This document discusses various types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathies, gout, and calcium pyrophosphate dihydrate deposition disease. It provides details on the clinical presentation, imaging appearance, and characteristics of each condition. Rheumatoid arthritis predominantly involves small joints of the hands and feet and can lead to erosions, periarticular osteopenia, and subluxation. Seronegative spondyloarthropathies like psoriatic arthritis and ankylosing spondylitis are associated with HLA-B27 and involve the spine, sacroiliac joints, and entheses. Gout typically causes monoarticular inflammation at the
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3. • Joint inflammation is characterized by bone erosions, os-teopenia,
soft-tissue swelling, and uniform joint space loss.
• The hallmark of joint inflammation is erosion of bone,which is focal
discontinuity of the thin, white, subchondral bone plate.
• early joint inflammation will produce marginal erosions prior to
erosions of the subchondral bone plate beneath the articular surface.
• uniform joint space narrowing.
15. SEPTIC ARTHRITIS
• if inflammation is limited to a single joint,infection must first be
excluded.
• Hematogenous spread.m/c by staphylococcal or streptococcus.
• Acute presentation.
• joint space may be initially widened owing to the effusion.
• Most common in knees in adults and knees or hips in children
• Periarticular osteopenia, uniform joint space narrowing, soft-tissue
swelling, and bone erosions.
16.
17.
18. When abscess formation is this extensive and the clinical findings are minimal,
always think of tuberculous arthritis.
20. Rheumatoid Arthritis
• Spondyloarthropathy with proximal distribution of hands and legs
and lack of bone proliferation.
• women of 30–60 years.
• Rheumatoid factor and antibodies to cyclic citrullinated peptide
• Appendicular skeleton in a b/l symmetrical pattern. joint subluxation
and subchondral cysts are seen
• marginal erosions and periarticular osteopenia.
• It affects synovium diffusely, other sites of involvement include
tendon sheaths and bursae.
23. Rheumatoid Arthritis
• predominantly in MCP-joints and the carpus, not in DIP-joints. 5th
metatarsal head, often the first site of a bone erosion in the foot.
• peripheral joints includes the knees , hips, and the sacroiliac and
glenohumeral joints.
• C1-C2 articulation, the odontoid process may be eroded, and the
anterior atlantodens interval may be abnormally widened (>3mm in
adults), especially with neck flexion.
• swan neck deformity and boutonnie`re deformity.
38. Seronegative Spondyloarthropathies
• Rheumatoid factor negative (seronegative)
• Distal involvement in the hands and feet with added features of bone
proliferation. associated with HLA-B27.
• includes psoriatic arthritis, reactive arthritis, and ankylosing
spondylitis.
• cartilaginous joints and enthesis are involved to a greater extent.
• Entheseal involvement leads to increased density and irregular bone
proliferation.
39. Psoriatic arthritis
• Psoriatic arthritis is a peripheral type of spondyloarthritis with
Erosions and bone proliferation predominantly in a distal distribution
• HLA-B27
• bilateral or unilateral, symmetric or asymmetric marginal erosions.
• The hands are most commonly involved followed by the feet.
• soft-tissue swelling in single digit as a “sausage digit”
• bone proliferation produces an irregular and indistinct appearance
“fuzzy” appearance or “whiskering”
• Periostitis
40.
41. • One end of the joint forming a cup and the other a pencil that
projects into this cup appearance of pencil and cup,”
• Ivory phalanx,” which classically involves the distal phalanges
(especially in the first digit) with sclerosis, enthesitis, periostitis, and
soft-tissue swelling
• sacroiliacjoint involvement in psoriatic arthritis isusually bilateral,
either symmetric or asymmetric in distribution
42.
43.
44.
45.
46.
47.
48. Reactive arthritis.
• Reactive arthritis is a sterile arthritis after enteric or urogenital
infection in young males
• An association with urethritis and conjunctivitis, as well as
seropositivity for the HLA-B27 antigen. (typically calcaneus is
involved)
• joint inflammation,bone proliferation, periostitis, and enthesitis,
juxta-articular osteoporosis.
• Lower extremities m/c, u/l or b/l and symmetric or asymmetric.
52. Ankylosing spondylitis
• HLA-B27 positive, Men m/c affected b/w 20 to 40 yrs
• Axial arthropathy, with enthesitis (edema, shiny corners), syndesmophytes and
sacro-iliitis.
• Sacroiliac joint disease is bilat-eral and symmetric. bone ero-sions, the adjacent
bone is often scle-rotic and joint space narrowing ,bone fusion eventually occur.
• MRI can beuseful in the diagnosis of sacroiliitis byshowing joint fluid and
marrow edema.
• Spine involvement(TL AND LS) is characterized by osteitis, syndesmophyte
formation, facet inflammation, andeventual facet joint and vertebral body
fusion
• shiny corner sign.
• Squared vertebral body
53. • Classification criteria for SpA from the
Assessment of SpondyloArthritis International
Society (ASAS) are:
• ≥3 months of back pain and age of onset ≤ 45
years
• and sacroiliitis on imaging plus ≥1 clinical
feature
• or HLA-B27+ plus 2 other clinical features
61. Diffuse Idiopathic Skeletal Hyperostosis
• bulky ossification and calcification of the anterior longitudinal
ligament and the paraspinal connective tissue over more than 4
contiguous levels
• Typically preservation of disc height without profound degenerative
disc disease.
64. Gout
• monoarticular red, inflamed, swollen joint, typically in the lower limb and
classically affecting the first metatarsophalangeal joint (podagra) with
juxtaarticular erosions.
• undersecretion of uric acid by kidneys (90%) : chronic kidney disease
Hypertension, hyperparathyroidism, alcoholism, drugs (e.g.furosemide,
thiazide diuretics, ethambutol, pyrazinamide, aspirin),lead poisoning.
• M/C in males in age > 40 yrs
• overproduction of uric acid (10%):myeloproliferative disorders
Haemolysis ,extreme exercise,Lesch-Nyhan syndrome.
65.
66. Plain radiograph
• Characteristic radiologic changes in the chronic stage of gout
• joint effusion (earliest sign), eccentric erosions.
• “punched-out” erosions with sclerotic margins in a marginal and juxta-
articular distribution, with overhanging edges, also known as rat bite
erosions.
• preservation of joint space.
• tophi: pathognomonic athognomonic, eccentric nodular soft tissue swelling
due to crystal deposition
• Dual-energy CT can distinguish between urate mineralisation and
calcification.
72. Calcium pyrophosphate dihydrate deposition
disease/ pseudogout.
• > 50 yrs
• severe acute or subacute pain, swelling, erythema, and warmth, of
one or more joints and is usually self-limited.
• m/c knee and the upper joints
• weakly positively birefringent
• like osteoarthritis with an unusual distribution, for example, they
tend to be symmetric in distribution and involve non-weight bearing
joints.
• knee: medial meniscus and patellofemoral joint
73.
74. • wrist joint (mainly radiocarpal and scapholunate joints)
• stepladder pattern of joint narrowing is narrowing is progressively
less severe from the radiocarpal joint to the midcarpal joint.
• metacarpophalangeal joints:2nd and 3rd preferentially
• echogenic MSU crystals line the surface of articular cartilage, whereas
echogenic CPPD calcifications are located within the cartilage itself
