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Arthritis/DJD
Arthritis/DJD
186
Anatomy
Professional
12/10/2012

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Term
periarticular site of tendon or ligament insertion into bone
Definition
enthesis
Term
involves more than four joints
Definition
polyarticular
Term
involving two to four joints
Definition
pauciarticular
Term
involving a single joint
Definition
monoarticular
Term
extension of cortical bone at the site or periarticular ligament insertion indicating degeneration
Definition
osteophyte
Term
ossification of a spinal ligament; indicates the inflammatory process
Definition
syndesmophyte
Term
spinal osteophyte
Definition
spondylophyte
Term
spinal inflammatory arthritis
Definition
spondyloarthropathy
Term
inflammatory arthritis without rhumatoid factor
Definition
seronegative arthritis
Term
seronegative arthritides that stimulate rheumatoid arthritis clinically but not radiographically or pathologically
Definition
rheumatoid variants
Term
what is the most common arthritis?
Definition
osteoarthritis (DJD)
Term
___ most commonly involves finger joints and weight bearing joints (won't affect ankles unless trauma is present)
Definition
DJD
Term
Asymmetric destruction, non uniform loss of articular space, osteophytes, subchondral sclerosis, subchondral cysts, interarticular loose bodies, intra-articular deformity, and joint subluxation is characterized by
Definition
DJD
Term
Eburnation is a form of
Definition
subchondral sclerosis
Term
The most common area of intra-articular deformity is __
Definition
hip
Term
DJD in males is more common in ages
Definition
less than 45
Term
DJD in females is more common in ages
Definition
greater than 45
Term
what is the most common cervical degenerative spondylolisthesis
Definition
C7 anterolisthesis
Term
Calcification of the anterior annulus is ___
Definition
intercalary bone
Term
where do osteophytes normally form in the hip joint
Definition
superolateral acetabular rim or at the lateral and inferomedial surfaces of the femoral head
Term
Where is DJD typically found in the knee joint
Definition
medial femorotibial
Term
What is a common feature of DJD of the knee joint
Definition
sharp tibial emminence
Term
Where is DJD most common in the foot
Definition
first MTP joint
Term
What is the measurement for the GH joint
Definition
4-5
Term
Where is DJD most commonly found in the shoulder
Definition
AC Joint
Term
GH DJD is most commonly found
Definition
after trauma
Term
Loose bodies and a compromised joint space secondary to trauma is DJD commonly found in the
Definition
elbow
Term
DJD of the hand and wrist is commonly found in the
Definition
1st CMC (metacarpal/trapezium)
Term
Where are herberden nodes found
Definition
DIP JOINTS
Term
Where are bouchards nodes found
Definition
PIP Joints
Term
Do not confuse herberdens nodes and bouchards nodes with
Definition
seasmoid bones
Term
Herberden nodes and bouchards nodes represent
Definition
hypertonic changes
Term
What are the 2 types of arthritis?
Definition
non inflammatory
inflammatory
Term
What are 2 types of non inflammatory arthritis
Definition
DJD
DISH
Term
What are 8 common sites affected in DJD
Definition
wrist, hip, knee, PIPs, cervical spine, lumbar spine, thoracic spine, toes
Term
What are 8 radiological features of DJD (name 5 on test)
Definition
Asymmetrical distribution
Non uniform loss of articular space
Osteophytes
Subchondral sclerosis
Subchondral cysts
Intra-articular loose bodies (joint mice)
Intra- articular deformity
Joint subluxation
Term
Thin disc without osteophytic changes is characteristic of ___
Definition
DJD
Term
Really large osteophytes are characteristic of
Definition
claw osteophyte
Term
Radiolucency within the disc is characteristic of
Definition
gas
Term
Degree of degenerative changes ___ correlate with pain
Definition
does not
Term
Posterior translation of the vertebrae
Definition
retrolisthesis
Term
What are 3 radiological features of SI joint DJD
Definition
narrowing of joint space
subchondral sclerossis iliac side of SI joint first
osteophytes
Term
What are 5 radiological features of Hip DJD
Definition
non uniform joint space narrowing
osteophytes
subchondral sclerosis
subchondral cysts
deformity
Term
Most common site of hip DJD
Definition
superior lateral
Term
Knee DJD radiological features
Definition
hypertrophy and spurring of bone and erosion of the cartilage
Term
Where does knee DJD usually start
Definition
medial compartment
Term
What are 6 radiological features of knee DJD
Definition
decreased medial compartment
Osteophytic changes (tibial eminence, adjacent medial)
Subchondral sclerosis
Subchondral cysts
Loose Bodies
Subluxations
Term
Ankle DJD is
Definition
not a typical location
Term
Radiological features of DJD of the ankle
Definition
Non uniform loss of joint space
Subchondral sclerosis
Subchondral cysts
Loose Bodies
Subluxations
Term
What toe is usually involved in DJD of the foot
Definition
big toe
Term
Radiological features of DJD of the foot
Definition
Non uniform loss of joint space
Subchondral sclerosis
Osteophytes
Loose Bodies
Term
When is there DJD of the shoulder
Definition
it is non typical unless there is trauma
Term
Radiological features of DJD of the shoulder
Definition
Subchondral sclerosis
Subchondral cysts
Loose Bodies
Subluxations
Osteophytic changes (inferior)
Term
Elbow DJD is usually seen
Definition
secondary to trauma
Term
Where in the wrist is there usually DJD changes
Definition
1st carpal metacarpal articulation
Term
DJD of the hands will show __ on the DIPs
Definition
heberden's nodes
Term
DJD of the hands will show ___ on the PIPs
Definition
Bouchards Nodes
Term
RA of the hands is seen typically at the
Definition
PIPs and MCPs
Term
Diffuse Idiopathic Skeletal Hyperostosis is aka these 6 names
Definition
Spondylolitis ossificans liamentosa
Spondylosis hyperostotica
Physiological vertebral ligamentous calcification
Generalized juxta-articular ossification of ligaments of the vertebral column
Ankylosing hyperostosis of the spine
Forestiers Disease
Term
Two target sites of DISH
Definition
Cervical spine
Thoracolumbar spine
Term
What are 3 clinical features of dish
Definition
spinal stiffness
mild local pain and discomfort
dysphagia (later)
Term
Up to 30% of patients with dish will present with
Definition
diabetes mellitus
Term
Radiologically with dish the disc space will be
Definition
preserved
Term
Disease of the spine that shows exuberant hyperostosis, ligament calcification/ossification, periostitis at ligament attachments
Definition
DISH
Term
Exuberant hyperostosis will appear as
Definition
flowing candle wax
Term
In the cervical spine what also can go under calcification with DISH
Definition
PLL
Term
In a patient with dish where would you see a sharp claw like osteophyte in the joint space
Definition
pubic symphysis
Term
Destructive articular disease that is secondary to loss or impairment in joint proprioception
Definition
neurotrophic arthropathy
Term
Joint undergoes premature and excessive traumatic degenerative changes that lead to severe destruction and instability
Definition
neurotrophic arthropathy
Term
What are the 3 etiologies of neurotrophic arthropathies
Definition
congenital
iatrogenic
acquired
Term
What are 7 things that can cause neurotrophic arthropathy
Definition
diabetes mellitus
neurosyphillis
alcoholism
syringomelia
multiple sclerosis
Trauma
Tumor
Term
What are the 4 areas that neurotrophic arthropathies commonly affect
Definition
shoulder, hips, knee, feet
Term
Recurrent joint effusion is the classical sign of
Definition
neurotrophic arthropathy
Term
What are 3 red flags of neurotrophic arthropathy
Definition
altered gait
loss of deep tendon reflex
pain insensitivity
Term
6 D's of hypertrophic neurotrophic arthropathy
Definition
distended joint
density increased
debris production
dislocation
disorganization
destruction
Term
Reabsorbed articular joint, tapered bone ends, licked candy stick appearance are features of
Definition
Atrophic neurotrophic arthropathy
Term
Benign arthropathy that is characterized by synovial tissue producing foci of cartilage in an asymmetrical pattern
Definition
Synoviochondrometaplasia (SCM)
Term
Patient presents with insidious onset of intensifying pain, crepitus with locking, and swelling
Definition
SCM
Term
Most common joints affected with SCM
Definition
knee
hip
ankle
elbow
wrist
Term
3 Radiological features of SCM
Definition
Loose bodies (round, ovoid, smooth, laminated, stippled, internal trabeculae)
DJD
Occasional extrinsic bone erosions
Term
Progressive Disease of unknown etiology that targets the synovial tissues
Definition
Rheumatoid Arthritis
Term
Onset of RA is
Definition
20-60
Term
Who is more commonly affected by RA
Definition
Females 3:1
Term
Patient presents with an insidious onset of morning stiffness with pain/tenderness with movement. There is viewable soft tissue swelling of at least 2 joints bilaterally
Definition
RA
Term
RA is an
Definition
autoimmune disease
Term
DJD is an
Definition
wear and tear disease (injury, age, etc)
Term
Onset usually between 30-50 but can occur at any age
Definition
RA
Term
Usually middle aged 40-60
Definition
DJD
Term
Joint pain, swelling, stiffness, decreased ROM, fever, fatigue, and loss of energy
Definition
RA
Term
Joint stiffness, pain , decreased ROM
Definition
DJD
Term
Worse in the morning or after long rest and lack of activity
Definition
RA
Term
Tends to get worse with activity throughout the day
Definition
DJD
Term
Approx 1.3 million people in the USA have __
Definition
RA
Term
Approx 21 million people in the USA have ___
Definition
DJD
Term
RA is different than DJD in the hands because it tends to affect the
Definition
PIPs and MCPs
Term
OA in the hands will affect the
Definition
DIPs and PIPs
Term
Labs with RA will show
Definition
elevated ESR
70% rheumatoid factor
Increased CRP
Anemia
Term
RA will have a ___ distribution
Definition
symmetrical
Term
6 radiological features of RA
Definition
soft tissue swelling (synovial edema) and mass
juxta articular osteopenia (hyperemia)
marginal erosions (pannus erosions)
ankylosis
deformity
juxta articular periosteal new bone
Term
In RA the joint space loss will be
Definition
uniform
Term
is it possible to have RA with OA
Definition
yes but it isn't very common
Term
Deformity of the extension of the joint
Definition
boutonniere deformity
Term
Deformity of the flexion of the joint
Definition
Swan neck deformity
Term
RA of the shoulder will have
Definition
erosion of the superior humeral head (osteopenia
Term
SI joints with RA will have
Definition
bilateral uniform loss of joint space
pitting
Term
D/D of unilateral sacroilitis
Definition
Reiters
Psoriatic
Term
Bilateral protrusio acatabuli with increased teardrop distance
Definition
RA of the Hip
Term
Knee xray with RA will have
Definition
uniform loss of joint space with pannus formation
Term
A patient with RA of hands it is important to check for ___ before adjusting
Definition
transverse ligament instability
Term
RA of the cervical spine will have
Definition
erosion of the dens (anterior and posterior)
anterior arch erosion
posterior tubercle erosion
Term
Chronic sero - inflammatory disorder of the axial skeleton of unknown etiology
Definition
Ankylosing spondylitis
Term
Onset of AS
Definition
15-35
Term
Genetic predisposition of AS
Definition
males 10:1
Term
AS initially begins in the
Definition
SI joints
Term
After the SI joints AS will travel to
Definition
throacolumbar
Term
Complications of AS
Definition
Iritis
Aortitis
Valvular incompetence
Aneurysms
Conduction blocks
Upper pulmonary fibrosia
Inflammatory bowel disease
Renal Failure
Carrot Stick fx
Andersson's lesion
Term
Labs of AS
Definition
Elevated ESR
Mild anemia
Positiive HLA B27
Negative RA latex (sero -)
Term
Target sites of AS
Definition
SI
Throacolumbar
Pubic symphysis
cervical spine
shoulders
hips
heels
Term
Sage 1 features of AS
Definition
pseudo widening of the SI joints
Term
Stage 2 features of AS
Definition
Erosion and sclerosis (pitting)
Term
Stage 3 features of AS
Definition
ankylosis
Term
Can you adjust a patient in the inflammatory phase of AS
Definition
No it will make it worse
Term
SI Joints presenting with AS will be
Definition
bilateral and symmetrical
Term
Osteitis of the vertebral bodies with AS will show
Definition
romanus lesions
sclerosis (shiny corner sign)
marginal syndesmophytes (bamboo spine, poker spine)
Term
Apophyseal joints presenting with AS will show
Definition
Erosions
sclerosis
ankylosis
Term
Fusion of the apophyseal joints with AS will show a ___ sign
Definition
trolly track sign
Term
A single central radiodense line on frontal radiographs going down through the spinous process
Definition
Dagger sign seen in AS
Term
Hips presenting with AS will be
Definition
bilateral symmetrical
protrusio acatabuli
eventual ankylosis
erosions, periostitis at trochancters, ischial tuberosities
Term
Shoulders presenting with AS will have erosions
Definition
lateral humeral head
ankylosing of distal clavicle
periostitis greater tuberosity, AC ligament
Term
Heels presenting with AS will have
Definition
erosions, localized osteopenia, periostitis at the achilles and plantar aponeurosis insertions
Term
Whiskering of the cortical margins of bone
Definition
periostitis
Term
___ Arthritis is associated with inflammatory bowel disease
Definition
Enteropathic
Term
Enteropathic arthritis will not go to the ___
Definition
cervical spine
Term
Enteropathic arthritis is the same as
Definition
AS but it does not go to the cervicals
Term
Sero - arthritis that will show silvery scaly skin manifestations on the forearm, knee, back
Definition
Psoriatic
Term
Onset of psoriatic
Definition
20-50
M=F
Term
Psoriatic of the hands affects the
Definition
DIP and PIP
Term
Tapered bone ends in psoriatic arthritis is known as
Definition
pencil and cup deformity
Term
In DJD there is proliferation of bone, in psoriatic arthritis there is
Definition
taking away of bone
Term
Arthritis mutilans of psoriatic arthritis is
Definition
fusion of digits
Term
Psoriatic arthritis of the hips is
Definition
bilateral but asymmetric
Term
Psoriatic arthritis will show not bilateral or symmetrical ___ syndesmophytes
Definition
non marginal
Term
Also called reactive arthritis
Definition
Reiters Syndrome
Term
Reiters is defined by
Definition
urethritis, conjunctivitis, polyarthritis
Term
The most common etiology of Reiters
Definition
venereal
Term
Genetic predominance of Reiters
Definition
Male (50:1)
Term
Target site of Reiters
Definition
Unilateral SI, toes, feet, knee
Term
Less common sites of Reiters
Definition
throacolumbar, cervical
Term
Labs of Reiters
Definition
Elevated ESR
Anemia
Leukocytosis
HLA b27 sero -
Term
Reiters has a predilection for the
Definition
lower extremity
Term
Soft tissue swelling, osteoporosis, uniform loss of joint space, marginal erosions, periostitis, deformity, non marginal syndesmophytes
Definition
Reiters
Term
chronic connective tissue disorder
Definition
SLE
Term
most common characteristic of SLE occurs in the
Definition
hands
Term
Radiological features of SLE
Definition
demineralization of bone
calcinosis circumscripta (elbows, forearms, shoulder)
diffuse soft tissue calcification
AVN if chronic
Term
Generalized systemic inflammatory connective tissue disease that builds up collagen in skin and other organs
Definition
scleroderma
Term
Scleroderma commonly affects
Definition
30-50 year old females
Term
Scleroderma patients will have ___ phenomenon
Definition
raynauds
Term
Radiological features: retraction, tapered fingers, calcification, bone reabsorbtion
Definition
scleroderma
Term
Patient <30 with with intra articular calcifications, chondrocalcinosis
Definition
CPDD (pseudogout)
Term
Calcium Pyrophosphate Deposition Disease is most commonly in the
Definition
wrist, knee, ankle
elbow, shoulder, hip
Term
OCI is more common in
Definition
Males 20-40
Term
OCI presents
Definition
bilateral although not symmetrical
Term
Bilateral opaque areas on the illium on the side of the SI joint with pain association is known as
Definition
OCI
Term
Patient presents with peripheral arthritis, digital clubbing, long bone periostitis
Definition
Hypertrophic Arthropathy
Term
Target sites of hypertrophic arthropathy
Definition
long bones of arms and legs
Term
Most common cause of hypertrophic arthropathy
Definition
bronchogenic carcinoma
Term
Arthritide known as the disease of kings
Definition
gout
Term
Gout is induced by deposits of
Definition
sodium monourate
Term
aggreagation of sodium monourate crystals
Definition
tophi
Term
gout has a predilection to the
Definition
feet
Term
The clinical presentation of gout is seen in
Definition
males 20:1 greater than 40
Term
4 stages of gout
Definition
asymtomatic
acute
polyarticular
chronic
Term
Target sites of gout
Definition
big toe
wrist
elbow
Term
radiographic features of gout
Definition
dense soft tissue tophi
preservation of joint space
juxta articular erosions
marginal erosions
intraosseous erosions
normal bone density
periosteal new bone
secondary DJD
chrondrocalcinosis
AVN
Term
Labs seen in gout
Definition
Elevated ESR
Leukocytosis
Hyperuricemia
Term
Tendinitis, bursitis, and joint pain
Definition
HADD
Term
HADD is commonly seen in patients
Definition
women 40-70
Term
HADD commonly affects a single joint and the most common one being
Definition
the shoulder
Term
Clinical feature of HADD
Definition
pain tenderness, localized swelling, decreased ROM
Term
Target sites of HADD
Definition
shoulder, hip, cervical spine, elbow , wrist, lumbar spine
Term
Supraspinatous tendon seen with HADD is seen on
Definition
external rotation
Term
Infraspinatous tendon seen with HADD is seen on
Definition
internal rotation adjacent to the greater tuberosity
Term
Subscapularis tendon seen with HADD is seen on
Definition
internal rotation, adjatcent to the lesser tuberosity
Term
The hip joint most common affected tendon is
Definition
gluteus maximus seen below the greater trochanter
Term
HADD of the spine is seen on
Definition
longus coli anterior to C1 and C2
Term
Pelligrini Steida is HADD of the
Definition
medial collateral ligament
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