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Radiologic Diagnosis of

Arthritis
Lecture by
Paulus Rahardjo

osteopenia

The starting point for an


algorithm would be
joint space narrowing.

The next step is to determine


if the joint process is
inammatory or
degenerative.

osteopenia

An inammatory condition is suggested by:

JOINT SPACE NARROWING +


Bone erosions (characteristic nding)
Osteopenia
Soft-tissue swelling
Early erosions will appear as
discontinuities of the thin, white,
subchondral bone plate, commonly
involving the joint margins
Uniform joint space narrowing may also
be present.

A degenerative process is characterized by:


.

JOINT SPACE NARROWING +


osteophytes;
bone sclerosis;
subchondral cysts, or geodes;
asymmetric joint space
narrowing;
and lack of inammatory
features such as bone erosions

osteopenia

Joint space
narrowing
Marginal Erosion
(discontinuity of
bony cortex)

Inamatory arthritis
(Rheumatoid)

Joint space narrowing,


Subchondral sclerosis,
and
Osteophyte formation

Degenerative Arthritis
(Osteoarthritis/
Osteoarthrosis)

Typical Osteoarthritis
Osteoarthritis is typically the result of articular
cartilage damage and wear and tear from
repetitive microtrauma that occurs throughout
life,
Genetic, hereditary, nutritional, metabolic,
preexisting articular disease, and body habitus
factors may contribute in some cases.
This process tends to involve specic joints
during specic decades of a persons life and
depends in
part on the patients body habitus and level of
physical activity.

Typical X-ray ndings and


age
Knee joints,
joint space narrowing is
typically asymmetric
and
most commonly
involves the medial
femorotibial
compartment,
possibly with the
patellofemoral
compartment

Typical X-ray ndings and


age
Hip joint
Joint space
narrowing is
asymmetric,
with superior
migration of the
femoral head more
common than
medial migration

Typical X-ray ndings and


age

PA

FROG-LEG

Typical X-ray ndings and


age
4th decade
of life and
beyond

Typical X-ray ndings and


age
typical osteoarthritis is
1st carpometacarpal
joint,
beginning after the 5th
decade of life,
owing in part to
stresses related to
constant use of
opposing thumbs or
joint
laxity

Typical X-ray ndings and


age
Osteoarthritis also
characteristically
interphalangeal
joints of the hands
after the 4th or 5th
decades of life; this
is related in part to
degree of use and
overuse

Typical X-ray ndings and


age
Osteoarthritis of
the
rst
metatarsophalange
al joint is common
beginning in the 5th
decade of life and
may be associated
with hallux valgus
deformity.

osteopenia

Atypical Osteoarthritis
If radiographic ndings of osteoarthritis are identied but
the involved joint is not one commonly affected by osteoarthritis,
the severity of the ndings are excessive or unusual, or
the age of the patient is unusual,

Then other less common causes for cartilage damage and


osteoarthritis should be considered.
Possible causes for this atypical appearance of
osteoarthritis include:

trauma,
crystal deposition disease,
neuropathic joint,
and hemophilia
congenital and developmental anomalies,
such as dysplasia, that disrupt normal biomechanics.

Atypical Osteoarthritis
Traumatic 2O OA

CPPD crystal
deposition

Atypical Osteoarthritis
CPPD crystal
deposition

CPPD crystal
deposition

Still disease

(or seronegative
chronic arthritis) a type of juvenile chronic arthritis (or juvenile RA)
Common radiographic features of arthritis in Still disease include
soft-tissue swelling and osteopenia;

However, there are several distinct differences when compared


with adult rheumatoid arthritis;

Delayed joint space narrowing and erosive changes,


possible periostitis,
Growth disturbances, and,
later, joint fusion

The presence of periostitis is due to the relatively loosely


adherent periosteum in children compared with that in adults.
Growth disturbances include osseous overgrowth of the
epiphyses due to chronic hyperemia and bone undergrowth due
to premature growth plate fusion.

Still disease

(or seronegative
chronic arthritis) a type of juvenile chronic arthritis (or juvenile RA)

osteopenia

Synovium

Synovium in joint cavity.


Inner surface (except articular cartilage)
covered with synovium

Rheumatoid Arthritis

Marginal erosion

Marginal erosion +
osteopenia

If joint inammation is limited to a single joint


infection must rst be carefully excluded

Bone erosion about the fth metacarpophalangeal joint with osteopenia

Joint space narrowing


RA- symetric

OA- Asymetric

Joint space narrowing


RA- Symetric

Gouty arthritis
Caused by monosodium urate crystals
The radiographic features of gout do
not t into the presented algorithm, in
that joint space narrowing occurs late
In addition, the erosions are
characteristic in that they are
frequently near a joint but not specically
marginal
they have sclerotic margins that produce a
punched-out appearance.

Periarticular osteopenia is also absent.


Another clue to the diagnosis of gout is
the presence of marked soft-tissue
swelling from gouty tophus deposition.
Calcication of such tophi is uncommon
The most common site for gout
involvement is the 1st
metatarsophalangeal joint of the foot.

THANK YOU

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