Rheumatoid arthritis

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Rheumatoid arthritis

  1. 1. Rheumatoid arthritis Dr/ Hytham Nafady
  2. 2. Definition • Generalized CT disorder of unknown etiology involving the synovial tissue.
  3. 3. Incidence • Age: 20-60 with a peak between 40 & 50. • Juvenile rheumatoid arthritis onset below 16 years. • Sex: F > M (3:1).
  4. 4. Rheumatoid nodules
  5. 5. Pathology
  6. 6. Pannus vascularized granulation tissue Bare areas
  7. 7. Distribution: bilateral & symmetrical. Location:
  8. 8. Rheumatoid arthritis Osteoarthritis
  9. 9. Hand • PIP joint. • MCP joint. The distal interphalangeal (DIP) joint is spared, in contrast with •seronegative arthropathies, •degenerative arthirits & •erosive arthritis.
  10. 10. Periarticular soft tissue swelling
  11. 11. Juxtaarticualr osteoporosis
  12. 12. Marginal bone erosions
  13. 13. Narrowing of the joint space
  14. 14. Juxta-articular periostitis
  15. 15. Subcortical cysts
  16. 16. Subluxation • Loss of parallel articular surfaces.
  17. 17. Dislocation
  18. 18. Boutonnière deformity
  19. 19. Swan neck deformity
  20. 20. Mallet finger • Flexion at the DIJ usually due to extensor tendon injury.
  21. 21. Ulnar deviation & palmar subluxation at MCP joints
  22. 22. Zigzag deformity
  23. 23. Arthritis mutilans • Sever polyarticular joint deformity
  24. 24. Wrist • Distal ends of radius & ulna. • Capral bones (specilly triquetrium & pisiform). RA of the wrist
  25. 25. RA of the wrist
  26. 26. Erosion of the ulnar styloid process Pathology: Pannus formation in • The prestyloid recess, • Extensor carpi ulnaris tendon sheath or • Radioulnar joint.
  27. 27. Erosion of the radial styoid process
  28. 28. Erosion of the carpal bones
  29. 29. Spotty carpal sign • Multiple carpabl bone erosions
  30. 30. Sudek’s atrophy • Demineralizatio of bone. • Joint space preserved. • Soft tissue atrophy.
  31. 31. TB
  32. 32. RA of the foot • Interphalangeal joint of the big toe. • Meta-tarso-phalangeal joints from the 5th to the 1st in decreasing order of frequency. RA of the foot
  33. 33. RA of the foot
  34. 34. Marginal bone erosions
  35. 35. Lanios deformity
  36. 36. RA of the large joints • Elbow. • Hip.
  37. 37. RA of the elbow
  38. 38. Olecranon bursitis
  39. 39. RA of the hip
  40. 40. Protrusio acetabulae • P R O T R usio: • Paget • Rheumatoid arthritis (& other inflammatory arthritides). • Osteogenesis imperfecta, Osteomalacia, osteoporosis • Traumatic • Rickets.
  41. 41. RA of the cervical spine • Atlanto-occipital joint. • Atlanto-axial joint. • Sub-axial joints.
  42. 42. RA of the cervical spine
  43. 43. Rotatory atlanto-axial subluxation Type 1 Type 2 Type 3 Type 4 Incidence Most common Rare Rare neurological deficit Most benign high risk high risk Facet joint Unilateral facet subluxatioin Unilateral facet subluxation Bilateral facet subluxation Bilateral facet subluxation C1 ant / post displacement No anterior displacement Anterior displacement Anterior displacement Posterior displacement. Transverse ligament Intact injured injured
  44. 44. Anterior subluxation Lateral view Flexion view Open mouth view Bone erosions Anterior atlanto-axial subluxation
  45. 45. Lateral atlanto-axial subluxation
  46. 46. Vertical atlanto-axial subluxation (basilar invagination)

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