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  2. 2. Osteoartrite- É a DAD mais comum – primária e secundária- Primária: mulheres, IFD e IFP e base do polegar e bilateral- Achados :- Estreitamento do espaço articular- Esclerose- Osteófitos- Hiperostose esquelética idiopática: mecanismo não parece ser ostress e não é tão incapacitante- OA erosiva: osteoporose e erosões; dolorosa e debilitante(kellgren)- ATM, AC, SI e sínfise púbica
  3. 3. Osteoarthritis (DJD). Plain film of a finger with osteoarthritis (DJD) of thedistal and proximal interphalangeal joints. Both joints demonstrate joint Diffuse Idiopathic Skeletal Hyperostosis (DISH). A lateral view of the lumbar spine showsspace narrowing, subchondral sclerosis, and osteophytosis, which are extensive osteophytosis without significant disk space narrowing or sclerosis. This is ahallmarks of DJD. classic picture for diffuse idiopathic skeletal hyperostosis.
  4. 4. Primary Osteoarthritis. Bilateral hand films in a patient with primary osteoarthritis. Present areclassic findings of osteophytosis, joint space narrowing, and sclerosis at the distalinterphalangeal joints, the proximal interphalangeal joints, and at the base of the thumb. This isbilaterally symmetric, which is typical for primary osteoarthritis.
  5. 5. Osteoarthritis of the Sacroiliac (SI) Joint. A young woman who is a professional dancer complained of left-sided hip pain. An anteroposterior film of the pelvisdemonstrated left SI joint sclerosis, joint irregularity, and erosions. A complete workup to rule out a human leukocyte antigen (HLA) –B27 spondyloarthropathy wasnegative, and no laboratory or clinical evidence for infection was found. Her clinical history pointed to this being completely occupation-related, and an aspiration biopsy torule out infection was therefore not performed. This is not an unusual appearance for degenerative joint disease of the SI joint
  6. 6. Subchondral Cyst or Geode of the Shoulder. This patient has marked degenerative joint disease (DJD) of the shoulder, with joint space narrowing,sclerosis, and osteophytosis. A large lytic process (arrows) is seen in the humeral head, which is a subchondral cyst or geode often seen in associationwith DJD. Because of the DJD in the shoulder, a biopsy to rule out a more sinister lesion in the humeral head should be avoided.
  7. 7. Artrite Reumatóide- Doença do tec. Conjuntivo- Pode acometer qualquer articulação- Achados:- Edema de partes moles- Osteoporose- Estreitamento do espaço articular- Erosões marginais- Processo proximal de simetria bilateral- Erosões marginais nas grandes articulações- Migração axial do femur- Elevação do ombro- AR + DAD
  8. 8. Rheumatoid Arthritis. An erosive arthritis affecting primarily the carpal bones and themetacarpophalangeal joints is seen that has associated osteoporosis and soft tissue swelling(note the soft tissue over the ulnar styloid processes). It is a bilaterally symmetric process in thispatient, which is classic.
  9. 9. Rheumatoid Arthritis of the Hip. Note the severe joint space narrowing in this patientMigration of the Femoral Head. A drawing of the hip showing routes of migration of the femoral with rheumatoid arthritis. The femoral head has migrated in an axial direction, with fairlyhead. Osteoarthritis of the hip tends to cause superior (S) migration of the femoral head in concentric joint space narrowing. Minimal secondary degenerative changes haverelation to the acetabulum, whereas rheumatoid arthritis tends to cause axial (A) migration of the occurred, as noted by the sclerosis in the superior portion of the joint; however, thesefemoral head in relation to the acetabulum. have been diminished somewhat by the osteoporosis that usually accompanies rheumatoid arthritis.
  10. 10. Rheumatoid Arthritis in the Shoulder. An anteroposterior view of the shoulder inthis patient with rheumatoid arthritis shows that the distance between theacromion and the humeral head is diminished (arrowheads). Ordinarily, thisspace is about 1 cm in width to allow the rotator cuff to pass freely beneath theacromion. This is a common finding in rheumatoid arthritis as well as in calciumpyrophosphate dihydrate deposition disease. Secondary Degenerative Joint Disease (DJD) in the Knee in a Patient With Rheumatoid Arthritis .
  11. 11. Espondiloartropatias HLA-B27- Espondilite anquilosante- Doença inflamatória intestinal- Artrite psoriática- S. de Reiter- Anquilose ossea- Formação proliferativa de novo osso- Predominantemente axial- Sindesmófitos – marginais e simétrico ; ñ marginais e assimétricos- Comprometimento da SI é comum- A. psoriática e Reiter: predomínio distal, erosões e edema
  12. 12. Marginal, Symmetric Syndesmophytes in Ankylosing Spondylitis. Bilateral marginal syndesmophytes are seen bridging the disk spaces throughout the lumbar spine in this patient. This is a so-called bamboo spine and is classic for ankylosing spondylitis and inflammatory bowel disease.Psoriasis With Syndesmophytes
  13. 13. Syndesmophytes in Psoriatic Arthritis. Large, bulky, nonmarginal, Ankylosing Spondylitis. Bilateral symmetric sacroiliac joint sclerosis and erosions are seen in thisasymmetric syndesmophytes (arrows) are seen in this patient with patient with ankylosing spondylitis. Inflammatory bowel disease could have a similar appearance.psoriatic arthritis Although this is classic for these two disorders, it would not be that unusual for psoriatic disease or Reiter syndrome to have this same appearance. Although less likely, it would be possible for infection and even degenerative joint disease to be bilateral in this fashion
  14. 14. Fusion of the Sacroiliac (SI) Joints in Ankylosing Spondylitis. Bilateral complete fusion of the SIjoints in this patient with ankylosing spondylitis makes the SI joints totally indistinguishable.Inflammatory bowel disease could have a similar appearance.
  15. 15. Causes of Sacroiliac Joint Disease- Ankylosing spondylitis- Inflammatory bowel disease- Psoriatic arthritis- Reiter syndrome- Infection- Degenerative joint disease- Gout
  16. 16. Psoriatic Arthritis With Sacroiliac (SI) Joint Disease. Unilateral SI sclerosis and erosions are CT of the Sacroiliac (SI) Joints in Psoriasis. A CT scan through the SI joints in thisseen in this patient with psoriatic arthritis. Ankylosing spondylitis and inflammatory bowel disease patient with psoriatic arthritis shows unilateral SI joint sclerosis and erosionsvirtually never have this appearance. (arrows), typical for psoriatic arthritis or Reiter disease.
  17. 17. Ankylosing Spondylitis With Hip Disease. Anteroposterior view of the pelvis in this patient withankylosing spondylitis shows bilateral complete fusion of the sacroiliac joints. Concentric left hipjoint narrowing is present with axial migration of the femoral head. This would be a typical findingin rheumatoid arthritis or, as in this example, in ankylosing spondylitis. Note the secondarydegenerative joint disease changes in the left hip as well.
  18. 18. Psoriatic Arthritis. A. Cartilage loss at the proximal interphalangeal joints of the third, fourth, and fifth digits in this hand is apparent, with erosions noted most prominently in thefourth digit (arrow). These erosions are not sharply demarcated but are covered with fluffy new bone. These are termed proliferative erosions. Note also the periostitis along theshafts of each of the proximal phalanges. B. Advanced psoriatic arthritis. Fusion or ankylosis is apparent across the proximal interphalangeal joints of the second through the fifthdigits. Several of the distal interphalangeal joints are also ankylosed. Severe joint space narrowing at the metacarpophalangeal joints is noted. This distal distribution is typical forpsoriatic arthritis in advanced stages.
  19. 19. Reiter Syndrome. Lateral view of a calcaneus in a patient with Reiter syndrome shows poorly Reiter Syndrome. Anteroposterior view of the large toe in a patient with Reiter diseasedefined new bone on the posteroinferior margin of the calcaneus with a calcaneal spur which is shows fluffy periostitis (arrow) in the erosions adjacent to the interphalangeal joint ofalso poorly defined. This is typical of psoriatic or Reiter disease, as opposed to the well-formed the great toe. Marked soft tissue swelling is also present throughout the great toe.calcaneal spur in degenerative joint disease. These changes are typical in appearance and location for Reiter disease or psoriatic arthritis.
  20. 20. Artrite Induzida por Cristais Gota-Cristais de urato de monossódio na cartilagem articular- 4 – 6 anos para causar alterações radiológicas- Achados:- Erosões bem definidas- Nódulos de tec. mole- Distribuição aleatória nas mãos sem osteoporose pronunciada- MTF do halux- Acentuada deformidade e condrocalcinose
  21. 21. Pseudogota-Tríade- Dor intermitente- Condrocalcinose- Destruição articular- Condrocalcinose: medial e lateral do joelho, fibrocartilagemtriangular do punho e sínfise púbica.- DAD de DDPC: ombro, cotovelo, a. radiocarpal, patelofemural eMCF
  22. 22. Hallmarks of GoutWell-defined erosions (sclerotic margins)Soft tissue nodulesRandom distributionNo osteoporosisMost Common Location of Chondrocalcinosis in CalciumPyrophosphate Dihydrate Deposition DiseaseKneeTriangular fibrocartilage of wristSymphysis pubis
  23. 23. Gout. Sharply marginated erosions, some with a sclerotic margin, are noted throughout thecarpus and proximal metacarpals. These erosions are classic in gout. Note the absence ofmarked demineralization. Gout. A sharply marginated erosion with an overhanging edge (arrow) and a sclerotic margin is seen in the metatarsophalangeal in the great toe in this patient with gout. This appearance and location are classic for gout, whereas psoriatic arthritis and Reiter disease usually involve the interphalangeal joint and do not have erosions that are this sharply marginated.
  24. 24. Advanced Gout. Marked diffuse and focal soft tissue swelling is presentthroughout the hand and wrist in this patient with long-standing gout. Chondrocalcinosis in the Knee. Cartilage calcification known asDestructive, large, well-marginated erosions, some with overhanging edges, chondrocalcinosis is seen in the fibrocartilage (white arrow) and in theare noted near multiple joints. The focal areas of soft tissue swelling are hyaline articular cartilage (black arrow) in this patient with calciumcalled tophi, some of which are calcified. These only calcify with coexistent pyrophosphate dihydrate deposition disease.renal disease.
  25. 25. Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (CPPD) Arthropathy.Chondrocalcinosis in the Wrist. This patient with calcium pyrophosphate Degenerative joint disease (DJD) of the elbow is seen in this patient with CPPD. Notedihydrate deposition disease exhibits chondrocalcinosis in the triangular the joint space narrowing, with minimal sclerosis and large osteophytes (arrows).fibrocartilage of the wrist (curved arrow). A small amount of chondrocalcinosis is Osteophytes of this nature are termed drooping osteophytes and are often seen inalso seen in the second metacarpophalangeal (small arrow). Triangular ligament CPPD. The elbow is an unusual place for DJD to occur except in the setting of CPPDcalcification is one of the more common locations for chondrocalcinosis to occur. or trauma.
  26. 26. Colagenoses- Esclerodermia- LES- Dermatomiosite- DMTC- Osteoporose e perda de tecido mole- LES: desvio ulnar das falanges- Calcificação de tec moles na esclerodermia e dermatomiosite
  27. 27. Systemic Lupus Erythematosus. Marked soft tissue wasting, as noted by the concavity in thehypothenar eminence, and ulnar deviation of the phalanges, seen primarily in the right hand, arehallmarks of systemic lupus erythematosus.
  28. 28. Scleroderma. Diffuse subcutaneous soft tissue calcification is seen throughout the hands andwrists in this patient with scleroderma. Soft tissue wasting and osteoporosis are also present, aswell as bone loss in multiple distal phalanges secondary to the vascular abnormalities oftenpresent in this disease.
  29. 29. Hemochromatosis. Anteroposterior view of the hand in this patient withSarcoid. Anteroposterior view of the hand in this patient with sarcoid demonstrates hemochromatosis shows severe joint space narrowing throughout the hand, which isclassic changes of bony involvement with this granulomatous process. Note the most marked at the metacarpophalangeal joints. Associated sclerosis at thelacelike pattern of destruction, which is seen most prominently in the proximal metacarpophalangeal joints with large osteophytes seen off the metacarpal headsphalanges and in the distal third phalanx. suggests degenerative joint disease (DJD). These are very unusual joints for DJD to occur in, yet this is the classic appearance of hemochromatosis.
  30. 30. Artropatia Neuropática ou de Charcot-Destruição, luxação e osso heterotópico- Início estreitamento do espaço articular- Pé diabético 1º e 2º tarso-metatarso- Paralisia
  31. 31. Charcot Joint. Anteroposterior view of the knee in this patient with tabes Charcot Spine. Anteroposterior view of the spine in this paraplegic patient shows severedorsalis shows the classic changes of a neuropathic or Charcot joint. Note destruction of the L2 and L3 vertebral bodies and the intervening disk space, heterotopicthe severe joint destruction, the subluxation, and the heterotopic new bone new bone (arrow), and malalignment or dislocation. Numbers indicate lumbar vertebrae.(arrow).
  32. 32. Lisfranc Charcot Joint. Dislocation of the second and third metatarsals along with joint destruction and large amounts of heterotopic new bone arepresent in the foot of this diabetic patient. These findings are classic for a Charcot joint, which has been termed a Lisfranc fracture-dislocation. Itis most commonly seen secondary to trauma rather than as a Charcot joint but is the most common neuropathic joint seen today.
  33. 33. Hemofilia ARJ Paralisia- Crescimento excessivo das extremidades com diáfise grácil- Com ou sem destruição articular- ARJ e Hemofilia alargamento da fosso intercondilar
  34. 34. Muscular Dystrophy Simulating Juvenile Rheumatoid Arthritis (JRA) orJuvenile Rheumatoid Arthritis (JRA). A lateral view of the knee in this patient with JRA Hemophilia. Anteroposterior view of the ankle in this patient with muscularshows the classic findings of overgrowth of the ends of the bones and associated dystrophy shows subtle changes of overgrowth of the distal tibia and fibulargracile diaphyses. These changes can also be seen in patients with hemophilia or epiphyses. Marked tibiotalar slant, which can also be present in JRA orparalysis. hemophilia, is also present.
  35. 35. Osteocondromatose Sinovial-Metaplasia da sinóvia- Focos de cartilagem na articulação(calcificam)- Joelho, quadril e cotovelo- condromatose sinovial tumefativa- sinovectomia
  36. 36. Synovial Osteochondromatosis Without Calcification. Anteroposterior view of the hip in thisSynovial Osteochondromatosis. Anteroposterior view of the hip in this patient shows that the femoral neck is eroded, with the femoral head having an “applepatient with left hip pain shows multiple calcified loose bodies in the hip core” appearance. This has occurred from the pressure erosion of multiple nonossified loosejoint, which is virtually diagnostic of synovial osteochondromatosis. bodies in the joint. This is nonossified synovial osteochondromatosis (probably more properly termed synovial chondromatosis). It usually does not cause this degree of bony erosion and is indistinguishable from pigmented villonodular synovitis.
  37. 37. Tumefactive Synovial Osteochondromatosis. Plain film of the shoulder (A) shows a partiallycalcified mass which is eroding the medial aspect of the humerus. Coronal proton-density MR (B)and T2WI (C) of the shoulder reveal a large mass encircling the humeral head, which wasinterpreted as a sarcoma. A biopsy was performed and called “chondrosarcoma,” whichresulted in a forequarter amputation. The intra-articular nature of the mass was not appreciateduntil after the radical surgery, when it was correctly recognized as synovial chondromatosis.
  38. 38. Sinovite Vilonodular Pigmentada- Processo inflamatório crônico da sinóvia, edema articular, dor edestruição, hemossiderina.
  39. 39. Atrofia de SudeckDor , edema e disfunção – pós trauma
  40. 40. Necrose Avascular- Esteróides, traumatismo, tx renal, AAS, colagenoses, alcoolismo.- Aumento da densidade óssea numa articulação normal- Achados:- Derrame articular- Densidade em placas ou mosqueada- Transparência subcondral- Colapso da superfície articular- Unilateral- Osteocondrite dissecante -Menor e mais focal - trauma : joelho, talus e umero - destacamento de fragmento ósseo
  41. 41. Early Avascular Necrosis of the Hip. Patchy sclerosis is present in the femoral head in this Avascular Necrosis (AVN) of the Hip. Subchondral lucency (arrows) is seen inpatient with a renal transplant and avascular necrosis of the right hip. No subchondral lucency or the weight-bearing portion of this hip with AVN. Patchy sclerosis throughout thearticular surface irregularity in the weight-bearing region is yet present, with the exception of a femoral head is also noted.small cortical irregularity seen laterally.
  42. 42. Avascular Necrosis of the Hip. An axial T1WI (time of repetition 600; time of echo 20) of the hips shows a focal area of abnormality in the left femoral head (arrow), which is characteristic for AVN. The low-signal, serpiginous border is a typical finding, as is the anterior location.Avascular Necrosis (AVN) of the Shoulder. Articular surface collapseis present in this shoulder with long-standing AVN. Dense bonysclerosis is also present.
  43. 43. Osteochondritis Dissecans. A small focal area of avascular necrosis (AVN) inthe medial epicondyle of the femur (black arrows) is present, which is an area Osteochondritis Dissecans of the Talus. A focal area of avascular necrosis inof osteochondritis dissecans. Part of the area of AVN has shed a bony the talus, as seen here (arrows), is called osteochondritis dissecans. The talus is the second most common site after the knee and, as in the knee, can causefragment (white arrow) that is loose in the joint, which is known as a loose a joint mouse, or loose body in the joint.body or “joint mouse.
  44. 44. Kienbock Malacia. Avascular necrosis (AVN) of the lunate, or Kienböck malacia, is Kohler Disease. Flattening and sclerosis of the tarsal navicular (arrow) in children isdemonstrated in this patients wrist. The increased density and partial fragmentation of the thought by many to be avascular necrosis and is called Köhler disease. Others havelunate are characteristic for AVN. Also, note the slightly shortened ulna (in comparison with found this to be an asymptomatic normal variant and believe that it is an incidentalthe radius), which is called negative ulnar variance. Negative ulnar variance is said to have finding.a high association with Kienböck malacia.
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