OF COLLAGEN AND COLLAGEN-LIKE DISEASES ↓
• Seropositive Exudation of plasma
- Rheumatoid arthritis ↓
• Seronegative (rheumatoid factor negative) Altered capillary permeability
- Ankylosing spondylitis ↓
- Inflammatory bowel disease Accumulation of RBC
- Reiter’s syndrome ↓
- Psoriasis Hemosiderin deposition
- Scleroderma
- SLE • Thickening of synovial
membrane
RHEUMATOID ARTHRITIS • Elevated synovial fluid cell
• Uniform narrowing
• Bilaterally symmetric
• Periarticular swelling
• Marginal erosions
• Juxtaarticular osteoporosis
• No new bone formation
• Subluxations
• Synovial cysts
Atlantoaxial subluxation
RHEUMATOID ARTHRITIS
• Marked erosive changes
RHEUMATOID ARTHRITIS
• Ulnar deviation at the wrist
• Proximal joints of hands and
• “Penciling of ulna”
feet
• Fingers • Atlantoaxial subluxation
- Swan-neck deformity
• Swan-neck deformity
- Boutonniere deformity
• Boutonniere deformity
• Cervical spine • Ulnar deviation
- Atlantoaxial subluxation (25%) • Fibular deviation
• Predilection of the proximal joints of the hands ADULT RA & JUVENILE RA
and feet (carpal, MCP/tarsal, MTP) Adult RA Juvenile RA
Age Older Younger
Penciling of ulna
No.of joints Polyarticular Monoarticular or
- Erosion of ulnar styloid process
involved pauciarticular
- “Ulnar deviation”
Spontaneous No Up to 50%
resolution
Involvement Hands, feet, Central large jts –
larger jts hips, knees
Periostitis More rare Uncommon
Effect of N/A Growth
immature disturbance
skeleton
SERONEGATIVE
- Negative for Rheumatoid factor
- Most patients have (+)HLA B-27
- Bamboo spine
- Pencil-in-cup deformity
- “Can’t see, can’t pee, can’t climb a tree”
- “Whiskering” = Enthesopathy
- Arthritis mutilans
• Ankylosing spondylitis
• Inflammatory Bowel Disease
• Reiter’s syndrome
• Psoriasis
• Scleroderma PSORIASIS
• SLE • Unilateral sacroiliac sclerosis
• Pencil-in-cup
ANKYLOSING SPONDYLITIS: Sacroiliac joint “pencil” – blunted distorted osseous surface
• Bilateral sclerosis ↓
Protruding into
↓
“cup” – expanded osseous surface
• Bilateral fusion
• Syndesmophytes
• Syndesmophytes
- Thicker
- Non-marginal
- Skip segments
REITER’S SYNDROME
• Erosive calcaneal enthesopathy
SCLERODERMA
• Acro-osteolysis GOUTY ARTHRITIS
- Resorption of distal phalangeal tufts
TYPICAL DISTRIBUTION OF ARTHRITIS IN THE HIPS
CPPD
INFECTIOUS ARTHRITIS
• Acute
- Pyogenic
- Septic
• Chronic
- Pyogenic
- Tuberculous
TYPICAL DISTRIBUTION OF ARTHRITIS IN THE HANDS - Other
SEPTIC ARTHRITIS
• Monoarthritis
• Do aspiration
• Rapid course
• Poorly defined bone destruction
NEUROPATHIC OR TRAUMATIC
• Primary neurologic disease
• Diabetes
- Most common
CMC (first carpometacarpal)
CCMC (common carpometacarpal) DIABETES ARTHRITIS
ST (scaphotrapezial)
• Repeated trauma, extensive deformity
MC (midcarpal)
RC (radiocarpal) • “Charcot joint”
DRUJ (distal radioulnar joint) • Lisfranc deformity (1st-2nd metatarsal base)
HEMOPHILIC ARTHRITIS