Arthropathies/Connective Tissue Diseases 1

1. Osteoarthritis (DJD) 2. Rheumatoid Arthritis 3. Ankylosing Spondylitis4. Psoriatic Arthritis 5. Reiter Syndrome6. CPPD7. Gout

1. Sutton's Law Even though over 90 different rheumatic diseases are recognized by the American College of Rheumatology, only three entities are commonly seen in most clinical radiology practicesA.OsteoarthritisB.rheumatoid arthritis C.calcium pyrophosphate dihydrate (CPPD) deposition disease

2. Radiographic Hallmarks 3. Pattern Approach

Arthropathies with Female Predominance

Disorder female:male ratio

Rheumatoid Arthritis 2:1 to 3:1

Primary osteoarthritis(> 45 years)

CPPD 1:1

4. Demographics (Age and gender) 5. The Law of Parsimony

Arthropathies with Male Predominance

Disorder male:female ratio

Ankylosing spondylitis

4:1 to 10:1

Psoriatic2:1 to 3:1, but controversial

Reiter's 5:1 to 50:1

Gout 20:1

DISH 3:2

CPPD 1:1

Primary osteoarthritis(< 45 years)

Enteropathic arthropathy

Ulcerative colitis 4:1

Crohn's disease 1:1 

AGE

Age Group Age of Onset Disorder

Young (< 20 years)

< 20 yearsJuvenile chronic

arthritisSeptic arthritis

Middle (> 20 years)

onset 15 - 35 years

Ankylosing spondylitis

Reiter's

Young adultsEnteropathic arthropathies

25 - 55 yearsRheumatoid

arthritisPsoriatic arthritis

Older patients (> 55 years)

> 55 yearsOsteoarthritisDISHCPPD 

Neurologic and Musculoskeletal Imaging Studies

Chapter 7 part 2

Osteoarthritis (DJD). DIP&PIP

hallmarks of DJD1.joint space narrowing, 2.subchondral sclerosis, 3.and osteophytosis,

Primary Osteoarthritis. joint space narrowing, and sclerosis at the DIP&PIP&1thCMC

Hallmarks of Rheumatoid Arthritis

1. Soft tissue swelling2.Osteoporosis3.Joint space narrowing4.Marginal erosions5.Proximal distribution (hands)6.Bilateral symmetry

Early RA will demonstrate erosions in the distal radioulnar joint, ulnar styloid, radial styloid, and triquetro-pisiform joint

Rheumatoid Arthritis. erosive arthritis ,osteoporosis and soft tissue swelling

Rheumatoid Arthritis, the boutonniere deformity

Rheumatoid Arthritis, the swan neck deformity

Rheumatoid Arthritis of the Hip. severe joint space narrowing

Rheumatoid Arthritis in the Shoulder. the distance between the acromion and the humeral head is diminished (arrowheads). Ordinarily, this space is about 1 cm in width . This is a common finding in rheumatoid arthritis as well as in calcium pyrophosphate dihydrate deposition disease

Glenohumeral joint space narrowing with marginal erosions within the humeral head. Ligamentous/tendinous injury results in rotator cuff degeneration with a "high-riding" humeral head.

Causes of High-Riding Shoulder

Rheumatoid arthritisCalcium pyrophosphate dihydrate deposition disease (CPPD)Torn rotator cuff

Diffuse involvement of joint with extensive erosion in olecranon articulation and joint space narrowing with trochlea of humerus seeming to "dig into" olecranon. Joint effusion and olecranon bursitis may also occur.

Normal C1 and C2. A lateral radiograph (A) and drawing (B) of the upper cervical spine showing the normal distance of less than 2.5 mm from the anterior arch of C1 to the odontoid process (dens) of C2 (arrows).

Instability of the transverse ligament of C1. In this patient with rheumatoid arthritis, (A) shows very little space (which is normal) between the posterior aspect of the arch of C1 and the anterior portion of the odontoid (arrows). With flexion (B), this space markedly widens, and the odontoid is free to compress the spinal cord, which is posterior to it.

particularly look for C1-C2 involvement which can have catastrophic consequences

Secondary Degenerative Joint Disease (DJD) in the Knee in a Patient With Rheumatoid Arthritis. osteoporosis and joint space narrowing. Secondary DJD is occurring, as evidenced by the sclerosis and osteophytosis; however, these findings are out of proportion to the severe joint space narrowing