RADD 2711 Lecture 9 Summer 2011

RADD 2711 Lecture 9 Summer 2011 - ARTHRITIC DISORDERS...

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Unformatted text preview: ARTHRITIC DISORDERS ARTHRITIC DISORDERS HADD HADD HADD HADD Hydroxyapatite Deposition Disease – Calcifying tendinitis and bursitis HADD HADD 40­70 yoa, M=F MC = Single joint *shoulder also…elbow, wrist, fingers, hip, knee, foot, spine Most definitive method of dx = x­ray HADD HADD Etiology = unknown – Focal area of degeneration – crystal deposition TENDON CALCIFICATION: – At insertion site – Does not blend into cortex of adjacent bone – Ovoid calcifications, sharp margins – Disappear with U/S and active mobilization HADD HADD MC = shoulder rotator cuff, hip, upper C –spine BURSAL CALCIFICATION – Impossible differentiation from tendon Ca++ radiographically – MC subacromial, subdeltoid and ischial bursae CPPD CPPD CPPD CPPD Calcium Pyrophosphate Dihydrate crystal deposition disease “Pseudo­gout” – produces gout­like symptoms CPPD CHONDROCALCINOSIS CPPD ARTHROPATHY PSEUDO­GOUT SYNDROME CPPD CPPD >30 yoa Chronic progressive joint pain Peripheral joints – Knees, wrists, hands, ankles, hips, elbows CPPD CPPD Crystal deposition into cartilage – Hyaline and fibrous types In and around joints – *knee – wrist CPPD CPPD Radiologic Features: – A. Chondrocalcinosis: 1. HYALINE CARTILAGE: thin, linear, parallel to articular cortex – MC – wrist, knee, elbow, hip and shoulder CPPD CPPD 2. FIBROCARTILAGE: thick, irregular, shaggy poorly defined margin – MC – periphery of the meniscus of the knee, triangular fibrocartilage of wrist, symphysis pubis, annulus fibrosus Yellow arrows – DJD Red arrows – CPPD, lunotriquetral ligament, triangular fibrocartilage CPPD CPPD B. Pyrophosphate Arthropathy – Structural joint changes occurring due to CPPD crystals within a joint – Similar DJD changes EROSIVE OA EROSIVE OA EROSIVE EROSIVE OSTEOARTHRITIS “INFLAMMATORY OA” Episodic and acute inflammation of the DIP and PIP joints Bilateral Symmetric EOA EOA Middle­aged females Pain, edema, redness, nodules, ROM 15% develop RA after >12 yrs Familial? EOA EOA RADIOLOGIC CHANGES: – DJD changes WITH bone erosions – *DIP joints – CENTRAL EROSIONS “GULL WINGS SIGN” EOA EOA Main DDX: 1. Rheumatoid arthritis – rarely involves the DIP joints, has +’ve lab results Rhemautoid Arthritis EOA EOA Main DDX: 2. Psoriatic arthritis – marginal erosions with adjacent periostitis Psoriatic Arthritis EOA EOA Main DDX: 3. Non­inflammatory DJD – no erosions, identical to EOA DJD RHEUMATOID RHEUMATOID ARTHRITIS Normal Rheumatoid Arthritis RHEUMATOID ARTHRITIS RHEUMATOID ARTHRITIS Connective tissue disorder Etiology unknown Attacks synovial tissue RHEUMATOID ARTHRITIS 20­60yoa Female, 3:1 (in 20­40 yoa group) 1:1 (>40 yoa) Pain, tenderness, stiffness, swelling “Jelling phenomenon” RHEUMATOID ARTHRITIS Bilateral, symmetrical Peripheral joint involvement Begin at IP and MCP joints Progresses proximally RHEUMATOID ARTHRITIS Firm, non­tender rheumatoid nodules – Accumulation of inflammatory cells – In 20% of patients – severe cases – 5mm to 3cm – On extensor surfaces RHEUMATOID ARTHRITIS Haygarth’s nodes – Soft tissue swelling – MCP joints RHEUMATOID ARTHRITIS Lab values: – ↑ ESR and ↑ C-reactive protein – Presence of rheumatoid factor (not specific for RA) FELTY’S SYNDROME: Rheumatoid arthritis + Leukopenia + Splenomegaly RHEUMATOID ARTHRITIS Poor prognosis if… – Presence of subcutaneous nodules and high levels of rheumatoid factor – Exacerbation of disease for more that 1 year – Onset earlier than 30 yoa – Extra­articular manifestations RHEUMATOID ARTHRITIS **RA NOMENCLATURE**: Page 1012 – Y & R Table 10­25 RHEUMATOID ARTHRITIS PATHOLOGY: 1. acute synovitis with edema periarticular edema juxta­articular hyperemia RHEUMATOID ARTHRITIS PATHOLOGY: 2. Synovial proliferation forms pannus Pannus = vascular tissue – spreads over intra­articular surface of bone and cartilage RHEUMATOID ARTHRITIS PATHOLOGY: 3. At BARE AREA – where intra­articular bone in direct contact with synovium… MARGINAL EROSIONS RHEUMATOID ARTHRITIS PATHOLOGY: 4. Cyst­like cavities – pannus enters marrow spaces of the subchondral bone 5. Hylaine cartilage erodes and narrows RHEUMATOID ARTHRITIS PATHOLOGY: 6. Joint fills with pannus…progressive fibrous ankylosis RHEUMATOID ARTHRITIS RADIOGRAPHIC FINDINGS BILATERAL, SYMMETRICAL PERIARTICULAR SOFT TISSUE SWELLING JUXTA­ARTICULAR OSTEOPOROSIS UNIFORM LOSS OF JOINT SPACE MARGINAL EROSIONS (RAT BITE EROSIONS) MARGINAL EROSIONS (RAT BITE EROSIONS) DEFORMITY OTHERS… ­LARGE PSEUDO­CYSTS ­JUXTA­ARTICULAR PERIOSTITIS ­ANKYLOSIS RHEUMATOID ARTHRITIS MC SITES: – Hand – Foot – Hip ­ Wrist ­ Knee ­ Cervical spine RHEUMATOID ARTHRITIS HANDS: DIP joints not involved ­ *DDX Irreversible changes – 3­6 months RHEUMATOID ARTHRITIS HANDS: Marginal erosions – MC at: – radial margins of 2nd and 3rd metacarpal heads – Radial margins of the distal and proximal ends of the proximal phalanges RHEUMATOID ARTHRITIS HANDS: – Boutonniere deformity – Swan­neck deformity – Digital ulnar deviation *Zigzag deformity – Carpal radial deviation Boutonniere deformity Swan­neck deformity Zigzag deformity ...
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