RADD 2712 Lecture Notes - Midterm Exam Review 1

RADD 2712 Lecture Notes - Midterm Exam Review 1 - SKELETAL...

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SKELETAL RADIOLOGY B MIDTERM ARTHRITIC DISORDERS – continued from Radd A. Inflammatory joint disease – characterized by painful soft tissue swelling of the joints. This category is further divided again based on a laboratory test into rheumatoid types and rheumatoid variants (we will be doing rheumatoid variants in Radd C). o Rheumatoid types – Rheumatoid factor test is positive or potentially positive, so this is an autoimmune disease. Rheumatoid factor is actually IgM in the serum that is reactive to IgG. This includes rheumatoid arthritis, systemic lupus erythematosus, progressive systemic sclerosis/scleroderma, dermatomyositis, and transient viral infections. Rheumatoid types start peripherally in the hands and feet and are 2-3 times more common in females than males. Rheumatoid types are symmetrical and involve small joints. The primary target for rheumatoid arthritis is the synovial membrane. This is the secondary target for other types of arthritis. o Rheumatoid Arthritis (starts on page 1010) – a classic example of an autoimmune disease. 80% of cases are symmetric and bilateral involvement. There is thickening of the joint capsule which produces excess synovial fluid. This leads to hyperemia and soft tissue swelling, pain, and stiffness. This process comes and goes. The repetitious process causes collagenase to form from the chronic inflamed synovial membrane. Collagenase destroys everything uniformly; the hyaline cartilage, and bare bone is eroded. It can completely destroy the joint to the point where it is unrecognizable. Granulation tissue (new capillaries and fibroblasts) begin to form called pannus of granulation tissue when referring to rheumatoid arthritis. Chronic scarring can result in a bony fusion across the joint. There is a 2-3:1 female to male ratio before menopause. Rheumatoid arthritis affects the PIP, MCP, and entire wrist in the hand. The 1 st DIP can be affected, but the 2-5 isn’t (lupus and scleroderma can be in the DIP). All other extremity joints are affected. The spine, especially the upper cervical region is affected in 50-80% of cases or Rheumatoid arthritis. It starts in the small distal joints and moves proximally. Rheumatoid’s target is the synovial membrane. For other arthritic conditions the joint is a secondary target so they are usually milder and less destructive. Rheumatoid arthritis along with lupus and scleroderma can attack the lungs, it is a multisystemic disease.
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Bumps and nodules of subcutaneous granulation tissue along the forearm are indicative of a more severe case (there would be a higher titer of rheumatoid factor). Similar nodules may be found in the lungs. Baker’s cyst – synovial herniation due to increased pressure in the
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RADD 2712 Lecture Notes - Midterm Exam Review 1 - SKELETAL...

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