256   |   Recognizing Joint Disease: An Approach to Arthritis

TABLE 25-2 CLASSIFICATION OF ARTHRITIS

Category Hallmarks Types Remarks

Hypertrophic Bone formation Primary osteoarthritis Most common; mechanical stress; hands, hips, and knees most
arthritis Osteophytes common
Secondary osteoarthritis Degenerative joint disease (DJD) secondary to prior trauma or
avascular necrosis
Charcot arthropathy Fragmentation; joint destruction; sclerosis; most often
secondary to diabetes
Calcium pyrophosphate Chondrocalcinosis; DJD in unusual sites
deposition disease
Erosive Erosions Rheumatoid Carpals, metacarpal-phalangeal joints, proximal
arthritis interphalangeal joints of hands; osteoporosis; soft tissue
swelling
Gout Juxtaarticular erosions with overhanging edges; long latency;
metatarsal-phalangeal joint of big toe; no osteoporosis
Psoriatic Juxtaarticular erosions of distal interphalangeal joints of
hands; pencil-in-cup deformity; enthesophytes
Hemophilia Remodeling from hemarthroses and hyperemia; same changes
in knee in female—think of juvenile rheumatoid arthritis
Ankylosing spondylitis HLA B27+; bilateral sacroiliac (SI) joints; syndesmophytes
Seronegative Rheumatoid factor negative; HLA B27+; SI joints;
spondyloarthropathies syndesmophytes; reactive, psoriasis
Infectious Osteopenia and soft tissue swelling; Pyogenic Early destruction of articular cortex; osteoporosis
arthritis early and marked destruction of Tuberculosis Gradual and late destruction of articular cortex; marked
most or all of the articular cortex osteoporosis

HYPERTROPHIC ARTHRITIS
■ Hypertrophic arthritis is typified by bone formation and
includes:
♦ Osteoarthritis (degenerative arthritis, degenerative
joint disease), which is further divided into:
• Primary osteoarthritis
• Secondary osteoarthritis
♦ Erosive osteoarthritis
♦ Charcot arthropathy (neuropathic joint)
♦ Calcium pyrophosphate deposition disease (CPPD)

Primary Osteoarthritis (Also Known as Primary

Degenerative Arthritis, Degenerative Joint
Disease—DJD)
■ This is the most common form of arthritis, estimated to
affect over 20 million Americans. It results from intrinsic
degeneration of the articular cartilage, mostly from the
mechanical stress of excessive wear and tear in weight-
bearing joints.
■ It mostly involves the hips, knees, and hands and increases
in prevalence with increasing age.

The imaging findings in osteoarthritis (Fig. 25-4):

♦ Marginal osteophyte formation. A hallmark of
hypertrophic arthritis, osseous transformation of
cartilaginous excrescences, and metaplasia of synovial
lining cells leads to the production these bony
protrusions at or near the joint.
♦ Subchondral sclerosis. This is a reaction of the bone
to the mechanical stress to which it is subjected when
its protective cartilage has been destroyed.
♦ Subchondral cysts. As a result of chronic impaction,
necrosis of bone, and/or imposition of synovial fluid
FIGURE 25-4 Osteoarthritis. The hallmarks of osteoarthritis are demonstrated in this patient’s
right hip. There is marginal osteophyte formation (solid white arrows), a process by which there is
osseous transformation of cartilaginous excrescences, and metaplasia of synovial lining cells leading
to the production of bony protrusions at or near the joint. There is also subchondral sclerosis (solid
black arrows), representing reaction of the bone to the mechanical stress to which it is subjected
when its protective cartilage has been destroyed. There is also subchondral cyst formation (dotted
black arrows).

https://kat.cr/user/Blink99/
 Recognizing Joint Disease: An Approach to Arthritis   |   257

A B
FIGURE 25-5 Osteoarthritis of hip (A) and knee (B). In osteoarthritis destruction of the cartilaginous buffer between the apposing bones of a joint leads to narrowing of the joint space usually on the
weight-bearing side of the joint. A, In the hip, the superior and lateral surface is weight-bearing and is therefore most affected (white arrow), whereas in the knee (B), the medial compartment is weight-bearing
and more affected (black arrow).

A B
FIGURE 25-6 Osteoarthritis of the hands. A and B, In the hands osteoarthritis affects primarily the distal and then proximal interphalangeal joints. There are osteophytes at the distal and proximal pha-
langeal joints (white arrows), and the joint spaces are narrowed (both A and B). There is also subchondral sclerosis present at the carpal-metacarpal joint of the thumb (black arrow). Osteoarthritis of the hands
occurs most often in older women.

into the subchondral bone, cysts of varying sizes form to affect the distal interphalangeal joints, especially in
in the subchondral bone. older females.
♦ Narrowing of the joint space. Seen in all forms of
arthritis. Secondary Osteoarthritis (Secondary
■ What joints are involved? Degenerative Arthritis)
♦ In osteoarthritis, destruction of the cartilaginous buffer ■ Secondary osteoarthritis is a form of degenerative arthritis
between the apposing bones of a joint leads to of synovial joints that occurs because of an underlying,
narrowing of the joint space most often on the predisposing condition, most frequently trauma, that
weight-bearing side of the joint: hip (superior and damages or leads to damage of the articular cartilage.
lateral) and knee (medial) (Fig. 25-5). ■ The radiographic findings of secondary osteoarthritis are the
♦ In most patients with osteoarthritis of the same as those for the primary form, with several special clues
interphalangeal joints of the hands, the first to help suggest secondary osteoarthritis:
carpometacarpal joint (base of thumb) is also ♦ It occurs at an atypical age for primary osteoarthritis
affected (Fig. 25-6). It is also common for osteoarthritis (e.g., a 20-year-old with osteoarthritis) (Box 25-1).

https://kat.cr/user/Blink99/