Typical manifestations of arthritic lesions
Patients with arthritis usually have typical presentations and can be diagnosed by imaging. In the early and middle stages of the lesion, the correct diagnosis can be made by X-ray. Diagnosis is usually based on the site of the abnormal joint and some other imaging features (table 1).
The site of joint involvement may exclude some diseases, suggesting a possible lesion. For example, terminal interphalangeal joint lesions are common in psoriatic arthritis, osteoarthritis, and invasive osteoarthritis, but are not seen in rheumatoid arthritis, so this disorder is not considered. Similarly, lesions of the sacroiliac joint should take into account ankylosing spondylitis, inflammatory enteropathic osteoarthritis, psoriatic spondyloarthropathy, chronic reactive arthritis, osteoarthritis, and diffuse idiopathic bone hypertrophy. Common diseases Of joint involvement are shown in Table 2. Note that joints affected early in the disease can be distinguished from joints that are affected or rarely affected in the later stages of the disease.
Although the joint involvement site can play a role in definitive diagnosis, as described above, there are many related disorders. Other signs play an important role in further defining the diagnosis of the diseases listed in the table. The following elaboration of some of the signs helps to diagnose.
Age and gender are the basis for earlier applications. Some arthritis tends to occur in children (juvenile arthritis, hemophilic arthritis, inflammatory enteropathic arthritis, septic arthritis), and some tend to occur in adolescents (except for lesions that tend to occur in children, rheumatoid arthritis and ankylosing spondylitis that occur earlier). Some diseases are more common in women (hemophilic osteoarthropathy, hemochromatosis), and some diseases are more likely to occur in one sex (gout, ankylosing spondylitis, chronic reactive osteoarthritis occurs in men, rheumatoid arthritis occurs in women).
The course of progression is characterized by one of the most important features. Some arthritis is erosive, and rheumatoid arthritis is more typical. Others are simple bone formation (also called hyperplasia). These bone formations occur in the form of osteophytes (eg, osteoarthritis), ossification with attachment points or ligaments (eg, ankylosing spondylitis, diffuse hypertrophic osteoarthropathy, ossification of the posterior longitudinal ligament), or periostitis (eg, psoriatic arthritis, chronic reactive arthritis, juvenile idiopathic arthritis). Others may be mixed, sometimes starting with erosion but bone density is related to the age and sex of the patient. Older women are often accompanied by diffuse osteoporosis with or without rheumatoid arthritis. Therefore, we believe that normal bone density is characteristic of osteoarthritis and gout, and that older patients with these diseases may have manifestations of osteoporosis.
Another example that can be confusing is a young adult patient who has had a kidney transplant at the end of the kidney disease. Erosion in these patients may be gout or starch deposition. Nevertheless, bone density will decrease due to renal osteodystrophy and the use of corticosteroids after kidney transplantation. Gout in this case should explain erosion, although presenting with osteoporosis. Focal osteoporosis can also help identify inflammatory joints, as congestion during inflammation filters calcium.
The timing and manner in which cartilage is destroyed may be another useful parameter. Some arthritis, such as gout, typically causes significant erosion before cartilage is destroyed. However, most inflammations, such as rheumatoid arthritis, lead to early edge erosion but also relatively early cartilage destruction. The cartilage destruction mode can also distinguish between inflammatory arthritis, which is the uniform destruction of the entire joint, while osteoarthritis is the partial focal cartilage destruction of the weight-bearing part.
Adjacent calcifications and ossifications can also actually help with diagnosis. Cartilage calcification is not unique to pyrophosphate arthropathy, but is most commonly seen here. The presence of cartilage calcification should also raise questions about traumatic osteoarthritis and hemochromatosis. The calcified morphology of gout nodules is usually unique. The calcification or ossification of synovial chondromatosis differs from bone fragments in The Charcot joints. Therefore, the characteristics of calcification and ossification are helpful in the diagnosis.
Peripheral joint stiffness is most common in psoriatic arthritis and JIA. Spondyloarthropathy (most commonly in ankylosing spondylitis), diffuse hypertrophic arthropathy, and JIA are often found in the spine. Other, rarer arthropathies can also show stiffness. On the other hand, stiffness is particularly rare in rheumatoid arthritis. Don't be fooled by surgical plasty in patients with severe rheumatoid arthritis. Plasty is usually done to stabilize the interphalangeal joints and may resemble stiffness.
Early manifestations of arthropathy
We now diagnose arthropathy early, taking precedence over any plain film changes. This ability is necessary because early application of disease-modifying drug therapy can prevent joint destruction. The benefits of early diagnosis are clear, allowing patients to be more active and have fewer plasty. Nevertheless, the lesions are small and lack plain film presentation, relying solely on MR and ultrasound, is difficult to diagnose. Early tenosynovitis and hinge can be determined from ultrasound, while MR can show tenosynovitis, arthroea and bone marrow oedema in rheumatoid arthritis long before actual erosion. Inflammatory changes in vertebral body angles can be determined in MR, and can be found in ankylosing spondylitis even in smaller tendons and adjacent bone marrow edema, which is often a dead angle of the image (interspinous ligament, sacral vertebrae, macrosteel) and is easily overlooked. Even when evaluating lower back pain on a spinal MR examination, pay close attention to these locations.
Later manifestations of arthropathy
Typical manifestations are present in the terminal stage of arthropathy. Typical manifestations of rheumatoid arthritis are seen in deformities and erosion changes or postural changes in spinal fusion in ankylosing spondylitis. Nonetheless, there may be non-standard potential fusion manifestations as lesions increase, especially when ineffective treatment. A rheumatoid patient who fails medical treatment may have arthritis damage to the hand (remember that pencil cap and joint damage do not occur specifically in psoriatic arthritis). Another case of ankylosing spondylitis also involves erosion lesions involving peripheral joints. Eventually, the typical disease process can be confused with end-stage gout, which, if misdiagnosed or treated improperly, can lead to large erosion foci. It is important to remember that gout can be like any condition and is located in any joint.
Coexistence of arthropathy
The coexistence of two more common arthropathies is uncommon, especially in the elderly. Confusion can begin, but can be identified by knowing the patient's incidence of disease, and attention should also be paid to the morphology and location of abnormal presentation. The most common combination is a new type of rheumatoid arthritis superimposed osteoarthritis. Osteoarthritis in this case is often diagnosable, typically involving the 1st metacarpophalangeal joint and proximal interphalangeal joint, but with new inflammatory changes in the metacarpophalangeal joint. Older patients can also develop pyrophosphate arthropathy, superimposed on osteoarthritis and rheumatoid arthritis. Charcot arthropathy with diabetes mellitus can be superimposed septic arthritis. Remembering these may help in the diagnosis when the lesions are atypical.
conclusion
There are many subheadings for specific lesions involving specific joints that cannot be discussed extensively. Separate sections are then listed in detail.
bibliography
1.Haavardsholm EA, et al:Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis:bone marrow oedema predicts erosive progression. Ann Rheum Dis.2008;67(6):794-800.
2.Kim NR,et al:“MR corner sign”:value for predicting presence of ankylosing spondylitis. AJR Am J Roentgenol.2008;191(1):124-8.
This article is excerpted from Non-Traumatic Osteomyoskeletal Diagnostic Imaging
Source: Huaxia Imaging Diagnostic Center
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【Copyright Notice】This platform is a public welfare learning platform, reprinted for the purpose of transmitting more learning information, and has indicated the author and source, such as teachers who do not want to be disseminated can contact us to delete