ARTHRITIS
AN ALGORITHM
Radiographic evaluation of arthritis: inflammatory conditionsJon A. Jacobson, Gandikota Girish, Yebin Jiang, and Donald ResnickRadiology 2008 248:2, 378-389
SOMETHING DIFFERENT Hypertrophic/proliferative
Degenerative: primary or secondarySecondary AKA atypical OA
Hemophilia Gout trauma
ErosiveRheumatoid + variants
InfectiousTBPyogenic/bacterial
EROSIVE Synovial proliferation Pannus Inflammatory erosions Uniform joint space narrowing Soft-tissue swelling RA + seronegative variants
ReitersAnkylosing spondylitisEnteric arthropathyPsoriatic arthropathy
RA Multiple joints: systemic Periarticular osteopenia Juxtaarticular bony erosions (non-
cartilage non-protected bone) Subluxation and gross deformity Periarticular soft tissue swelling
RA
RA C-SPINE
CERVICAL SPINE IMAGING IN RA
Younes, Mohamed, et al. "Compared imaging of the rheumatoid cervical spine: prevalence study and associated factors." Joint Bone Spine 76.4 (2009): 361-368.
The prevalence of rheumatoid cervical spine involvement was 47.5% by standard radiography, 28.2% by CT, and 70% by MRI.
Rheum involvement with high Sharp score and elevated CRP
17.5% of those with Cspine abn were w/o sx. Overall rheumatoid involvement of the cervical spine
was not significantly associated with any of the epidemiological, clinical, laboratory, imaging, or therapeutic factors evaluated in the study.
THE RECOMMENDATIONS
PSORIATIC
PSORIATIC SPINE
AK- CLASSIC
AK
SYNDESMOPHYTES
DISH Criteria:SI and facet joints normal
4 contiguous vertebrae
No disc space narrowing
REACTIVE ARTHROPATHY
ENTERIC ARTHROPATHY
TB
SI
HYPERPROLIFERATIVE Subchondral sclerosis, osteophytes No erosions Asymmetric joint space Nearly all arthritides can lead to DJD*Weight-bearing radiograph for early
detection Mobius battle
Microtrauma – not just body habitus but body habits AKA repeated use
OA- OSTEOPHYTES
DJD
OA-SPINE
CPPD
CPPD
HEMOCHROMATOSIS
NEUROPATHIC
NEUROPATHIC SPINE
GOUT
Monu, Johnny UV, and Thomas L. Pope Jr. "Gout: a clinical and radiologic review." Radiologic Clinics of North America 42.1 (2004): 169-184.
GOUT