Rheumatoid arthritis x ray: Difference between revisions

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==Overview==
==Overview==
 
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 joint|MCP]] joints, [[boutonniere deformity|boutonniere]] and [[swan neck deformity|swan neck]] deformities, hitchhiker’s thumb deformity, scapholunate dissociation, ulnar translocation, and [[ankylosis]]. Feet findings on xray are [[subtalar joint]] involvement, posterior [[calcaneus|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 bones|osteoporotic]] fractures, and erosion of spinous processes.
==X Ray==
==X Ray==
Hallmark of rheumatoid arthritis are :
The hallmark of [[rheumatoid arthritis]] is:<ref name="pmid12477226">{{cite journal |vauthors=Devauchelle-Pensec V, Saraux A, Alapetite S, Colin D, Le Goff P |title=Diagnostic value of radiographs of the hands and feet in early rheumatoid arthritis |journal=Joint Bone Spine |volume=69 |issue=5 |pages=434–41 |date=October 2002 |pmid=12477226 |doi= |url=}}</ref>
*Soft tissue swelling:
*Soft tissue swelling:
**This is an early finding in the course of rheumatoid arthritis.
**It is an early finding in the course of [[rheumatoid arthritis]].
**Soft tissue swelling is fusiform and periarticular which is due to the combination of joint effusion, edema and tenosynovitis.
**Soft tissue swelling is [[fusiform]] and periarticular results from of joint effusion, [[edema]], and [[tenosynovitis]].
*Joint space narrowing can be symmetrical or concentric.
*[[Joint]] space narrowing:
*Marginal erosions can result from the erosion by pannus of the bony “bare areas”
**It can be symmetrical or [[concentric]].
'''Hand and wrist findings'''
*Marginal erosions:
Common joints involved are:
**These may result from the erosion by [[pannus]] of the [[bone]] also called as “bare areas”.
*PIP and MCP joints (especially 2nd and 3rd MCP)
'''Hand and wrist'''
*Ulnar styloid
 
The common joints involved in a patient with rheumatoid arthritis, include:
*PIP and [[MCP joint|MCP]] joints (especially 2nd and 3rd [[MCP joint|MCP]])
*[[Ulnar]] [[Styloid process|styloid]]
*Triquetrum
*Triquetrum
Findings seen are:
The findings may include:<ref name="pmid1731813">{{cite journal |vauthors=van der Heijde DM, van Leeuwen MA, van Riel PL, Koster AM, van 't Hof MA, van Rijswijk MH, van de Putte LB |title=Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis |journal=Arthritis Rheum. |volume=35 |issue=1 |pages=26–34 |date=January 1992 |pmid=1731813 |doi= |url=}}</ref><ref name="pmid26247204">{{cite journal |vauthors=Koh JH, Jung SM, Lee JJ, Kang KY, Kwok SK, Park SH, Ju JH |title=Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis |journal=PLoS ONE |volume=10 |issue=8 |pages=e0135409 |date=2015 |pmid=26247204 |pmc=4527732 |doi=10.1371/journal.pone.0135409 |url=}}</ref>
*Subchondral cysts
*Subchondral [[cysts]]
*Ulnar deviation of the MCP joints
*[[Ulnar]] deviation of the [[MCP joint|MCP]] joints
*Boutonniere and swan neck deformities
*[[Boutonniere deformity|Boutonniere]] and [[Swan neck deformity|swan neck]] deformities
*Hitchhiker’s thumb deformity
*Hitchhiker’s thumb deformity
*Scapholunate dissociation, ulnar translocation
*Scapholunate dissociation, ulnar translocation
*Ankylosis
*[[Ankylosis]]
[[File:Rheumatoid-hands.jpg|200px|thumb|centre|Swan neck deformity <br>Source: A.Prof Frank Gaillard <ref> "https://radiopaedia.org, ref="https://radiopaedia.org/cases/7245">rID: 7245</ref>]]
[[File:Rheumatoid-arthritis.jpg|200px|thumb|centre|Boutonniere deformity<br> Source:Case courtesy of Dr Hani Salam<ref> "https://radiopaedia.org/"Radiopaedia.org</ref>]]
'''Feet'''
'''Feet'''
Various radiological findings are:
 
*Subtalar joint involvement
Various radiological findings of the feet that may be seen in rheumatoid arthritis include:
*Posterior calcaneal tubercle erosion
*[[Subtalar joint|Subtalar]] joint involvement
*Posterior [[Calcaneus|calcaneal]] tubercle erosion
*Hammertoe deformity
*Hammertoe deformity
*Hallux valgus
*[[Hallux]] [[valgus]]
<gallery>
 
Image:Rheumatoid-arthritis-001.jpg
[[Image:Rheumatoid-arthritis-feet.jpg|200px|centre|thumbnail|Marginal erosions involving the MTP joint of the right little toe<br> Source: Case courtesy of Dr Ian Bickle, <ref> href="https://radiopaedia.org/">Radiopaedia.org</ref><ref> href="https://radiopaedia.org/cases/27301">rID: 27301</ref>]]
Image:Rheumatoid-arthritis-002.jpg
 
Image:Rheumatoid-arthritis-003.jpg
 
Image:Rheumatoid-arthritis-004.jpg
'''Shoulder'''
Image:RA-distal-clavicle-erosion-001.jpg|Distal clavicle erosion
 
</gallery>
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
[[Image:Rheumatoid-arthritis-distal-clavicle-resorption.jpg|200px|centre|thumbnail|Distal clavicle resorption <br> Source:Case courtesy of Radswiki <ref>href="https://radiopaedia.org/">Radiopaedia.org</ref><ref> href="https://radiopaedia.org/cases/11884">rID: 11884</ref>]]
 
'''Knee'''
 
Various radiological findings of the knee joint that may be seen in rheumatoid arthritis include:<ref name="pmid2754663">{{cite journal |vauthors=Fuchs HA, Kaye JJ, Callahan LF, Nance EP, Pincus T |title=Evidence of significant radiographic damage in rheumatoid arthritis within the first 2 years of disease |journal=J. Rheumatol. |volume=16 |issue=5 |pages=585–91 |date=May 1989 |pmid=2754663 |doi= |url=}}</ref>
*[[Joint]] effusions
*Loss of joint space
*[[Prepatellar bursitis]]
'''Hip'''
 
Various radiological findings of the hip joint that may be seen in rheumatoid arthritis include:
*Concentric loss of [[joint]] space
*Acetabular protrusio
[[Image:Rheumatoid-arthritis-of-hip-with-erosion-and-pseudoarthrosis.jpg|centre|200px|thumbnail|Severe degenerative changes to the left hip with marked erosive change  <br>Source:Case courtesy of Dr Jeremy Jones<ref> href="https://radiopaedia.org/">Radiopaedia.org</ref><ref> href="https://radiopaedia.org/cases/6464">rID: 6464</ref>]]
 
 
'''Spinal cord'''


==Sources==
Various radiological findings of the spinal cord joint that may be seen in rheumatoid arthritis include:
Copyleft images obtained courtesy of RadsWiki [http://www.radswiki.net]
*[[Atlantoaxial]] subluxation
*Atlantoaxial impaction: cephalad migration of C2
*[[Osteoporosis]] and [[Osteoporotic bones|osteoporotic]] fractures
*Erosion of spinous processes
[[Image:Rheumatoid-arthritis-of-the-cervical-spine-1.jpg|200px|centre|thumbnail|Cervical spine<br> Source:Case courtesy of Dr Muhammad Essam, <ref> href="https://radiopaedia.org/">Radiopaedia.org</ref><ref> href="https://radiopaedia.org/cases/29388">rID: 29388</ref>]]


==References==
==References==
{{Reflist|2}}


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[[Category:Needs content]]
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{{WH}}
{{WH}}
{[WS}}
<references />

Latest revision as of 17:24, 25 April 2018

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

Overview

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]

Feet

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]


Shoulder

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]

Knee

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

Hip

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]

References

Template:WH

  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
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