Thursday, October 14, 2010

Arthritis in X-ray

Rheumatoid arthritis (RA)
  • Age : แก่
  • Location : ข้อเล็กๆ เป็น Bilateral symmetry, M/C @ MCP, Wrist, Elbow, Hip
  • Finding :
    • Fusiform soft tissue swelling
    • Osteoporosis
    • Joint space narrowing (in Hip = Protrusio acetabuli)
    • Marginal erosion
    • Subchondral cyst
    • Bony ankylosis
    • Deformity & Subluxation
      • Swan-neck
      • Boutonniere
      • Hitchhiker
      • Mallet finger
Seronegative Spondyloarthropathy (SNSA)
   มักไม่พบ Osteoporosis แต่มี Bony proliferation ซึ่งในภาพถ่ายรังสีมักจะพบ 3 อย่างนี้ คือ Marginal whiskering, Subchondral sclerosis, Periostitis
   SNSA แบ่งเป็น 3 โรค คือ
  1. Ankylosing spondylitis
    • Age : น้อย
    • Location : SI joint, Spine, Hip (Axial skeleton)
    • Finding : 
      • Bony destruction lesion
      • Bony proliferation (Ossification, Sclerosis, Osteophyte)
      • Inflammation of adjacent organ (Discitis, Periostitis)
      • Bamboo spine = syndesmophyte of Spine
  2. Psoritic arthritis
    • Age : กลางคน
    • Location : Asymmetrical, M/C @ Hand, Foot, Spine
    • Finding : 
      • Marginal erosion
      • Bony proliferation
      • Joint space narrowing
      • Turf resorption*** เป็น ลักษณะเฉพาะของโรค
      • Marginal erosion + Bony proliferation @ Finger = "Pencil and cup apperance"
  3. Reiter's Syndrome
    • Age : น้อย
    • Triad : Urethritis + Arthritis + Conjunctivitis
    • Location : Asymmetrical at Lower extremity
    • Finding :
      • Joint space narrowing with adjacent proliferation
      • Marginal erosion
      • Periostitis
      • Soft tissue swelling
Gouty Arthritis
  • Age : แก่
  • Location : Asymmetry, M/C @ ข้อเล็กๆ ของ Lower extremity. (Esp. 1st MTP)
  • Finding :
    • Tophi @ Extensor side
    • Punched out osteolytic lesion
    • Overhanging edge
    • Normal joint space (early), Narrowing (late)
Osteoarthritis (OA)
  • Age : แก่
  • Location : Knee, Hand, Hip, Spine
  • Finding :
    • Joint space narrowing
    • Subchondral sclerosis
    • Subchondral cyst
    • Osteophyte (PIP = Bouchard's / DIP = Heberden's) [BP/HD]
    • Intra-articular loose body
    • Deformity (esp. in Knee => Genu varus [โก่ง])
    • Disc degenerative (อาจพบ Vacuum phenomenon)
Erosive osteoarthritis (OA + Inflam)
  • Age : กลาง - แก่
  • Location : DIP > PIP > MCP bilateral symmetrical
  • Finding : 
    • Central bone erosion + Marginal osteophyte => Gull-wing apperance
    • + Bony ankylosis

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