Multiple symmetric joint inflammation in a proximal distribution in the hands or feet without bone proliferation suggests rheumatoid arthritis. Inflammation of a single joint should raise concern for infection. This is characterized by bone erosions, osteopenia, soft-tissue swelling and uniform, symmetric joint space loss. When findings are atypical (unusual combination of age, affected joint and severity) think of posttraumatic, CPPD, neuropathic or rare diseases like hemophilic arthritis. This is characterized by osteophytes and subchondral sclerosis with an asymmetric distribution both when you compare left and right as well as within the joint itself. In the presence of joint space narrowing, it is important to differentiate degenerative from inflammatory conditions. This flow chart shows the approach to the radiographic evaluation of arthritis. CRMO - chronic recurrent multifocal osteomyelitis.Diffuse Idiopathic Skeletal Hyperostosis.You can click on all images for an enlarged view. Secondary osteoarthritis can also be a sign of lowgrade progression of the original disease. Remember that secondary osteoarthritis can develop. If it is a follow up case, then check disease progression and look for new erosions.If it is not typical osteoarthritis or rheumatoid arthritis, then use the systematic approach in the first paragraph.Master yourself in diagnosing osteoarthritis and rheumatoid arthritis and remember the distinct features between these two entities.If it is the first examination, then try to make a differential diagnosis based on imaging findings as well as patient information and lab findings. ![]() When you start looking at arthritis cases, remember the following: Sometimes the abnormalities are pathognomonic for a specific disease, but more often the findings are non-specific because there is a lot of overlap between different joint diseases. A long list of diagnoses has to be considered when looking at X rays of the hand and feet, each with its own extensive set of findings. In this article we provide an overview of the different imaging findings of common joint diseases as a useful tool in daily musculoskeletal radiology.Īrthritis is a challenging topic.
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