6. General age of onset of arthritis
0-20 years 20-40 years More than 40 years
JRA Ankylosing spondylitis
Osteitis condensa ilis
Lupus erythematosus
Psoriatic arthritis
Rheumatoid arthritis
scleroderma
Degenarative joint disease
Gout
DISH
Hypertrophied
osteoarthropathy
7. Sex predisposition of arthritis
MALE FEMALE
Ankylosing spondylitis JRA
Gout Lupus erythematosus
Hypertrophied osteoarthropathy Osteotis condensa ili
Reiters syndrome RA
Secondary osteoarthritis Primary osteoarthritis
Scleroderma
9. c) Cartilage :
-Narrowing of joint space
-calcifications
d) Distribution :
-Monoarticular or polyarticular
-Proximal / distal
-Symmetry
e) Soft Tissue :
-Swelling , diffuse or focal
-Calcification
10.
11.
12. Inflammatory Degenerative Metabolic
Soft tissue swelling and
oedema.Fusiform soft
tissue swelling .Usually no
soft tissue calcification.
Soft tissue masses within
periarticular soft
tissue.Ecentric soft tissue
swelling.tophi calcification.
Uniform loss of joint space Non uniform loss of joint
space,weight bearing area
Relative preservation of joint
space-late feature
Predisposition of bony
ankylosis
Subchondral cyst and
sclerosis.Joint
subluxation.Intraarticular
loose bodies
Some feature of synovitis.
Overlapping degenerative
change
13.
14.
15. -Inflammatory Arthritis :
-Two types of Inflammatory Arthritis :
(i) Autoimmune Arthritis
(ii) Seronegative Spondyloarthropathies
16. Rheumatoid arthritis
• a) Incidence :
• More in females(1:3)
• Onset is generally in adulthood, peaking in the
4th and 5th decades
• RA first affects the small joints in the hands
and wrists
17. Pathology
• Initial synovial inflammation within joints,bursa and
tendon sheaths with cellular
infiltrate,hyperaemia,edema and increased synovial
fluid
• Synovium hypertrophied to form granulation
tissue(pannus) which spread over cartilage surface
• At bare areas pannus directly invades into the
bone,resulting in marginal erosion and cartilage
destruction
• Fibrous and bony ankylosis occurs
• Rheumatoid nodule
18. Preferred sites of early involvement :
• Hands : 2nd and 3rd MCP joints
• Feet : 4th and 5th MTP joints
• -N.B. As a rule, the DIP joints are spared
19. General radiologic feature-
• Bilateral symmetry
• Periarticular soft tisuue swelling(oedema ,synovial
congestion)-first radiographic sign.
• Juxta-articular osteopenia(hallmark,inflammatory
hyperaemia,loss of bone density of epi-metaphysis)
• Uniform loss of joint space
• Marginal erosion(no definite sclerotic border)due to
pannus
• Juxta-articular periostitis
• Larege pseudocyst
• Joint deformity
20.
21. Early changes are soft tissue swelling (white arrow) , joint space
narrowing (blue arrow) and erosions of the proximal interphalangeal
(PIP) joints (red arrows)
22.
23. Deformity
Combination of joint destruction,ligament laxity,and
altered muscular action,subluxation,dislocation
and osseuos misalignment are common
a) Ulnar deviation of the MCP joints
b) Boutonierre deformity :Hyperextension of DIP
and flexion of PIP
c) Swan neck deformity :Hyperextension of PIP and
flexion of DIP
d.Telescope fingers : shortening of phalanges due to
dislocations
27. • -N.B. : RA in specific locations
• 1-RA in shoulder :
• -Erosion of the distal clavicle
• Uniform loss of glenohumeral joint space
• -Marginal erosions of the humeral head , tends to occur in the
superolateral aspect of the humeral heads
• -Rotator cuff tear
• Humerus subluxated superiorly
• 2-RA in hip :
• -Uniform loss of joint space (cf osteoarthritis where there is
tendency for superior loss of joint space)
• Minimal erosion,Protrusio acetabuli(bilateral) , which is defined as >
3 mm medial deviation of the femoral head beyond the ilioischial
line in males and > 6 mm in females(-Osteoarthritis –unilateral)
29. • 3-RA in spine :
• 1-Erosion of the Dens , the cervical spine is involved in
up to 70 % of patients
• 2-Atlantoaxial Subluxation
• 3-Basilar Invagination (Vertical Subluxation)
• 4-Erosion and fusion of apophyseal joints
• 5-Erosion of spinous processes
• 6-Destruction of intervertebral disks
• 7-Osteoporosis and osteoporotic fractures
• **N.B. : A characteristic finding of RA is atlantoaxial
(C1-C2) sublaxation
30. • 4-RA in knee :
• -Joint effusion
• -Typically involves the lateral or non-weight bearing portion
of the joint
• -Loss of joint space involving all three compartments
(medial & lateral tibiofemoral and patellofemoral) , in
contrast , OA tends to first affect the medial tibiofemoral
articulation
• -Lack of subchondral sclerosis and osteophytes (cf OA) , if
osteophytes & symmetrical cartilage space narrowing are
present then secondary OA should be considered
• Osteopenia,marginal erosion(tibial condyle),Baker”s cyst
31. Uniform joint space loss (yellow arrows) , unlike the medial compartment preference of
osteoarthritis (OA) , erosions may occur but they are not as prominent as in the hands ,
there are no osteophytes , Baker's cysts (arrowhead) are frequently found behind the knees
of patients with RA
33. • 5-RA in the Feet :
• -The feet are commonly involved in RA
• -Typically the MTP joints in the forefoot and the
talocalcaneonavicular joint in the midfoot are
involved
• -Up to 20 % of patients have the MTP joint as the
first site of involvement
• 6-RA in the Elbow :
• -RA involves the elbow in approximately 1/3 of
patients
34.
35. Juvenile rheumatoid arthritis
• 1-Incidence :
• -RA with onset at < 16 years
• -70% of JRA is seronegative
• -Still's disease = JRA + lymphadenopathy
+splenomegaly
36. • 2-Radiographic Features :
-Soft tissue swelling
-Osteopenia
-Loss of joint space
-Erosions
-Growth retardation secondary to premature closure of growth plates ,
short metacarpals
-Overgrowth of epiphyses (increased perfusion)
-Joint subluxation
-Spinal involvement is very common (70%) and typically precedes
peripheral arthritis :
*Diffuse ankylosis of posterior articular joints (diagnostic)
*C2 subluxation (due to destruction of posterior ligament)
*Odontoid fracture
37. Periarticular osteopenia (arrows) and soft-tissue swelling which is most
marked at the proximal interphalangeal and metacarpophalangeal
joints of the index finger (arrowheads)
38. Widespread osteopenia , carpal crowding (due to cartilage loss) and several
erosions affecting the carpal bones and metacarpal heads in particular in a
child with advanced juvenile idiopathic arthritis (JIA)
40. Erosions of the radial head and capitellum (arrowheads) , uniform radiocapitellar joint
space narrowing and displacement of the anterior and posterior fat pads (arrows)
owing to proliferative synovitis
41. Plain radiograph of the knee shows osteopenia with enlargement of the distal femoral
epiphysis , epiphyseal overgrowth is thought to result from chronic hyperemia
42. Ankylosis in the cervical spine at several levels due to long-standing
juvenile idiopathic arthritis (JIA)
43. Scleroderma
• a) Incidence :
• -Also known as systemic sclerosis
• -A multi-system autoimmune connective
tissue disorder
• As such , it affects many separate organ
systems : MSK , Pulmonary , Cardiac ,
• GIT , Hepatobiliary and renal
44. • b) Radiographic Features :
• -Imaging findings demonstrate bone and soft tissue changes
• -The hands (finger tips) are the most common site of involvement
• 1-Bone changes :
• -Acro-osteolysis (resorption of the distal portion of the distal phalanges) is
characteristic , especially if there is accompanying calcification
• -Periarticular osteoporosis
• -Joint space narrowing
• -Erosions
• 2-Soft tissue Changes :
• -Subcutaneous and periarticular calcification
• -Atrophy especially at tips of fingers
• -Flexion contractures
47. PA radiograph shows flexion of the fingers , loss of the tufts of the
index finger and middle finger distal phalanges and calcification
including finger tip calcification
49. Systemic lupus erythematosus
• a) Incidence :
• -Nonerosive arthritis (in 90% of SLE)
• resulting from ligamentous laxity and joint
deformity
• -Distribution is similar to that seen in RA
50. • b) Radiographic Features :
• -Prominent subluxations of MCP
• -Usually bilateral and symmetrical
• -No erosions
• -Radiographically similar to Jaccoud's
arthropathy
• -Soft tissue swelling may be the only indicator
51.
52. Jaccoud’s arthropathy of hands , A 55 years old patient diagnosed with SLE for 17 years ago shows
findings of arthropathy such as metacarpal ulnar deviation , swan neck deformity (fine white
arrow) , boutonniere deformity (black arrow) and Z deformity of thumb (thick white arrow)
53. Periarticular osteoporosis with marked alignment abnormalities at the 2nd-5th MCP joints ,
there is significant ulnar deviation with hyperextension of the 2nd-5th PIP joints bilaterally ,
degenerative changes are seen at the DIP joints with marked flexion deformities as well , the
carpal joints are well-maintained and there is no significant erosive change noted
54. Seronegative spondyloarthropathy
• Group of non rheumatoid seronegative disorders
that have clinical ,radiological and familial
interrelationships.Definite criteria for diagnosis
• Absence of rheumatoid factors
• Peripheral arthropathy
• Sacroilitis with or without ankylosing spondylitis
• Clinical overlap
• Increased incidence of the disease in the family
55. • (ii) Seronegative Spondyloarthropathies :
• 1-Ankylosing Spondylitis
• 2-Reiter's Syndrome (Reactive Arthritis)
• 3-Psoriasis
• 4-Enteropathic Arthropathies
**N.B. : Sacroiliitis is a hallmark of the spondyloarthritis ,
symmetric sacroilitis is caused by IBD & AS , while
asymmetric sacroilitis is caused by psoriatic arthritis and
reactive arthropathy , an important cause of unilateral
sacroilitis is septic arthritis , especially in an
immunocompromised patient or with IV drug abuse , septic
arthritis usually presents with erosive changes in a patient
with fever & SI joint pain
56. Ankylosing spondylitis
• a) Incidence :
• -Seronegative spondyloarthropathy results in
fusion (ankylosis) of the spine and sacroiliac
(SI) joints
-More in adult males
-Can be associated with pulmonary fibrosis
(upper lobe predominant) , aortitis and
cardiac conduction defects
57. Xray findings
• a) Sacroiliac Joints :
• -Sacroiliitis is usually the first manifestation and is
symmetrical and bilateral
-Grading of Sacroilitis :
*Grade 0 : Normal
*Grade I : some blurring of the joint margins suspicious
*Grade II : minimal sclerosis with some erosion
*Grade III : definite sclerosis on both sides of joint with severe
erosions with widening of joint space
with or without ankylosis
*Grade IV : complete ankylosis
58. (a) Grade I : reduced demarcation of joint space , (b) Grade II : small localized
areas with erosions and subchondral sclerosis without alteration of joint
width , (c) Grade III : Sclerosis & erosions with partial ankylosis of the joint
space , (d) Grade IV : total ankylosis of joint space
61. • 1-Shiny corner sign :
• -Represents small erosions at the superior and inferior
endplates (corners on lateral radiograph) of the vertebral
bodies with surrounding reactive sclerosis , Romanus
lesions are erosions while shiny corners are sclerosis of
prior Romanus lesions at the corner of the body
• 2-Vertebral body squaring :
• -Refers to loss of normal concavity of the anterior border
• 3-Marginal syndesmophyte formation :
• -Thin vertical dense spicules bridging the vertebral bodies
63. A-C , Marginal Syndesmophyte , observe the vertical orientation and thin nature of the
ossification (arrows) typical of ankylosing spondylitis
D-F , Osteophytes , note that claw (arrows) and traction (arrowheads) spurs are more
horizontally oriented thicker and more distinctive in degenerative joint disease
64. • 4-Bamboo sign :
• -Seen on AP
• -Late fusion and ligamentous ossification
• 5-Dagger Sign :
• -Single central radiodense line on frontal radiographs
related to ossification of supraspinous and interspinous
ligaments
• 6-Trolley-track sign :
• -Seen on AP view
• -Central line of ossification (supraspinous and interspinous
ligaments) with two lateral lines of ossification (apophyseal
joints)
65. • 7-Anderson lesion :
• -Insufficiency fracture of the ankylosed spine
• 8-Enthesopathy :
• -Common
66. Bamboo Spine , note that complete interbody ankylosis by marginal
syndesmophytes produces this distinctive undulating spinal contour
70. • a) Sacroiliac Joints :
• -Because the sacroiliac joints are predominantly
made of fibrous connective tissues
(fibrocartilage) and contain very little synovial
fluid, these articulations may be considered
entheses
-These features may explain why sacroiliac joints
are spared during rheumatoid arthritis and also
explain their characteristic involvement during
spondyloarthropathies
71. • 1-The earliest signs of sacroiliitis :
• -Subchondral bone edema is associated with
• increased signal in fat-saturatedT2 or STIR and with
T1+C fat-saturated
• -Inflammatory enhancement of the fibrous connective
tissue of the joint may also be present
• 2-Later in the course of the disease :
• Inflammation usually decreases and subchondral
edema is progressively replaced by fatty post
inflammatory bone marrow which appears
hyperintense on T1
72. Coronal STIR (A) and T1+C fat-saturated (B) images of sacroiliac joints
show hyperintensity of subchondral bone marrow (arrows
73. Coronal T1+C fat-saturated of sacroiliac joints shows enhancement of
connective fibrous tissues (arrows) , Hyperintensity of right iliac
subchondral bone marrow (arrowhead) is also seen
74. • 3-The final stage of sacroiliac
• involvement shows :
• Subchondral sclerosis followed by fusion of
the joint with ankylosis , MRI may show
sclerotic changes , hypointense on T1 and kT2
and fusion of the articulation
75. Axial (A) T1+C fat-saturated (B) T1 of sacroiliac joints show
subchondral hypointensity indicative of sclerotic changes (arrows)
76. • b) Spine :
• 1-The earliest inflammatory changes :
• -Inflammatory appearance of the ligaments and of
their insertions (enthesitis)
• -The enthesis is defined as the site of insertion of a
tendon , ligament , joint capsule or fascia to bone
-Four different entities can be distinguished :
1-Spondylitis (Romanus spondylitis)
2-Spondylodiskitis (Andersson aseptic spondylodiskitis)
3-Arthritis of the zygapophyseal joints
4-True ligamentous inflammatory involvement
77. • 1- Romanus Spondylitis :
• -Consists of inflammatory changes involving the
edges of the vertebral endplates
• -Involvement of the anterior edges is secondary
to enthesitis of the anterior longitudinal ligament
whereas involvement of the posterior edges is
secondary to enthesitis of the posterior
longitudinal ligament
• -Hyperintense edematous corners on T2 and
T1+C ,fat-suppressed , low signal in T1
79. • 2- Andersson Aseptic Spondylodiskitis :
• -Consists of inflammatory changes involving
the disk and adjacent vertebral endplates
which appear hyperintense on T2 and T1+C
fat-suppressed , hypointense on T1
80. (A) T1 , (B) T2 , (C) STIR , (D) T1+C show abnormal signal intensity
along the end plates of L3 and L4 vertebra with desiccation of
intervening disc , signal intensity is hypointense on T1 and
hyperintense on T2 and fat saturation , after administration of
intravenous Gadolinium , these showed enhancement
81. • 3-Arthritis of the Zygapophyseal Joints :
• -May occur with bone marrow edema effusion
and erosions and may undergo ankylosis at
the end stage
• -The costovertebral and costotransverse joints
may also be involved
82. Sagittal STIR shows hyperintensity of vertebral endplates adjacent to
intervertebral disk , corresponding to Andersson aseptic
spondylodiskitis (arrows) , hyperintensity of bone marrow around
zygapophyseal joints corresponds to arthritis (arrowheads
83. • 4-True Ligamentous Inflammatory Involvement:
• -Although ligamentous lesions are most
commonly confined to the bone insertions , they
can also involve other parts of the ligament ,
corresponding to true ligamentous inflammation
• -T1+C fat-saturated is more sensitive than T2 or
STIR in the detection of this type of involvement
• -All the vertebral ligaments may be affected ,
most often the interspinal and the supraspinal
ligaments
84. T1+C fat-suppressed shows vertebral inflammatory changes (arrows)
and shows discrete enhancement of interspinal and supraspinal
ligaments (arrowheads)
85. • 2-Later in the course of the disease :
• -Inflammation may decrease and
inflammatory zones may be replaced by fatty
postinflammatory bone marrow
• -MRI may show fatty infiltration at either edge
of the vertebral endplates
• representing postinflammatory change after
Romanus spondylitis or Andersson
spondylodiskitis
86. Postinflammatory fatty vertebral changes after Romanus spondylitis ,
Sagittal T1 shows circumscribed hyperintensity of anterior edges of
vertebral endplates corresponding to fatty infiltration of bone marrow
long after florid inflammatory Romanus spondylitis (arrows)
87. • 3-The last stage of spinal involvement consists of :
• -Sclerotic changes , bone formations and ankylosis
• -Syndesmophytes , consisting of bone outgrowth forming an
osseous bridge between two adjacent vertebrae (these bone
formations are different from osteophytes because their initial
directions are not horizontal but vertical)
• -Syndesmophytes (end stage of Romanus spondylitis) are
responsible for the development of peripheral spinal ankylosis
• -Ankylosis may also be central , secondary to bone formations
passing through the disk (end stage of Andersson
spondylodiskitis) , ankylosis of the zygapophyseal joints may also
be observed.
• -Insufficiency vertebral fractures may occur in
spondyloarthropathies and are known as Andersson fractures
88. Syndesmophytes , Sagittal (A) and coronal (B) CT scans of thoracic
and lumbar spine show syndesmophytes corresponding to osseous
bridge between two adjacent vertebrae (arrows)
89. 2.Psoriatic arthritis
• a) Incidence :
• -Seronegative spondyloarthropathy
(inflammatory upper extremity polyarthritis)
associated with psoriasis
• (10%-20% of patients with psoriasis will
develop arthritis)
• -In 90%, the skin changes precede the arthritis
90. • b) Radiographic Features :
• Bone density is normal.
• -Combination of productive and erosive changes
(distinguishable feature from RA) in a predominantly distal
distribution (i.e.interphalangeal more than MCP joints)
• -The disease most commonly involves the hands , followed
by feet, it can also affect sacroiliac joints and spine
• -Bone production :
• *Mouse ears : bone production adjacent to erosions
• *Ivory phalanx : sclerosis of distal phalanx
91. -Erosions are aggressive :
• *Pencil in cup deformity, most commonly
affecting the DIPs
• *Resorption of terminal tufts
-Ankylosis (10%) : most common in hands and feet
• -sausage digit :Periostitis along tubular bone of
hands and feet which is sclerotic and expanded
associated with soft tissue swelling of entire digit
• -Joint space loss is usually severe
• -Sacroiliitis is usually bilateral and asymmetrical
92. -A and B : Mouse Ears ,
note the combination of
erosions and fluffy
periostitis produces the
mouse ears appearance
in psoriasis
-C and D : Gull Wings ,
observe that the
biconcave articular
contour produces the gull
wings appearance of
erosive osteoarthritis
94. Psoriatic arthritis , classic radiographic findings around the distal
interphalangeal joints include soft tissue swelling , erosions with
accompanying bone proliferation and lack of osteoporosis
95. Pencil in cup appearance
Periarticular erosion and bone resorption
96. Pencil in cup deformity (arrows) , resorption of the tuft of the distal
phalanx (acroosteolysis) can be observed (arrowhead) , ankylosis of
the distal joint is a strong sign of psoriatic arthritis (crossed arrow)
98. • Spine-
• Asymmetric paravertebral ossification-usually
thicker and larger than syndesmophytes of AS.
• Incomplete non marginal syndesmophytes
99.
100. 3.Reiter’s syndrome
• a) Incidence :
• -Seronegative spondyloarthropathy with lower
extremity “Feet” erosive joint disease (known as
reactive arthritis)
• -More in males (age , 15-35 years)
• -Follows an infection at a different site commonly
enteric or urogenital
• -Classic triad occurs in minority of patients :
• 1-Urethritis or cervicitis
• 2-Conjunctivitis
• 3-Arthritis
101. • b) Radiographic Features :
• Regional osteopenia-resemble RA
• Distal lower extremity involvement (MTP >>
calcaneus > ankle > knee) is more common than
upper extremity involvement.
• -It can have a very similar appearance to psoriatic
arthritis with the classic features of ill defined
erosions , enthesopathy and bone proliferation.
• -The posterior superior aspect of the calcaneus is
a frequent site of erosion.
102. • -However , the distribution is slightly different
,where hand involvement is the most common
site in patient's with psoriatic arthritis , hand
involvement with Reactive Arthritis is very
uncommon
• -Both Psoriasis and Reactive Arthritis can cause a
sacroiliitis (which is usually asymmetrical)
• -Bulky asymmetrical thoracolumbar osteophytes
with skip segments , spine involvement is similar
to psoriatic arthritis (in AS , no skip lesions)
104. Erosions in all the right metatarsophalangeal (MTP) joints with subluxation and valgus deformity o
most of the toes , smaller erosions in the four and fifth MTP joints of the left foot are also shown
106. Periosteal reaction at the plantar fascia insertion (black arrow) and
early erosion at the Achilles tendon insertion (white arrow) on the
calcaneus
108. 4-Enteropathic Arthropathies
• -Patients with IBD or infection may develop
arthritis indistinguishable from Reiter's disease
-IBD-associated sacroilitis is typically symmetrical
-Underlying disease :
• a) Ulcerative colitis (10% have arthritis)
• b) Crohn's disease
• c) Whipple's disease
• d) Salmonella , Shigella & Yersinia enteritis
infection
109. RA Psoriasic arthritis
Clinical history and serological -
Bilateral symmetrical small joints pain
RA positive
Clinical and serological-Almost always
accompanies skin disease,especially nail
changes
RA negative
HLAB-27-positive
Periarticular osteopenia Bone density normal
MCP ,PIP DIP
Erosive changes are symmetrical Erosive changes are asymmetrical
Periostitis –less frequent Periostitis(whiskering) more frequent
Ankylosis less common Ankylosis-more common
110.
111. RA Ankylosing spondylitis
Peripheral joints-more common.Small
joints
Peripheral joints-less common.Spine-
more common.
RA positive RA negative
HLAB27-negative HLAB27-positive
SI joint- change-less common ,less
severe,seen upto 30% of longstanding
cases,rarely ankylosis
SI joint change-more common,ankylosis
common
Enthesopathy/Periostitis-less common Enthesopathy-common
Osteopenia,erosion and joint space
narrowing-more prominent
osteopenia,erosion,joint space narrowing-
less prominent.rather shaggy periostitis
and ankylosis more common.
112. Infectious Arthritis
(Septic/supporative)
• a) Incidence :
• -More common in adults
• -usually from local trauma , surgery or
accident
• -Destruction of articular cartilage and cortex
114. • b) Etiology :
• -Usually staph aureus
• -Strept in infants
• -Hemophilus in preschoolers
• -Gonococcal arthritis in sexually active young
patients (80% women)
• -Gram negative in D.M. & Alcoholics
• -T.B. spread via blood stream from the lung
115. .
Radiologic Features
• The knee and hip are the most common sites.
• Joint effusion leads to distortion of the fat folds
• Periarticular osteopenia
• Rapid loss of joint space due to cartilage
destruction(symmetric); loss of the cortical white
line(subchondral cortical bone) and moth-eaten
pattern of bone destruction.
• Advance stage-dislocation of joint
• Bony ankylosis rarely occurs.
116. (A) During the progression of
infectious arthritis of the hip ,
this image was obtained early
in the disease and shows only
concentric joint-space loss
(B) During the progression of
infectious arthritis of the hip ,
subchondral erosions and
sclerosis of the femoral head
are present
(C) During the progression of
infectious arthritis of the hip , 8
months after the initial
examination , osteonecrosis
and complete collapse of the
femoral head are present,superolateral
displacement
117. Tubercular arthritis
Pathology
• Tubercular appendicular arthritis is most
common in the hip and knee.
• Cartilage destruction and marginal erosions
characterize the pathologic changes of
tubercular arthritis.
• Extended course of time
118. Radiological findings
.
• Uniform joint space narrowing, early destruction
of the subchondral cortex (cortical white line),
moth-eaten bone destruction, and juxta-articular
osteoporosis are the cardinal roentgen signs of
tubercular arthritis.
Phemister’s triad (tubercular arthritis):
• Progressive and slow joint space narrowing.
• Juxta-articular osteoporosis.
• Peripheral erosive defects of the articular surface.
119. Figure A. TUBERCULOSIS. A. AP Knee.
Observe the symmetric narrowing of the
joint space throughout the knee, a
radiographic sign of inflammatory joint
disease. There is lytic destruction of the
lateral distal condyle of the femur
(arrow). B. AP Knee, Follow-Up. Note the
complete disintegration
of the joint articulation, with resorption and
fragmentation of bone. Spotty disuse
osteoporosis is noted in the proximal
metaphysis of the tibia.
120. Septic arthritis Tuberculos arthritis
Age- Usually children Middle aged and elderly
Clinical course Rapid progression Slow progression
Acute onset of pain and
fever
Have primary foci of
tuberculosis
Sclerosis Marked Minimum
Joint space Narrowing occurs earlier Narrowing occurs later
Erosion Centrally and peripherally
located
Peripherally located
ankylosis Bony ankylosis Fibrous ankylosis
