1 / 27

Arthritis of the Hands

Arthritis of the Hands. On the Agenda. Normal Osteoarthitis Rheumatoid arthritis CPPD crystal deposition Gout Psoriatic arthritis. Normal Hand X-ray. Osteoarthritis (DJD). Gradual degeneration of articular cartilage Joint pain relieved with rest

Download Presentation

Arthritis of the Hands

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. Arthritis of the Hands

  2. On the Agenda • Normal • Osteoarthitis • Rheumatoid arthritis • CPPD crystal deposition • Gout • Psoriatic arthritis

  3. Normal Hand X-ray

  4. Osteoarthritis (DJD) • Gradual degeneration of articular cartilage • Joint pain relieved with rest • Morning stiffness resolves within 30 minutes • Traditionally affects DIPs, 1st IP • No systemic symptoms • Painless nodules • Heberden’s at DIPs • Bouchard’s at PIPs

  5. OA – Radiographic findings • Joint space narrowing • Osteophyte formation (white arrow) • Subchondral sclerosis (black arrows)

  6. Joint space narrowing distally • Marginal osteophytes • Relatively unchanged proximal structures

  7. Another example of OA • Oblique and AP views • 1st carpal metacarpal shows decreased joint space and subchondral sclerosis • 2nd and 3rd DIP shows osteophytes and subchondral sclerosis (Heberden’s nodes)

  8. Rheumatoid Arthritis • Systemic inflammatory disease • Affects synovial membranes • Pannus (granulation tissue) develop in joint spaces and erode into the articular cartilage and bone • Prolonged morning stiffness (>1 hr) • PIPs, MCPs, and wrist commonly involved • Symmetric joint involvement

  9. RA radiography - early • Earliest signs include soft tissue swelling due to effusion, tenosynovitis, and edema • Periarticular osteopenia • Marginal erosions often first seen at 2nd and 3rd MCPs and 3rd PIP articulations

  10. Severe erosive changes at radio-ulnar joints carpal bones at the metacarpal heads • Bilaterally symmetric

  11. Advanced RA • Boutonniere (top) • Swan neck • Labs: • +RF in 80%: IgM against Fc of IgG • Elevated ESR • Anemia of chronic disease

  12. RA - Late • Complete MCP involvement • Large marginal erosions have nearly destroyed the joints • Bones are lucent due to osteopenia • Ulnar deviation

  13. RA Bone Scan • Technetium-99 bone scan • Uptake shown in subclinical inflammation of joints • Symmetrical • Polyarticular

  14. Calcium pyrophosphate dihydrate crystals (CPPD) • “Pseudogout” • Associated with metabolic diseases such as hyperparathroidism, hemochromatosis, hypothyroidism • Compared to gout: • Large joints affected (2nd to 5th MCPs, radio-carpal) • Rhomboid crystals • Positive birefringence • Calcification of articular cartilage • No cortical erosions

  15. CPPD • Chondrocalcinosis • Distal radius and MCPs (2nd and 3rd) • Cartilage destruction similar to OA – differentiate by location • Location similar to RA – differentiate by absense of erosions • Calcium deposition at triangular fibrocartilage of the wrist (picture)

  16. CPPD • Diffuse condrocalcinosis at the radiocarpal joint, the MCP joints and the PIP • Joint space narrowing, sclerosis, and subchondral cysts within the carpals

  17. Brief summary so far

  18. Gout • Disorder of purine metabolism – overproduction versus underexcreation • Deposition of urate crystals in joint spaces • Middle-aged men • Acute onset of extreme pain in small joints with redness and swelling • Needle shaped crystals with negative bifringence • Asymmetric, monoarticular

  19. Gout

  20. Gout Radiography • All joints of hand and wrist possible (2nd-5th PIP most common) • Soft tissue swelling • Well demarcated osseous erosions with sclerotic rims and overhanging edges • No decrease in bone density • Tophi not calcified • Relative sparing of joint space until late in the disease • Long latent period between onset of symptoms and radiographic changes

  21. More gout

  22. Psoriatic Arthritis • HLA-B27 positive, RF negative • Inflammatory • Seronegative spondyloarthropathy • Asymmetric and bilateral • Primarily distal involvement associated with nail changes • No periarticular osteoporosis • Five different patterns • Usually accompanies skin disease

  23. Psoriatic Arthritis – Rad findings • Asymmetric proliferative erosions with ill-defined margins • Periosteal reaction • Soft tissue swelling • “Pencil-in-cup” deformity • Resorption of distal phalangeal tufts • Subluxation

  24. Psoriatic arthritis

  25. All done. Any questions?

  26. Source • http://rad.usuhs.mil/medpix • Additional listed on request

More Related