FILM QUIZ I

3 SEP 2021
OSTEOARTHRITIS
 OSTEOARTHRITIS
• Non-inflammatory degeneration of joint cartilage with secondary effects on
adjacent bone.
• M/C form of arthritis.
• Pain, stiffness, crepitus, deformity, and swelling
• 3 types identified
- Primary: unknown cause, 5th–6th decade, females 10:1, weight-bearing
joints.
- Secondary: known cause, 2nd–6th decade, equal sex distribution, any joint.
- Erosive osteoarthritis: inflammatory cause, 4th–5th decade, females 3:1,
interphalangeal joints.
 OSTEOARTHRITIS
Target sites
• Hand: IP>MCP joint
• Wrist: 1st CMC, trapezioscaphoid joint
Radiologic Features
 Radiologic Features
Wrist
• 1st CMC joint
• Radial subluxation of 1st MCP base
Hand
• Interphalangeal joints
• Enlargement of degenerating joints
- Heberden’s nodes -> DIP joints
- Bouchard’s nodes -> PIP joints
Diffuse marginal osteophyte

joint space narrowing

Subchondral bone sclerosis

FILM QUIZ II

3 SEP 2021
RHEUMATOID ARTHRITIS
 RHEUMATOID ARTHRITIS
• Systemic connective tissue disease targets synovial tissue
• Resulting in a widespread inflammatory polyarticular process.
• M/C in women aged 30–60 years.
• Symmetric peripheral joint pain and swelling
• Later deformities: ulnar deviation, boutonniere, swan neck
 RHEUMATOID ARTHRITIS
Target sites in hands
• MCP, PIP, midcarpal, radiocarpal, and DRUJ
• Predilection for the ulnar styloid process
• Bilateral and fairly symmetric
• May isolated carpal joint
• DIP less frequent, mild and rarely occur
• Earliest changes most in 2nd and 3rd MCP joints
and 3rd PIP joint
Radiologic Features
Marginal erosion

Juxtra-articular osteoporosis
Radiologic Features
 Radiologic Features
• Joint subluxation
• Volar subluxation of MCP join
 Diffuse periarticular osteopenia Boutonniere deformity

joint space narrowing

Bone erosions

Soft tissue swelling

Volar subluxation

2nd OA: Subchondral bone sclerosis, marginal osteophytes

at radiocarpal, ulnocarpal and distal radiocarpal joints.
Positive ulnar variance.
Ankylosis
FILM QUIZ III

3 SEP 2021
PSORIATIC ARTHRITIS
 PSORIATIC ARTHRITIS
• Seronegative spondyloarthropathy
• 10%–15% skin psoriasis will develop psoriatic arthritis
• Causes: Environmental and hereditary factors
 PSORIATIC ARTHRITIS
Target sites
• DIP, PIP of hands and feet
• MCP of hand, MTP of feet
• Calcaneus, SI joint, Spine
 Radiologic Features
• Signs of inflammatory arthritis DIP narrowing
• Bilateral or unilateral
• Symmetric or asymmetric
• Distal joint distribution
• Sausage digit = Involve several
joints in a single digit with soft
tissue swelling Soft tissue swelling

• Irregular bone proliferation =

“fuzzy” appearance or “whiskering”
Bone proliferation and
Periostitis
 Radiologic Features
• Several form periostitis
- Thin periosteal layer of new
bone adjacent to the cortex
- Thick irregular layer
- Irregular thickening of the
cortex itself
• May occur in an area without bone
erosions; such as site is the radial
aspect of the wrist extending into
the first metacarpal bone.
 Radiologic Features
• “Pencil in cup” = Bone destruction
involved joint, non-specific, but
commonly seen
• Sclerosis, enthesitis, periostitis, and
soft-tissue swelling
• Subluxation
• Tuft resorption: distal phalanx of
hand and feet

Tuft resorption
 Pencil in cup

Periarticular osteopenia

Periostitis
FILM QUIZ IV

3 SEP 2021
GOUTY ARTHRITIS
 GOUTY ARTHRITIS
• Disorder of purine metabolism: hyperuricemia leads to sodium monourate
crystals deposit into cartilage, synovium, periarticular, and subcutaneous
tissues.
• 4th and 5th decades, M>F
• Primary > secondary causes
• 4 stages apparent
- Asymptomatic hyperuricemia
- Aute gouty arthritis (especially at 1st MTP joint)
- Polyarticular gouty arthritis (chronic, long-standing disease)
- Chronic tophaceous gout (soft tissue accumulations)
 GOUTY ARTHRITIS
Target sites
• 1st MTP, other MTP joints, hands, and wrists
• Spine and sacroiliac
 Radiologic Features
• Tophi
• Preservation of joint space
• Bone erosions (marginal,
periarticular overhanging margin
sign, intraosseous)
• Normal bone density
• Periosteal new bone, secondary
degenerative joint changes,
chondrocalcinosis, and avascular
necrosis.
Bone destruction

Bone erosions (overhanging margin)

Periarticular soft tissue swelling

Preserve joint space

FILM QUIZ V

3 SEP 2021
CPPD ARTHROPATHY
 CPPD
• Inflammatory joint disease caused by deposition of CPPD into the synovial
fluid, linings, and articular cartilage.
• > 30 years of age, M=F
• Usually affects knees, wrists, and hands.
• Asymptomatic cases (20%)

Target sites
• M/C knee, wrist, and MCP joints
 Radiologic Features
• M/C sign: Cartilage calcification (chondrocalcinosis)
• Degenerative articular changes, except unusual articular distribution
• Unusual intraarticular distribution: prominent subchondral cysts, bone
destruction, and variable osteophyte size. (Patellofemoral,radiocarpal)

Wrist
• Chondrocalcinosis of the triangular fibrocartilage and the hyaline cartilages
of the entire carpus.
• Advanced involve in radiocarpal compartment. -> Scaphoid moves
proximally, Lunate moves distally
Radiologic Features
TFC Chondrocalcinosis