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]

X Ray

Hallmark of rheumatoid arthritis are :

• Soft tissue swelling:
  • This 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.
• Joint space narrowing can be symmetrical or concentric.
• Marginal erosions can result from the erosion by pannus of the bony “bare areas”

Hand and wrist findings

• Common joints involved are:
  • PIP and MCP joints (especially 2nd and 3rd MCP)
  • Ulnar styloid
  • Triquetrum
• Findings seen are:
  • Subchondral cysts
  • Ulnar deviation of the MCP joints
  • Boutonniere and swan neck deformities
  • Hitchhiker’s thumb deformity
  • Scapholunate dissociation, ulnar translocation
  • Ankylosis

Feet

• Various radiological findings are:
  • Subtalar joint involvement
  • Posterior calcaneal tubercle erosion
  • Hammertoe deformity
  • Hallux valgus

Shoulder

• Distal clavicle erosions
• Erosions of the superolateral aspect of the head of the humerus
• High riding shoulder due to subacromial-subdeltoid bursitis

Knee

• Joint effusions
• Loss of joint space
• Prepatellar bursitis

Hip

• Concentric loss of joint space
• Acetabular protrusio

Spine

• Atlantoaxial subluxation
• Atlantoaxial impaction: cephalad migration of C2
• Osteoporosis and osteoporotic fractures
• Erosion of spinous processes

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  Distal clavicle erosion

References

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