Rheumatoid arthritis x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]


The hallmark of rheumatoid arthritis is soft tissue swelling, joint space narrowing, and erosions. Hand and wrist findings on xray include subchondral cysts, ulnar deviation of the MCP joints, boutonniere and swan neck deformities, hitchhiker’s thumb deformity, scapholunate dissociation, ulnar translocation, and ankylosis. Feet findings on xray are subtalar joint involvement, posterior calcaneal tubercle erosion, hammer-toe deformity, and hallux valgus. Findings of shoulder such as distal clavicle erosions, erosions of the superolateral aspect of the head of the humerus, and high riding shoulder due to subacromial-subdeltoid bursitis. Knee findings include joint effusions, loss of joint space, and prepatellar bursitis. Hip findings include concentric loss of joint space and acetabular protrusio. Spine findings are atlantoaxial subluxation, atlantoaxial impaction: cephalad migration of C2, osteoporosis, and osteoporotic fractures, and erosion of spinous processes.

X Ray

The hallmark of rheumatoid arthritis is:[1]

  • Soft tissue swelling:
  • Joint space narrowing:
  • Marginal erosions:
    • These may result from the erosion by pannus of the bone also called as “bare areas”.

Hand and wrist

The common joints involved in a patient with rheumatoid arthritis, include:

The findings may include:[2][3]

Swan neck deformity
Source: A.Prof Frank Gaillard [4]
Boutonniere deformity
Source:Case courtesy of Dr Hani Salam[5]


Various radiological findings of the feet that may be seen in rheumatoid arthritis include:

Marginal erosions involving the MTP joint of the right little toe
Source: Case courtesy of Dr Ian Bickle, [6][7]


Various radiological findings of the shoulder joint that may be seen in rheumatoid arthritis include:

  • Distal clavicle erosions
  • Erosions of the superolateral aspect of the head of the humerus
  • High riding shoulder due to subacromial-subdeltoid bursitis
Distal clavicle resorption
Source:Case courtesy of Radswiki [8][9]


Various radiological findings of the knee joint that may be seen in rheumatoid arthritis include:[10]


Various radiological findings of the hip joint that may be seen in rheumatoid arthritis include:

  • Concentric loss of joint space
  • Acetabular protrusio
Severe degenerative changes to the left hip with marked erosive change
Source:Case courtesy of Dr Jeremy Jones[11][12]

Spinal cord

Various radiological findings of the spinal cord joint that may be seen in rheumatoid arthritis include:

Cervical spine
Source:Case courtesy of Dr Muhammad Essam, [13][14]



  1. Devauchelle-Pensec V, Saraux A, Alapetite S, Colin D, Le Goff P (October 2002). "Diagnostic value of radiographs of the hands and feet in early rheumatoid arthritis". Joint Bone Spine. 69 (5): 434–41. PMID 12477226.
  2. van der Heijde DM, van Leeuwen MA, van Riel PL, Koster AM, van 't Hof MA, van Rijswijk MH, van de Putte LB (January 1992). "Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis". Arthritis Rheum. 35 (1): 26–34. PMID 1731813.
  3. Koh JH, Jung SM, Lee JJ, Kang KY, Kwok SK, Park SH, Ju JH (2015). "Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis". PLoS ONE. 10 (8): e0135409. doi:10.1371/journal.pone.0135409. PMC 4527732. PMID 26247204.
  4. "https://radiopaedia.org, ref="https://radiopaedia.org/cases/7245">rID: 7245
  5. "https://radiopaedia.org/"Radiopaedia.org
  6. href="https://radiopaedia.org/">Radiopaedia.org
  7. href="https://radiopaedia.org/cases/27301">rID: 27301
  8. href="https://radiopaedia.org/">Radiopaedia.org
  9. href="https://radiopaedia.org/cases/11884">rID: 11884
  10. Fuchs HA, Kaye JJ, Callahan LF, Nance EP, Pincus T (May 1989). "Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease". J. Rheumatol. 16 (5): 585–91. PMID 2754663.
  11. href="https://radiopaedia.org/">Radiopaedia.org
  12. href="https://radiopaedia.org/cases/6464">rID: 6464
  13. href="https://radiopaedia.org/">Radiopaedia.org
  14. href="https://radiopaedia.org/cases/29388">rID: 29388