radiographic evaluation of arthritis: inflammatory conditions jon a. jacobson, gandikota girish,...
TRANSCRIPT
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ARTHRITIS
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AN ALGORITHM
Radiographic evaluation of arthritis: inflammatory conditionsJon A. Jacobson, Gandikota Girish, Yebin Jiang, and Donald ResnickRadiology 2008 248:2, 378-389
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SOMETHING DIFFERENT Hypertrophic/proliferative
Degenerative: primary or secondarySecondary AKA atypical OA
Hemophilia Gout trauma
ErosiveRheumatoid + variants
InfectiousTBPyogenic/bacterial
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EROSIVE Synovial proliferation Pannus Inflammatory erosions Uniform joint space narrowing Soft-tissue swelling RA + seronegative variants
ReitersAnkylosing spondylitisEnteric arthropathyPsoriatic arthropathy
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RA Multiple joints: systemic Periarticular osteopenia Juxtaarticular bony erosions (non-
cartilage non-protected bone) Subluxation and gross deformity Periarticular soft tissue swelling
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RA
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RA C-SPINE
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CERVICAL SPINE IMAGING IN RA
Younes, Mohamed, et al. "Compared imaging of the rheumatoid cervical spine: prevalence study and associated factors." Joint Bone Spine 76.4 (2009): 361-368.
The prevalence of rheumatoid cervical spine involvement was 47.5% by standard radiography, 28.2% by CT, and 70% by MRI.
Rheum involvement with high Sharp score and elevated CRP
17.5% of those with Cspine abn were w/o sx. Overall rheumatoid involvement of the cervical spine
was not significantly associated with any of the epidemiological, clinical, laboratory, imaging, or therapeutic factors evaluated in the study.
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THE RECOMMENDATIONS
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PSORIATIC
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PSORIATIC SPINE
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AK- CLASSIC
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AK
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SYNDESMOPHYTES
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DISH Criteria:SI and facet joints normal
4 contiguous vertebrae
No disc space narrowing
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REACTIVE ARTHROPATHY
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ENTERIC ARTHROPATHY
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TB
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SI
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HYPERPROLIFERATIVE Subchondral sclerosis, osteophytes No erosions Asymmetric joint space Nearly all arthritides can lead to DJD*Weight-bearing radiograph for early
detection Mobius battle
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Microtrauma – not just body habitus but body habits AKA repeated use
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OA- OSTEOPHYTES
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DJD
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OA-SPINE
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CPPD
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CPPD
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HEMOCHROMATOSIS
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NEUROPATHIC
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NEUROPATHIC SPINE
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GOUT
Monu, Johnny UV, and Thomas L. Pope Jr. "Gout: a clinical and radiologic review." Radiologic Clinics of North America 42.1 (2004): 169-184.
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GOUT