Imaging of joint diseases Qais A. Altimimy, DMRD, CABMS-RAD. Lecturer, Radiology Alkindy college of medicine, university of Baghdad 2014

There are three types of arthritis which ca be distinguished radiologically : 1. Degenerative arthritis: Osteophytes Subcondral sclerosis Uneven loss of articular space 2. Inflammatory arthritis: Unmarginated erosions Periarticular osteoporosis Soft tissue swelling Uniform loss of articular space 3. Metabolic arthritis lumpy soft tissue swelling Marginated bony erosions with overhanging edges

The joints commonly involved are DIP, 1st carpal-metacarpal, knee, hip and spine

OA – Radiographic findings 1. Joint space narrowing 2. Osteophyte formation (white arrow) 3. Subchondral sclerosis (black arrows)

Another example of OA Oblique and AP views 1st carpal metacarpal shows decreased joint space and subchondral sclerosis 2nd and 3rd DIP shows osteophytes and subchondral sclerosis (Heberden’s nodes)

Inflammatory arthritis There are three types 1. Auto immune arthritis: RA, Scleroderma, SLE and dermatomyositis 2. Seronegative spondyloarthropathies: AKS, Reiter and psoriasis 3. Erosive OA

Rheumatoid Arthritis (RA) Earliest signs include 1.soft tissue swelling due to effusion, tenosynovitis, and edema 2.Symmetric Periarticular osteopenia 3.Marginal erosions often first seen at 2nd and 3rd MCPs and 3rd PIP articulations Preferred sites of early involvement: Hand: 2nd & 3rd MCP joints Foot: 4th & 5th MTP joints

Late signs include: 1.Large marginal erosions have nearly destroyed the joints 2.Erosion of ulnar styloid 3.Subcondral cyst 4.Subluxation 5.Carpal instability and fusion

Severe erosive changes at radio-ulnar joints carpal bones at the metacarpal heads Bilaterally symmetric

Severe ulnar deviation Severe erosions of MCPs Complete destruction of the wrist Resorption of the carpals and the heads of the metacarpals Radial deviation of the wrist

Rheumatoid wrist: articular destruction, carpal fusion and carpal collapse. Severe destruction of the distal radius and ulna.

Atlanto-axial subluxation in RA Always a concern in patient with longstanding RA and neck pain or cervical neurological symptoms

Boutonniere deformity is one of the musculoskeletal manifestation of rheumatoid arthritis in hand with: flexion contracture of the PIP joints extension of the DIP joints 

Swan neck deformity is a deformity of the digits that consists of: hyperextension of the PIP joints compensatory flexion of the DIP  joints Swan neck deformity is seen in : 1.rheumatoid arthritis (classical association) 2.post-traumatic:Mallet finger 3.scleroderma 4.psoriatic arthritis

Ankylosing Spondylitis Sacriliac joints Are the initial site of involvement(bilateral symmeterical) Erosions early Sclerosis intermediate Ankylosis late Spine Early changes include squaring of the anterior vertebral body Progressive mineralization of Sharpey’s fibres to form osseous bridging syndesmophytes Bamboo spine Dagger sign apperance

Erosions and sclerosis on iliac side

Bamboo spine

Gout Radiological features are: Recurrent attacks of arthritis secondary to deposition of sodium urate crystals in and around joints Hyperuricemia not always present 90% of patients are male Radiological features are: 1.Affect lower>upper extremity, small>large joints 2.First MTP is the most common site 3.Marginal paraarticular erosions; overhanging edges 4.Erosions may have sclerotic borders 5.joint space is preserved

Charcot joint