T6 – Wk1, Day 337 – Ch10 Arthritic Disorders Outline

From Yochum and Rowe's Essentials of Skeletal Radiology, 3^rd ed, Volume Two

Ch 10 – Arthritic Disorders
(broad outline)

• INTRODUCTION TO RADIOLOGIC INTERPRETATION IN JOINT DISEASE
  
  • Perspectives in Interpretation of Joint Disease
    
  • Anatomic Considerations
    
  • Radiologic Considerations
    
  • Differential Diagnosis of Arthritis
    
• DEGENERATIVE DISORDERS – pg 958
  
  • Degenerative Joint Disease
    
  • Erosive Osteoarthritis
    
  • Diffuse Idiopathic Skeletal Hyperostosis
    
  • Ossified Posterior Longitudinal Ligament Syndrome
    
  • Neurotrophic Arthropathy
    
  • Synoviochondrometaplasia
    
• INFLAMMATORY DISORDERS – pg 1010
  
  • Rheumatoid Arthritis
    
  • Juvenile Rheumatoid Arthritis
    
  • Ankylosing Spondylitis
    
  • Enteropathic Arthritis
    
  • Psoriatic Arthritis
    
  • Reiter's Syndrome
    
  • Systemic Lupus Erythematosus
    
  • Jaccoud's Arthritis
    
  • Idiopathic Chondrolysis of the Hip
    
  • Scleroderma
    
  • Osteitis Condensans Ilii
    
  • Osteitis Pubis
    
  • Hypertrophic Osteoarthropathy
    
• METABOLIC DISORDERS – pg 1084
  
  • Gout
    
  • Calcium Phyrophosphate Dihydrate Crystal Deposition Disease
    
  • Hydroxyapatite Deposition Disease
    
  • Ochronosis
    
  • Tumoral Calcinosis
    
  • Sarcoidosis
    
  • Pigmented Villonodular Synovitis
    

 

Ch 10 – Arthritic Disorders
(specific outline)

INTRODUCTION TO RADIOLOGIC INTERPRETATION IN JOINT DISEASE

• Perspectives in Interpretation of Joint Disease – over 100 rheumatic conditions have been identified and classified. By understanding joint anatomy, pertinent clinical features, pathophysiology and important roentgen signs, a single dx or sort list of diff dx can usually be made.
  
  • Incidence of Individual Arthrities
    
    • weekly –
      
      • DJD (osteoarthritis)
        
    • Montly –
      
      • ankylosing spondylitis,
        
      • CPPD,
        
      • DISH,
        
      • Osteitis condesans ilii,
        
      • Psoriatic arthritis,
        
      • rheumatoid arthritis
        
      • synoviochondrometaplasia
        
    • Yearly
      
      • Gout
        
      • Infection
        
      • SLE
        
      • Reiter's syndrome
        
      • Scleroderma
        
  • Cinical Information – Table 10-2, General Age of Onset of Arthritis
    
    • 0-20 Years
      
      • Juvenile rheumatoid arthritis
        
    • 20-40 Years
      
      • Anklylosing spondylitis
        
      • Osteitis condensans ilii
        
      • SLE
        
      • Psoriatic arthritis
        
      • Reiter's syndrome
        
      • Scleroderma
        
      • Synoviochondrometaplasia
        
    • >= 40 Years
      
      • DJD
        
      • DISH
        
      • Gout
        
      • Hypertrophic osteoarthropathy
        
      • Pseudo-gout (CPPD)
        
  • Cinical Information – Table 10-3, Arthropathies Associated with Distinct Sex Predilection
    
    • Male
      
      • Ankylosing spondylitis
        
      • gout
        
      • hypertrophic osteoarthropathy
        
      • reiter's syndrome
        
      • secondary osteoarthritis
        
    • Female
      
      • Juvenile rheumatoid arthritis
        
      • SLE
        
      • Osteitis condensans ilii
        
      • Primary osteoarthritis
        
      • rheumatoid arthritis
        
      • scleroderma
        
• Anatomic Considerations – pg 952. Essentially, three broad categories of articulations exist in the body and are classified according to the tissue type at the junctional region: fibrous, cartilaginous and synovial.
  
  • Fibrous Joints – example; cranial sutures; syndesmoses (tibia-fibula, radius-ulna)
    
  • Cartilaginous – ex. symphysis pubis; intervetebral discs, manubriosternal junction. regarding IVD's, the inner fibers are made up of fibrocartilage and the outer fibers of collagen. attachment to the annulus is by way of penetrating fibers and Sharpey's fibers.
    
  • Synovial – ex, fingers, toes, knees, hips; apophyseal joints, sacroiliac joints
    
    • Joint Capsule – essentially serves the function of a ligament and not normally visible radiographically.
      
    • Synovial Membrane –
      
    • Synovial Fluid – a direct dialysate of blood plasma to which is added a mucoid substance secreted by the synovium. – provides lubrication and nutrition for the joint
      
    • Articular Cartilage – hyaline is the most common. it is composed of chondrocytes embedded in a matrix of collagen fibrils and a ground substance made up of mucopylysacchardes, particularly chondroitin sulfate
      
    • Subchondral Bone Plate – bony tissue beneath the articular cartilage is composed of a thin cortex and underlying cancellous trabeculae.
      
• Radiologic Considerations – pg 954    
  
  • Technologic Aspects – xray examination of a joint requires a minimum of two views perpendicular to each other with at least one view clearly demonstrating the opposing articular sufaces.
    
  • Anatomic-Radiologic Correlation – use the ABC's approach
    
    • A, Alignment
      
    • B, Bones
      
    • C, Cartilage
      
    • S, Soft tissue
      
  • Basic Terminology in Joint Disease – pg 955
    
    • enthesis – anatomic term for the transition zone btw bone and ligament or tendon
      
    • enthesopathy – inflammatory cellular infiltrate at the bone-ligament or bone-tendon junction. Seen in inflammatory arthritides, especially ankylosing spondylitis as cortical erosion and periostitis.
      
    • erosion – loss of bone owing to pressure atrophy or active breakdown of bone tissue.
      
    • hyperostosis – Exuberant ossification of a ligament or tendone, characteristically seen in diffuse idiopathic skeletal hyperostosis.
      
    • monoarticular – a single joint is involved in the dz process.
      
    • non-uniform loss of joint space – localized decrease in the joint cavity owing to isolated loss of cartilage usually at the most stressed site. This is a sign of degenerative arthritis.
      
    • osteophyte – degenerative bony outgrowth continuous with underlying cortex, covered with a cartilaginous cap, occurring at the insertion of a ligatent near a joint.
      
    • pauciarticular – two to four joints are involved in the dz process.
      
    • periostitis – elevation of the periosteum results in localized periosteal new bone and is seen in inflammatory arthritides.
      
    • polyarticular – more than four joints are involved in the dz process.
      
    • threumatoid variants – inflammatory arthropathies that may simulate theumatoid arthritis clinically but lack theumatoid factor and show different pathologic and radiographic features.
      
    • seronegative arthritis – inflammatory arthritis that lacks the presence of rheumatoid factor, including ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome and enteropathic arthritis.
      
    • spondyloarthropathy – inflammatory arthritis involving the spine.
      
    • spondylophyte – degenerative spinal osteophyte.
      
    • symmetric pattern of joint involvement – when comparing one side of the body with the other or one joint to another, the changes appear similar.
      
    • syndesmophyte – inflammatory ossification within a spinal ligament, especially ankylosing spondylitis (marginal type) and, less commonly, psoriasis or Reiter's syndrome (non-marginal type).
      
    • uniform loss of joint space – the entire joint cavity is decreased owing to complete loss of the cartilage independent of stressed areas: This is a sign of inflammatory arthritis.
      
• Differential Diagnosis of Arthritis, pg 955 – A successful diff dx among arthritic disorders is based on the correlation of clinical, pathologic and radiographic findings.
  
  • Inflammatory - …these include rheumatoid arthritis, psoriasis, ankylosing spondylitis and Reiter's syndrome.
    
  • Degenerative – in contrast to inflammatory dz, here we exhibit a non-uniform loss of joint space, Osteophytes, subchondral sclerosis, subchondral cysts and a predilection for being distrinctly asymmetric.
    
  • Metabolic – joint spaces are generally preserved …
    

My head is going to explode! I need to switch now to a different topic ….

DEGENERATIVE DISORDERS – pg 958

• Degenerative Joint Disease
  
• Erosive Osteoarthritis
  
• Diffuse Idiopathic Skeletal Hyperostosis
  
• Ossified Posterior Longitudinal Ligament Syndrome
  
• Neurotrophic Arthropathy
  
• Synoviochondrometaplasia
  

INFLAMMATORY DISORDERS – pg 1010

• Rheumatoid Arthritis
  
• Juvenile Rheumatoid Arthritis
  
• Ankylosing Spondylitis
  
• Enteropathic Arthritis
  
• Psoriatic Arthritis
  
• Reiter's Syndrome
  
• Systemic Lupus Erythematosus
  
• Jaccoud's Arthritis
  
• Idiopathic Chondrolysis of the Hip
  
• Scleroderma
  
• Osteitis Condensans Ilii
  
• Osteitis Pubis
  
• Hypertrophic Osteoarthropathy
  

METABOLIC DISORDERS – pg 1084

• Gout
  
• Calcium Phyrophosphate Dihydrate Crystal Deposition Disease
  
• Hydroxyapatite Deposition Disease
  
• Ochronosis
  
• Tumoral Calcinosis
  
• Sarcoidosis
  
• Pigmented Villonodular Synovitis