Radiographic evaluation of arthritis: inflammatory conditions Jon A. Jacobson, Gandikota Girish,...

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