1. dr. Sianny Suryawati, Sp.Rad Departemen Radiologi FK UWKS
APPROACH TO ARTHRITIS
dr. Sianny Suryawati, Sp.Rad
Departemen Radiologi FK UWKS

2. Arthritis or Not
DJD
AVN

3. DJD
PVNS

4. Classification HYPERTROPHIC INFECTIOUS EROSIVE Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of articular cortex
EROSIVE
Hallmark : Erosion

5. Normal joint
Normal knee joint

6. HYPERTROPHIC ARTHRITIS
DEGENERATIVE ARTHRITIS
Primary
Secondary
CHARCOT ARTHROPATHY

7. 1° DEGENERATIVE ARTHRITIS
Intrinsic degeneration of articular cartilage
Excessive wear and tear
Osteoarthritis (OA) is more common in the weight-bearing joints (the knee, hip, and spine)
Non-weight-bearing joints, such as the shoulder and elbow, can undergo the same degenerative process.

8. 1° DEGENERATIVE ARTHRITIS
The most common form of arthritis
Primary (idiopathic) form a affects individuals age 50 and older
Secondary form a may be seen in a much younger age group
Patients in the latter group have clearly defined underlying conditions leading to the development of degenerative joint disease

9. OA Pathology

10. Degenerative changes of the joint
NARROWING joint space
OSTEOPHYTES at bone margin
CYSTS formation at subchondral bone
SCLEROSIS at subchondral bone plate

11. 1° DEGENERATIVE ARTHRITIS
X-ray findings :
Narrowing of joint space
Subchondral sclerosis
Marginal osteophyte formation
Subchondral cysts

12. Joint narrowing

13. Osteoarthritis : Joint narrowing + Osteophyte/”lipping”

14. Subchondral sclerosis
Osteoarthritis
Subchondral cyst
Subchondral sclerosis

15. 2° DEGENERATIVE ARTHRITIS
Another process destroys articular cartilage
Degenerative changes supervene
How to recognize
Atypical locations (CPPD and knee)
Atypical appearance (marked DJD of 1 hip)
Atypical age (DJD in 20 year-old)

16. Causes : Trauma Hemophilia Infection Hemochromatosis
Avascular necrosis
Acromegaly
CPPD
Ochronosis RA
Wilson’s disease
Bottom line : Any arthritis can end as DJD

17. HYPERTROPHIC ARTHRITIS
DEGENERATIVE ARTHRITIS
Primary
Secondary
CHARCOT ARTHROPATHY

18. Charcot arthropathy General
Disturbance in sensation leads to multiple microfractures
Pain sensation intact from muscles and soft tissue
Causes :
Shoulders – syrinx, spinal tumor
Hips – tertiary syphilis, diabetes
Feet – diabetes

19. Charcot arthropathy Findings : Fragmentation Soft tissue swelling
Destruction of joints
Sclerosis
Osteophytosis

20. Charcot Arthropathy Complete disorganization of the joint
Fragmentation
Subluxation
The absence of osteoporosis is a characteristic feature of the neuropathic joint

21. Charcot Arthropathy
A 59-year-old woman with long-standing diabetes mellitus presented with neuropathic changes of left ankle joint

22. Classification HYPERTROPHIC INFECTIOUS EROSIVE Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of articular cortex
EROSIVE
Hallmark : Erosion

23. INFECTIOUS ARTHRITIS More common in adults
Usually from local trauma – surgery or accident
Children get osteomyelitis
Destruction of articular cartilage and cortex
Tends to affect one joint (DDx from gout)
Fingers from human bites
Feet from diabetes
Hips from THRs

24. Causes Usually staph – “early” destruction of articular cortex
Rapid course (unlike most arthritides)
TB spreads via bloodstream from lung
More protracted course
In children, spine most common; in adults, knee
Severe osteoporosis
Healing with ankylosis common in both

25. Septic arthritis of toe

26. Classification HYPERTROPHIC INFECTIOUS EROSIVE Hallmarks :
Bone production
Sclerosis
INFECTIOUS
Hallmark : Destruction of articular cortex
EROSIVE
Hallmark : Erosion

27. EROSIVE ARTHRITIS General Synovial proliferation (pannus formation)
Inflammation
Erosions seen in small joints (hands) better than large joints (hips)
Destroy portion of cortex

28. Inflammatory Arthritis

30. EROSIVE ARTHRITIS Bilaterally symmetrical
Earliest change : STS MCP, PIP, ulnar styloid
Radiocarpal joint most commonly narrowed
Periarticular demineralization
Begins MCP joints of 1st and 2nd fingers
Large joints usually no erosions

31. EROSIVE ARTHRITIS Can lead to 2 DJD
Marked narrowing of joint space with intact articular cortex, think of RA
Little or no sclerosis
Especially, hips and knees

32. Normal articular cortex
Erosive Arthritis

33. GOUT : General
Long latent period between onset of symptoms and bone changes
Asymmetric and monoarticular
More common in males
Most common at 1st MT-P joint
Tophi rarely calcify
Olecranon bursitis is common

34. GOUT : Findings Juxta-articular erosions
Sharply marginated with sclerotic rims
Overhanging edges (rat-bites)
No joint space narrowing until later
Little or no osteoporosis
Soft tissue swelling
Tophi not calcified

35. Gouty Arthritis

36. Gouty Arthritis

37. EROSIVE OSTEOATHRITIS
Post menopausal females
Changes like DJD but with marked inflammation and erosions
IP joint of hands and carpal-MCP joint of thumb
DDx : Psoriasis (skin changes)

38. Progression of erosive OA into rheumatoid arthritis

39. PSORIATIC ARTHRITIS
Almost always accompanies skin disease, especially nail changes
Involves DIP joints of hands > feet
Cup-in-pencil deformity
Resorption of terminal phalanges
No osteoporosis

40. REITER’S SYNDROME Urethritis, arthritis (50%) and conjunctivitis
Periostitis at sites of tendinous insertion
Whiskering
Like DISH, ankylosing spondylitis
Affects feet more than hands; also SI joints
Resembles RA
Reiter’s also has osteoporosis

41. ANKYLOSING SPONDYLITIS
HLA-B27 positive
B/L SI arthritis
Squaring of vertebral bodies
Bamboo-spine from continuous syndesmophytes
Peripheral large joint erosive arhtritis

42. Overview HYPERTROPHIC INFECTIOUS Degenerative arthritis
Primary
Secondary
Charcot arthropathy
INFECTIOUS
Pyogenic
Tuberculous

43. EROSIVE RA Gout Erosive osteoarthritis Psoriatic arthritis
Reiter’s syndrome
Ankylosing spondylitis

44. THE END