Arthropathies/Connective Tissue Diseases 1

1. Osteoarthritis (DJD) 2. Rheumatoid Arthritis 3. Ankylosing Spondylitis 4. Psoriatic Arthritis 5. Reiter Syndrome 6. CPPD 7. Gout

1. Sutton's Law Even though over 90 different rheumatic diseases are recognized by the American College of Rheumatology, only three entities are commonly seen in most clinical radiology practicesAmerican College of Rheumatology A.Osteoarthritis B.rheumatoid arthritis C.calcium pyrophosphate dihydrate (CPPD) deposition disease 2. Radiographic Hallmarks 3. Pattern Approach

Arthropathies with Fema le Predominance Disorderfemale:male ratio Rheumatoid Arthritis2:1 to 3:1 Primary osteoarthritis (> 45 years) CPPD1:1 4. Demographics (Age and gender) 5. The Law of Parsimony

Arthropathies with Male Predominance Disordermale:female ratio Ankylosing spondylitis4:1 to 10:1 Psoriatic 2:1 to 3:1, but controversial Reiter's5:1 to 50:1 Gout20:1 DISH3:2 CPPD1:1 Primary osteoarthritis (< 45 years) Enteropathic arthropathy Ulcerative colitis4:1 Crohn's disease1:1

AGE Age GroupAge of OnsetDisorder Young (< 20 years)< 20 years Juvenile chronic arthritis Septic arthritis Middle (> 20 years) onset years Ankylosing spondylitis Reiter's Young adults Enteropathic arthropathies years Rheumatoid arthritis Psoriatic arthritis Older patients (> 55 years) > 55 years Osteoarthritis DISH CPPD

Neurologic and Musculoskeletal Imaging Studies Chapter 7 part 2

Osteoarthritis (DJD). DIP&PIP hallmarks of DJD 1.joint space narrowing, 2.subchondral sclerosis, 3.and osteophytosis,

Primary Osteoarthritis. joint space narrowing, and sclerosis at the DIP&PIP&1thCMC

Hallmarks of Rheumatoid Arthritis 1. Soft tissue swelling 2.Osteoporosis 3.Joint space narrowing 4.Marginal erosions 5.Proximal distribution (hands) 6.Bilateral symmetry

Early RA will demonstrate erosions in the distal radioulnar joint, ulnar styloid, radial styloid, and triquetro-pisiform joint

Rheumatoid Arthritis. erosive arthritis,osteoporosis and soft tissue swelling

Rheumatoid Arthritis, the boutonniere deformity

Rheumatoid Arthritis, the swan neck deformity

Rheumatoid Arthritis of the Hip. severe joint space narrowing

Rheumatoid Arthritis in the Shoulder. the distance between the acromion and the humeral head is diminished (arrowheads). Ordinarily, this space is about 1 cm in width. This is a common finding in rheumatoid arthritis as well as in calcium pyrophosphate dihydrate deposition disease

Glenohumeral joint space narrowing with marginal erosions within the humeral head. Ligamentous/tendinous injury results in rotator cuff degeneration with a "high-riding" humeral head.

Causes of High-Riding Shoulder Rheumatoid arthritis Calcium pyrophosphate dihydrate deposition disease (CPPD) Torn rotator cuff

Diffuse involvement of joint with extensive erosion in olecranon articulation and joint space narrowing with trochlea of humerus seeming to "dig into" olecranon. Joint effusion and olecranon bursitis may also occur.

Normal C1 and C2. A lateral radiograph (A) and drawing (B) of the upper cervical spine showing the normal distance of less than 2.5 mm from the anterior arch of C1 to the odontoid process (dens) of C2 (arrows).

Instability of the transverse ligament of C1. In this patient with rheumatoid arthritis, (A) shows very little space (which is normal) between the posterior aspect of the arch of C1 and the anterior portion of the odontoid (arrows). With flexion (B), this space markedly widens, and the odontoid is free to compress the spinal cord, which is posterior to it.

particularly look for C1-C2 involvement which can have catastrophic consequences

Secondary Degenerative Joint Disease (DJD) in the Knee in a Patient With Rheumatoid Arthritis. osteoporosis and joint space narrowing. Secondary DJD is occurring, as evidenced by the sclerosis and osteophytosis; however, these findings are out of proportion to the severe joint space narrowing