Osteo arthritis and inflammatory

arthritis

Dr.Yanto Budiman. Sp.Rad, M.Kes

Bagian Radiologi FK/RS. Atma Jaya
• Divided into 2 class
– Degenerative join disease (Osteoarthritis)
– Inflammatory join disease (Rheumatoid
arthritis, Gout, Psoriasis athritis, spondylitis
Angkylosing, etc.)
Imaging modality for arthritic disease

• Plain films - cortical bone changes such as

erosions / osteophytes.
• USG -evaluating articular cartilage-
inflammation, erosions
• Magnetic resonance imaging (MRI)- early
changes such as cartilage thinning, early
marrow edema, or synovial inflammation
Osteo Arthritis
• DEGENERATIVE JOINT DISEASE
• Predilection : major weight bearing joints (
hip and knee), PIP, DIP of hand, wrist
involvement at the base of the thumb in a
trapezocentric distribution. MTP 1st
• unilateral and asymetric distribution.
• Sign of plain radiograph :
– Osteophytes, *in hand - Heberden’s nodes
(DIP), Bouchard’s nodes (PIP)
– narrowing of joint space,
– bone sclerosis,
– subchondral cysts
OA hand Plain radiograph of the finger
shows both Heberden’s node ( arrow ) and
Bouchard’s node ( arrowhead )
OA-knee
MRI-Non-invasive cartilage
assessment ( Cartigram )
MRI :defect of the cartilage in the medial facet of the
patela, subchondral edema, and a large joint
effusion.
OA

• Knee-MRI T1 Coronal plane , showing small

osteophyte and loss of cartilage in medial femorotibial
Rheumatoid Arthritis
• inflammatory joint condition –usually
billateral and simetrical

• Most common inflammatory arthritis, 1% of

the population, 2-3:1 female to male ratio,
peak incidence between ages 40 to 60

• Onset usually insidious over months

RA
• Plain radiograph finding :
– Marginal erosions and subchondral cysts
formation.
– Joint space narrowing due to destruction of the
articular surface
– Osteoporosis that can be generalized or focal
(juxta-articular),
– Boutonnière deformity, Swan-neck deformity,
Hitchhiker thumb deformity, Hitchhiker thumb
deformity. Opera-glass hand. Hammer-toe
deformity
RA
– Predilection : the carpal/tarsal, carpometacarpal
/tarsometatarsal,metacarpophalangeal/metatarso
phalangeal, and proximal interphalangeal joints
. rare for the distal interphalangeal joints to be
affected. In spine : C1-2
– Subluxations and mal-alignments at the MCP
and MTP joints are typical. The subluxations
tend to deviate the phalanges in the ulnar
direction
RA- Joints Commonly Involved
MCP 1st and 4th Narrowing joints space
.

16
Marginal Erosion

17
Rheumatoid Arthritis – marginal Erosion
• RA- shows multiple erosion in carpals bones- Plain
radiograph and MRI
RA hip joints - symmetric

20
Sela sendi menyempit merata

21
Osteoporosis juxta-artikular

22
 Rheumatoid arthritis
a. Classical RA sign : marginal
eosions, joint space narrowing
and osteoporosis
b. Boutonniere deformity
c. Hitchhiker thumb deformity

a.

b.

c.
Ankylosing Spondylitis

• (Marie–Strümpell Disease)
• a chronic, progressive infl ammatory
disease of unknown origin that affects the
axial skeleton (vertebral column plus the
pelvis), and is characterized by bilateral
sacroiliitis, stiffness of the axial joints
(ankylosis), and syndesmophytes formation.
• 3:1 male to female ratio
AS
• Plain radiograph finding
– Sacroiliitis involvement (90 % billateral)
– Vertebral bodies squaring ( caused by
enthesitis)
– Syndesmophytes (ossifications of the annulus fi
brosus–longitudinal ligament complex as a
healing process after enthesitis.)
– Dagger sign, Trolley track sign
 AS

a. b.

• Anteroposterior plain radiograph of the hip of a patient,

a. Early AS, shows Sacroileitis, b. advanced ankylosing
spondylitis (AS) shows complete sclerosis of the
sacroiliac joints bilaterally ( arrowheads )
Ankylosing spondylitis: lumbar vertebrae,
bamboo spine
 AS
• Anteroposterior plain
radiograph of the thoracic
vertebrae shows the dagger
sign
Gout Arthritis
• hyperuricemia with deposition of uric acid
monocrystals in the synovial fluid
inflammation  arthritis
• Clasically involves first MTP joint. ( more
than one joint may be involved- hand, feet,
elbow)
• Radiograph finding
– Gout erosion : "overhanging margin," with a rim of
eroded cortex hanging over a soft tissue density
called a "tophus."
Gout Arthritis

31
Gout Arthritis
• Tophi in MTP 1st –
shows overhanging
erosions
Gout
Psoriatic Arthritis
• Associated with psoriasis
• Tends to involve DIP of both hands, involve
multiple joints of single hand, single ray
joints.
• No/minimal osteoporosis, marginal
erosions, periosteal reaction, intraarticular
osseous excrescences
PsA
• Plain radiograph findings
– Osteoporosis is mild or absent
– Bony erosions
– Pencil and cup deformity
– Sausage fingers or toes, Ivory phalanx
Psoriatic Arthritis
Systemic Lupus Erythematosus (SLE)
• Autoimmune disease  autoantibodies and
immune complexes damage organs, tissue
and cells.
• Musculo sceletal manifestation :
polyarthritis, Joint deformities (hands and
feet) occur in (10%) no evidence of bone
or joint destruction, Myositis.
Classifitcation Criteria for theDiagnosis of SLE
Malar Rash Fixed erythema, flat or raised, over the malar eminences
Discoid rash Erythematous circular raised patches with adherent keratotic scaling and
follicular plugging
Photosensitivity Exposure to ultraviolet light causes rash
Oral ulcers Oral and pharyngeal ulcers
Arthritis Non-erosive arthritis of two or more peripheral joints, with
tenderness, swellling or effusion
Serositis Pleuritis or pericarditis
Renal disorder Proteinuri > .5g/dL or ≥ 3+, or cellular casts
Neurologic disorder Seizures or psychosis without other causes
Hematologic disorder Hemolytic anemia, leukopenia, trombocytopenia
Immunologic disorder Anti ds.DNA, anti-Sm, and/or anti phospholipid
Anti nuclear antibodies Abnormal titer of ANA
SLE
Systemic Sclerosis
• Scleroderma
• chronic systemic autoimmune diseases
characterized by fibrosis (or hardening),
vascular alterations, and autoantibodies.
• Musculosceletal : polyarthritis (fingers and
knees) , myositis, resorption of bone (
phalanges, ribs, clavicle, angle of mandible)
Sign on plain radiograph :
• subcutaneous soft tissue calcification
• Shortening and resorption of distal phalanges.
• resemble to rheumatoid arthritis
Scleroderma
Scleroderma

Calcinosis and Acroosteolysis

• Thank You