joint disease
types:
1-degenerative disease (osteoartheritis )
2- inflammatry disease (still disease ,RA)
3-infective disease (septic artheritis ,TB artheritis )
4-malignant disease (synovioma )
5-traumatic disease
6-congenital disease (displacement hip)
7-abnormal trabecular patteran (behejet disease
classification
Hypertrophic
Hallmarks
Bone production
Sclerosis
Infectious
Hallmark
Destruction of articular cortex
Erosive
Hallmark
Erosions
hypertrophic artheritis
Degenerative arthritis(osteoartheritis)
Primary
Secondary
Charcot arthropathy
primary digenerative artheritis :
Intrinsic degeneration of articular cartilage
Excessive wear and tear
Most commonly hips and knees
sencondary degenerative artheritis:
Another process destroys articular cartilage
Degenerative changes supervene
How to recognize
Atypical locations (knee)
Atypical appearance (Marked DJD of 1 hip)
Atypical age (DJD in 20 year-old)
causes: of 2 degenerative artheritis
Trauma
Infection
Avascular necrosis
CPPD
RA
Hemophilia
osteoartheritis:
RADIOLOGICAL SIGN :
1-normal bone density
2-narrowing of the joint space
3- cyst formation in the bone due to erosion
4-osteolytic lesion
5-sclerosis of the bone later
6-osteophyte formation
charcots artheropathy : 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
X-ray findings
Fragmentation
Soft tissue swelling
Destruction of joint
Sclerosis
Osteophytosis
infectious artheritis:
More common in adults
Usually from local trauma-surgery or accident
Children get osteomyelitis
Destruction of articular cartilage & cortex
Tends to affect one joint (DDx from gout)
Fingers from human bites
Feet from diabetes
erosive artheritis:
Rheumatoid arthritis
Gout
Hemophilia
Erosive osteoarthritis
Rheumatoid variants
Psoriatic arthritis
Reiter s
Ankylosing spondylitis
Inflammatory bowel disease
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
radiological finding:
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
rheumatoid artheritis :
Bilaterally symmetrical
Earliest change: MCP, PIP, ulnar styloid
Radiocarpal jt most commonly narrowed
Periarticular demineralization
Begins MCP jts of 1st and 2nd fingers
psoriatic artheritis:
Almost always accompanies skin disease, especially nail changes
Involves DIP joints of hands > feet
Cup-in-pencil deformity
Resorption of terminal phalanges
No osteoporosis
Reiters syndrome:
Urethritis, arthritis (50%) & conjunctivitis
Periostitis at sites of tendinous insertion
Whiskering
Like DISH, ankylosing spondylitis
Affects feet more than hands .
Resembles RA
Reiter’s also has osteoporosis
ankylosing spondylitis:
HLA-B27 positive
B/L SI arthritis
Squaring of vertebral bodies
Bamboo-spine from continuous syndesmophytes
Peripheral large joint erosive arthritis
inflammatry bowel disease:
Can occur with either Crohn’s or UC
More common with UC
Looks like AS in spine
Asymmetric sacroiliitis
Like psoriasis, TB
Peripheral joint STS without erosions
Large joints usually no erosions
Less commonly shoulders and elbows