Erosive arthritis Hands
- PMP women
- DIPS/ PIPS/ 1st CMC
- Joint space narrowing
- Subchondral bone changes - sclerosis and sometimes subchondral cysts.
- Gull wing - CENTRAL EROSIONS (subchondral) erosions + BONY SPURS
https://radiopaedia.org/articles/erosive-arthritis-differential?lang=gb
RA Hands
MCPS, PIPS, Wrist (carpal bones)
- Soft-tissue swelling
-Peri-articular osteopenia
- Joint space narrowing
- Marginal (peri-articular) bone erosions
- Subluxation
https://radiopaedia.org/articles/erosive-arthritis-differential?lang=gb
Psoriatic arthritis
Hands> feet> SIJ
DIPS, PIPS, thumb IP
- PENCIL IN CUP- MARGINAL erosions
- BONE PROLIFERATION > irregular, “fuzzy” appearance to the bone around thej oint
- joint subluxation / interphalangeal ankylosis
- periostitis- irregular thickening of the cortex
- dactylitis: “sausage digit”
- ACRO OSTEOLYSIS (tuft)
- arthritis mutilans: “telescoping fingers”
- IVORY PHLANX: distal phalanx of the great toe
https://radiopaedia.org/articles/erosive-arthritis-differential?lang=gb
Reactive arthritis
- Lower limb (knee, MTP, calcaneus) > upper
- Peripheral joints- Asymmetric involvement, Soft-tissue swelling, Erosions with new bone formation, Enthesopathy (e.g., calcaneal spurs)
Achilles tendon and plantar fascia- Erosions at insertion, Periosteal reaction, Calcifications
Unilateral or asymmetric sacroiliitis
**looks similar to psoriatic arthritis
https://radiopaedia.org/articles/erosive-arthritis-differential?lang=gb
SLE Hands
- Reducible subluxations
- NO erosions
Scleroderma hands
LOOKS SIMILAR TO RA, NO EROSIONS
- acro-osteolysis
- periarticular osteopenia
- joint space narrowing
- rheumatoid arthritis-like joint erosions
- severe resorption of 1st CMC with radial —subluxation is common
- pencil-in-cup deformity
- Soft tissue/ periarticular calcification
- soft tissue contraction
Arthritis multians
- PSA + RA
Polymyositis
Soft tissue/ muscle calc
Gout
FIRST MTP
●● soft tissue masses, preservation of joint space and bone density.
●● Effusion
●●‘punched out’ erosions - intra-articular/peri-articular, sclerotic and overhanging edges, often at the bases of MCs
●● Chondrocalcinosis (5%).
**Dual energy CT
MRI- tophi iso T1, hypo T2, enahnce with gad
Causes: undersecretion of uric acid - CKD, HTN, hyperparathyroidism, alcohol use, drugs (e.g. furosemide, thiazide diuretics, ethambutol, pyrazinamide, aspirin)
CPPD
Acute- mimics septic joint
> redness, swelling
CHONDROCALCINOSIS
Wrist> TFCC involvement> SLAC wrist
Knee> Patellofemoral compartment
Hands- hook like osteophytes 2nd and 3rd MCs
Haemochromastosis
Hook life osteophytes MC heads (all)
Acromegaly
- beak-like osteophytes of metacarpal heads
-spade-like enlargement of the terminal tufts - initially joint space widening then narrowing
SPINE X-RAY
●● Posterior vertebral scalloping
●● Increased anterior–posterior (AP) and transverse diameters VB
●● Narrowed interpedicular distance
●● Spur formation
●● Calcified discs
Increased heel pad thickness
MRI
- enhancing enlarged pituitary
Alkaptonuria
SPINE X-RAY
●● Marked calcification and loss of height of multiple intervertebral discs predominantly in the lumbar spine
●● No syndesmophytes
●● Intervertebral disc calcification
KNEE X-RAY
●● Premature osteoarthritis
●● Chondrocalcinoisis
Amyloid arthopathy
LARGE JOINTS
- juxta-articular soft tissue swelling
- mild periarticular osteoporosis
- juxta-articular and subchondral cystic lesions (geodes), usually with well-defined sclerotic margins
- joint space is usually normal in width until late in the course of the disease
CPPD Knee
chondrocalcinosis involving both menisci and hyaline cartilage
predominant patellofemoral joint osteoarthritis
calcifications of the gastrocnemius tendon
SLAC wrist
Causes: CPPD / unrecognised scapholunate dissociation
scapholunate diastasis (PA radiograph)
rotatory subluxation of the scaphoid (lateral radiograph)
features associated with dorsal intercalated segment instability (DISI) (lateral radiograph)
HPOA
Periosteal reaction in long bones
lung cancer- NSCL
pulmonary lymphoma
lung abscess
bronchiectasis
pulmonary metastases (osteosarcoma)
pleural fibroma
mesothelioma
cyanotic congenital heart disease
IBD
gastrointestinal lymphoma
Whipple disease
coeliac disease
primary biliary cholangitis
idiopathic
BONE SCAN
symmetric linear increase in tracer accumulation along diaphyseal and metaphyseal surfaces , tram-track sign
DDX- pachydermoperiostosis (primary hypertrophic osteoarthropathy), chronic venous insufficiency, thyroid acropachy
DISH features
dense ossification of ALL +/- osteophytes (versus fine calcification of the annulus fibrosis in AS)
> four contiguous vertebral bodies
IV disc spaces maintained
ossification of the superior portion of SIJs pelvic ligaments and PLL (versus posterior longitudinal ligament ossification with bulky anterior osteophyte formation in OPLL)
Juvenile idiopathic osteoarthritis
SYSTEMIC SYMPTOMS= STILLS DISEASE
Joints- like RA
knees: widened intercondylar notch is associated (but can also be seen in haemophilic arthropathy and tuberculous arthropathy)
atlantoaxial subluxation
odontoid erosions
ankylosis, especially of the facet joints
chest:
pericardial effusion
pleural effusion
Ank spond spine
early spondylitis - small erosions at corners of vertebral bodies + reactive sclerosis (Romanus lesions> shiny corner )
VB squaring
Andersson lesion- central VB endplate irregularities
diffuse syndesmophytes -“bamboo spine”
> paravertebral ossification running parallel to the spine
ossification of the supraspinous and interspinous ligaments - “dagger spine”
ossification of spinal ligaments, joints and discs
apophyseal and costovertebral arthritis and ankylosis
enthesophyte formation from enthesopathy
pseudoarthroses may form at fracture sites
dural ectasia
Ank spond pelvis + hips
Hip - bilateral and symmetric joint space narrowing, axial migration of the femoral head> protrusio acetabuli, and a collar of osteophytes at the femoral head-neck junction.
Pelvis
Whiskering of the pelvic bones> ischial tuberosities
ossification of the ligamentous origins.
Bilateral symmetrical Sacroilitis
- Ankylosing spondylitis*
- Inflammatory bowel disease
- Psoriatic arthropathy* - can be assymmetrical
- Osteitis condensans ilii – young, multiparous women. A triangular segment of bone sclerosis on the inferior aspect of the iliac side of the joint
- Hyperparathyroidism* – subchondral bone resorption + joint-space widening only.
DISH
Flowing calcifications > 4VBs
Normal IV discs
Calcification of PLL (50%)
NO SACROILITIS
Pelvis enthesophytes (iliac crest, ischial tuberosities, and greater trochanters)
LCH
Skull
solitary / multiple punched-out lytic lesions
beveled edge appearance
button sequestrum representing residual bone
geographic skull
Mandible
irregular radiolucent area
floating tooth: loss of lamina dura
Spine
vertebra plana- thoracic spine
Long bones
permeative and aggressive appearing lesion
DIAPHYSIS or metadiaphysis
endosteal scalloping, periosteal reaction (in the healing phase it can appear as solid benign periosteal reaction), cortical thinning, intracortical tunnelling, and associated soft tissue mass
