Arthritis of the HandsArthritis of the Hands
On the AgendaOn the Agenda
 NormalNormal
 OsteoarthitisOsteoarthitis
 Rheumatoid arthritisRheumatoid arthritis
 CPPD c...
Normal Hand X-rayNormal Hand X-ray
Osteoarthritis (DJD)Osteoarthritis (DJD)
 Gradual degeneration ofGradual degeneration of
articular cartilagearticular car...
OA – Radiographic findingsOA – Radiographic findings
 Joint space narrowingJoint space narrowing
 Osteophyte formation (...
 Joint space narrowingJoint space narrowing
distallydistally
 Marginal osteophytesMarginal osteophytes
 Relatively unch...
Another example of OAAnother example of OA
 Oblique and AP viewsOblique and AP views
 11stst
carpal metacarpalcarpal met...
Rheumatoid ArthritisRheumatoid Arthritis
 SystemicSystemic inflammatory diseaseinflammatory disease
 Affects synovial me...
RA radiography - earlyRA radiography - early
 Earliest signs include softEarliest signs include soft
tissue swelling due ...
 Severe erosive changes at radio-ulnar joints carpal bones at theSevere erosive changes at radio-ulnar joints carpal bone...
Advanced RAAdvanced RA
 Boutonniere (top)Boutonniere (top)
 Swan neckSwan neck
 Labs:Labs:
– +RF in 80%: IgM against+RF...
RA - LateRA - Late
 Complete MCPComplete MCP
involvementinvolvement
 Large marginalLarge marginal
erosions have nearlyer...
RA Bone ScanRA Bone Scan
 Technetium-99 boneTechnetium-99 bone
scanscan
 Uptake shown inUptake shown in
subclinicalsubcl...
Calcium pyrophosphate dihydrateCalcium pyrophosphate dihydrate
crystals (CPPD)crystals (CPPD)
 ““Pseudogout”Pseudogout”
...
CPPDCPPD
 ChondrocalcinosisChondrocalcinosis
 Distal radius and MCPs (2Distal radius and MCPs (2ndnd
and 3and 3rdrd
))
...
 CPPDCPPD
 Diffuse condrocalcinosisDiffuse condrocalcinosis
at the radiocarpal joint,at the radiocarpal joint,
the MCP j...
Brief summary so farBrief summary so far
GoutGout
 Disorder of purine metabolismDisorder of purine metabolism
– overproduction versus– overproduction versus
under...
GoutGout
Gout RadiographyGout Radiography
 All joints of hand and wristAll joints of hand and wrist
possible (2possible (2ndnd
-5-...
More goutMore gout
Psoriatic ArthritisPsoriatic Arthritis
 HLA-B27 positive, RF negativeHLA-B27 positive, RF negative
 InflammatoryInflamma...
Psoriatic Arthritis – Rad findingsPsoriatic Arthritis – Rad findings
 Asymmetric proliferative erosions with ill-Asymmetr...
Psoriatic arthritisPsoriatic arthritis
All done. Any questions?All done. Any questions?
SourceSource
 http://rad.usuhs.mil/medpixhttp://rad.usuhs.mil/medpix
 Additional listed on requestAdditional listed on r...
Arthritis of the hands
Upcoming SlideShare
Loading in …5
×

Arthritis of the hands

1,226 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,226
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
25
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Arthritis of the hands

  1. 1. Arthritis of the HandsArthritis of the Hands
  2. 2. On the AgendaOn the Agenda  NormalNormal  OsteoarthitisOsteoarthitis  Rheumatoid arthritisRheumatoid arthritis  CPPD crystal depositionCPPD crystal deposition  GoutGout  Psoriatic arthritisPsoriatic arthritis
  3. 3. Normal Hand X-rayNormal Hand X-ray
  4. 4. Osteoarthritis (DJD)Osteoarthritis (DJD)  Gradual degeneration ofGradual degeneration of articular cartilagearticular cartilage  Joint pain relieved with restJoint pain relieved with rest  Morning stiffness resolves withinMorning stiffness resolves within 30 minutes30 minutes  Traditionally affects DIPs, 1Traditionally affects DIPs, 1stst IPIP  No systemic symptomsNo systemic symptoms  Painless nodulesPainless nodules – Heberden’s at DIPsHeberden’s at DIPs – Bouchard’s at PIPsBouchard’s at PIPs
  5. 5. OA – Radiographic findingsOA – Radiographic findings  Joint space narrowingJoint space narrowing  Osteophyte formation (whiteOsteophyte formation (white arrow)arrow)  Subchondral sclerosis (blackSubchondral sclerosis (black arrows)arrows)
  6. 6.  Joint space narrowingJoint space narrowing distallydistally  Marginal osteophytesMarginal osteophytes  Relatively unchangedRelatively unchanged proximal structuresproximal structures
  7. 7. Another example of OAAnother example of OA  Oblique and AP viewsOblique and AP views  11stst carpal metacarpalcarpal metacarpal shows decreased jointshows decreased joint space and subchondralspace and subchondral sclerosissclerosis  22ndnd and 3and 3rdrd DIP showsDIP shows osteophytes andosteophytes and subchondral sclerosissubchondral sclerosis (Heberden’s nodes)(Heberden’s nodes)
  8. 8. Rheumatoid ArthritisRheumatoid Arthritis  SystemicSystemic inflammatory diseaseinflammatory disease  Affects synovial membranesAffects synovial membranes  Pannus (granulation tissue)Pannus (granulation tissue) develop in joint spaces anddevelop in joint spaces and erode into the articular cartilageerode into the articular cartilage and boneand bone  Prolonged morning stiffness (>1Prolonged morning stiffness (>1 hr)hr)  PIPs, MCPs, and wristPIPs, MCPs, and wrist commonly involvedcommonly involved  Symmetric joint involvementSymmetric joint involvement
  9. 9. RA radiography - earlyRA radiography - early  Earliest signs include softEarliest signs include soft tissue swelling due totissue swelling due to effusion, tenosynovitis,effusion, tenosynovitis, and edemaand edema  Periarticular osteopeniaPeriarticular osteopenia  Marginal erosions oftenMarginal erosions often first seen at 2first seen at 2ndnd and 3and 3rdrd MCPs and 3MCPs and 3rdrd PIPPIP articulationsarticulations
  10. 10.  Severe erosive changes at radio-ulnar joints carpal bones at theSevere erosive changes at radio-ulnar joints carpal bones at the metacarpal headsmetacarpal heads  Bilaterally symmetricBilaterally symmetric
  11. 11. Advanced RAAdvanced RA  Boutonniere (top)Boutonniere (top)  Swan neckSwan neck  Labs:Labs: – +RF in 80%: IgM against+RF in 80%: IgM against Fc of IgGFc of IgG – Elevated ESRElevated ESR – Anemia of chronicAnemia of chronic diseasedisease
  12. 12. RA - LateRA - Late  Complete MCPComplete MCP involvementinvolvement  Large marginalLarge marginal erosions have nearlyerosions have nearly destroyed the jointsdestroyed the joints  Bones are lucent dueBones are lucent due to osteopeniato osteopenia  Ulnar deviationUlnar deviation
  13. 13. RA Bone ScanRA Bone Scan  Technetium-99 boneTechnetium-99 bone scanscan  Uptake shown inUptake shown in subclinicalsubclinical inflammation of jointsinflammation of joints  SymmetricalSymmetrical  PolyarticularPolyarticular
  14. 14. Calcium pyrophosphate dihydrateCalcium pyrophosphate dihydrate crystals (CPPD)crystals (CPPD)  ““Pseudogout”Pseudogout”  Associated with metabolic diseases such asAssociated with metabolic diseases such as hyperparathroidism, hemochromatosis,hyperparathroidism, hemochromatosis, hypothyroidismhypothyroidism  Compared to gout:Compared to gout: – Large joints affected (2Large joints affected (2ndnd to 5to 5thth MCPs, radio-carpal)MCPs, radio-carpal) – Rhomboid crystalsRhomboid crystals – Positive birefringencePositive birefringence – Calcification of articular cartilageCalcification of articular cartilage – No cortical erosionsNo cortical erosions
  15. 15. CPPDCPPD  ChondrocalcinosisChondrocalcinosis  Distal radius and MCPs (2Distal radius and MCPs (2ndnd and 3and 3rdrd ))  Cartilage destructionCartilage destruction similar to OA –similar to OA – differentiate by locationdifferentiate by location  Location similar to RA –Location similar to RA – differentiate by absense ofdifferentiate by absense of erosionserosions  Calcium deposition atCalcium deposition at triangular fibrocartilage oftriangular fibrocartilage of the wrist (picture)the wrist (picture)
  16. 16.  CPPDCPPD  Diffuse condrocalcinosisDiffuse condrocalcinosis at the radiocarpal joint,at the radiocarpal joint, the MCP joints and thethe MCP joints and the PIPPIP  Joint space narrowing,Joint space narrowing, sclerosis, andsclerosis, and subchondral cysts withinsubchondral cysts within the carpalsthe carpals
  17. 17. Brief summary so farBrief summary so far
  18. 18. GoutGout  Disorder of purine metabolismDisorder of purine metabolism – overproduction versus– overproduction versus underexcreationunderexcreation  Deposition of urate crystals inDeposition of urate crystals in joint spacesjoint spaces  Middle-aged menMiddle-aged men  Acute onset of extreme painAcute onset of extreme pain in small joints with rednessin small joints with redness and swellingand swelling  Needle shaped crystals withNeedle shaped crystals with negative bifringencenegative bifringence  Asymmetric, monoarticularAsymmetric, monoarticular
  19. 19. GoutGout
  20. 20. Gout RadiographyGout Radiography  All joints of hand and wristAll joints of hand and wrist possible (2possible (2ndnd -5-5thth PIP mostPIP most common)common)  Soft tissue swellingSoft tissue swelling  Well demarcated osseousWell demarcated osseous erosions with sclerotic rims anderosions with sclerotic rims and overhanging edgesoverhanging edges  No decrease in bone densityNo decrease in bone density  TophiTophi notnot calcifiedcalcified  Relative sparing of joint spaceRelative sparing of joint space until late in the diseaseuntil late in the disease  Long latent period betweenLong latent period between onset of symptoms andonset of symptoms and radiographic changesradiographic changes
  21. 21. More goutMore gout
  22. 22. Psoriatic ArthritisPsoriatic Arthritis  HLA-B27 positive, RF negativeHLA-B27 positive, RF negative  InflammatoryInflammatory  SeronegativeSeronegative spondyloarthropathyspondyloarthropathy  Asymmetric and bilateralAsymmetric and bilateral  Primarily distal involvementPrimarily distal involvement associated with nail changesassociated with nail changes  No periarticular osteoporosisNo periarticular osteoporosis  Five different patternsFive different patterns  Usually accompanies skinUsually accompanies skin diseasedisease
  23. 23. Psoriatic Arthritis – Rad findingsPsoriatic Arthritis – Rad findings  Asymmetric proliferative erosions with ill-Asymmetric proliferative erosions with ill- defined marginsdefined margins  Periosteal reactionPeriosteal reaction  Soft tissue swellingSoft tissue swelling  ““Pencil-in-cup” deformityPencil-in-cup” deformity  Resorption of distal phalangeal tuftsResorption of distal phalangeal tufts  SubluxationSubluxation
  24. 24. Psoriatic arthritisPsoriatic arthritis
  25. 25. All done. Any questions?All done. Any questions?
  26. 26. SourceSource  http://rad.usuhs.mil/medpixhttp://rad.usuhs.mil/medpix  Additional listed on requestAdditional listed on request

×