Arthritis: by DR Samra Tahseen Registrar, Radiology LNH

ARTHRITIS
BY DR SAMRA TAHSEEN
REGISTRAR, RADIOLOGY
LNH
OSTEOARTHRITIS
• OA or degenerative joint disease (DJD), is the

most common of the arthritides.
• Terminology
• Because the osteoarthritis is not primarily an
inflammatory process, some authors prefer
the term osteoarthrosis instead.
Pathology
• Primary OA is the less common variant and is
characterised by the absence of an antecedent
insult, it is considered to be hereditary and
affects primarily middle-aged women.
• Secondary OA is the most common form, caused
by abnormal mechanical forces (e.g. occupational
stress, obesity) or by a previous joint insult (e.g.
trauma, rheumatoid arthritis).
Radiographic features
• General imaging features :
• The hallmarks of DJD are joint space
narrowing, sclerosis, and osteophytosis.
• If all three of these findings are not present on
a radiograph, another diagnosis should be
considered.
• Joint space narrowing: characteristically in
osteoarthritis is asymmetric whereas the joint
space narrowing in inflammatory conditions is
symmetric.
• e.g., In the hip the narrowing occurs
superiorly or sometimes axially in
osteoarthritis.
• Sclerosis: should be present in varying
amounts in all cases of DJD unless severe
osteoporosis is present.
• Osteoporosis will cause the sclerosis to be
diminished. For instance, in long-standing
rheumatoid arthritis in which the cartilage has
been destroyed, DJD often occurs with very
little sclerosis.
• Osteophytosis: sclerosis and osteophytosis
are prominent in DJD. Osteophytosis will also
be diminished in the setting of osteoporosis.
• Some osteophytes carry eponymous names
such as at the proximal interphalageal joint
(Bouchard’s nodes) & at distal interphalangeal
joint (Heberden’s nodes).
Subchondral cyst or Geode
• often found in joints affected with DJD.
• Geodes are cystic formations that occur around
joints in a variety of disorders.
• 1) DJD 2) rheumatoid arthritis 3) calcium
pyrophosphate dihydrate crystal deposition
disease (CPPD) 4) Avascular necrosis
• Geode formation takes place when synovial fluid
is forced into the subchondral bone, causing a
cystic collection of joint fluid.
Joints Affected by Osteoarthritis
Hip
Knee
Spine
All joints can be affected, however, the most commonly involved

are the weight bearing joints such as the hip, knee and spine. They
must withstand the significant forces generated by walking and
running, and therefore are prone to wearing out.
Total Knee Replacement
Normal Knee Arthritic Knee Replaced Knee

Total Hip Replacement
Normal Hip Arthritic Hip Replaced Hip

Degenerative Spondylolisthesis
RHEUMATOID ARTHRITIS
• Age group : 20-55 years
• M: F : 1:3
• Joints Involved : typically involves small joints
esp. Metatarsophalangeal &
Metacarpophalangeal Joints. But any joint can be
involved.
• Rhematoid arthritis is a systemic disease , other
body systems can be involved like lungs & Pleura.
X-RAYS FINDINGS
• 1. Soft tissue changes
• 2. Osteoporosis
• 3. Joint space changes & alignment
deformities
• 4. Periostitis
• 5. Erosions
• 6. Secondary Osteoarthritis
Periarticular Osteopenia
GROSS RA
ALIGNMENT DEFORMATIES
Swan Neck Deformity
Fibular deviation of toes
Bilateral Protrusio Acetabuli
Bilateral symmetrical joint space narrowing
with femoral head erosions
ANKYLOSING SPONDYLITIS
• 90% patients have HLA-B27 antigen positive.
• Common in young men in their late 10s and
20s , but recently it is been realized that
women are affected in equal nos.
Sacroiliac Joints
• Symmetrical changes.
• Erosions
• Sclerosis
• Joint narrowing
• Fusion of the joint.
Spinal Changes
• Erosions of vertebral margins healed by sclerotic
margin.
• Squaring of the vertebral bodies.
• Marginal syndesmophytes (calcification of annulus
fibrosis).
• Disc calcification
• Ossification of the anterior & posterior spinal
ligaments.
• Bamboo spine ( knobby appearance of spine )
Peripheral Joints
• Osteoporosis
• Erosions
• Joint space narrowing
• Joint ankylosis
Early changes of AS
CT SCAN
BAMBOO SPINE
Ossification of Anterior long ligament
Ossification of paraspinal ligaments
GOUT
• Gout is a crytal arthropathy due to deposition
of monosodium urate (MSU) crystals in and
around the joints.
• Epidemiology
• Typically occurs in those above 40 years.
• Male predilection of 20:1.
Radiographic Findings
Plain radiograph
• Predilection for the small joints of the hands and feet.
• Joints
• Joint effusion(earliest sign)
• Preservation of joint space until late stages of disease
• Absence of periarticular osteopaenia
• Eccentric erosions
• Well-defined “punched-out” erosions with sclerotic
margins in a marginal and juxta-articular distribution, with
overhanging edges.
• Surrounding soft tissues
• tophi: pathognomonic
• olecranon and prepatellar bursitis
• periarticular soft tissue swelling due to crystal
deposition in tophi around the joints is
common
Ultrasound
• While there can be variation in appearance,
tophi generally tend to be hyperechoic,
heterogeneous, have poorly defined contours.
They can be multiple grouped and surrounded
by anechoic halos.
MRI
• Signal characteristics of gouty tophi are
usually:
• T1: isointense
• T2
– variable 4
– majority of lesions are heterogeneously
hypointense
• T1 C+ (Gd): the tophus usually enhances
T1-Weighted Image
T2- Weighted Image( Fat Sat)
Post Contrast T1- Weighted Image
JOINT IMAGING
BY DR SAMRA TAHSEEN
REGISTRAR, RADIOLOGY
LNH
KNEE ULTRASOUND
• A number of knee abnormalities can be
identified on ultrasound, including:
• Patellar tendinosis / patellar tendon tear

• Quadriceps tendon tear
• Prepatellar bursitis
• Infrapatellar bursitis
• Popliteal cyst (Baker cyst)
BAKER’S CYST
• Baker cysts (or popliteal cysts) are fluid-filled
distended synovial-lined bursa arising
between the medial head of the
gastrocnemius and the semimembranosus
tendons via a communication with the knee
joint. They are usually located at or below the
joint line.
BAKER’S CYST
Ultrasound & MRI
•Normally the first line investigation:
•well-defined cyst with a 'neck' at its deepest extent, extending into
the joint space between the semimembranosus tendon and the
medial head of the gastrocnemius
•identification of a fluid-filled structure at the posteriomedial knee is
suggestive of a popliteal cyst, but identification of the 'neck'
between the tendons is necessary for a definitive diagnosis.
•usually anechoic, but may contain internal debris
•MRI
•Exquisitely outlines the cyst as a high T2 signal content mass
extending from the joint space.
BAKER’S CYST
BAKER’S CYST
BAKER’S CYST
JOINT EFFUSION
Patellar Tendinosis
Normal Medial Meniscus- Knee
Medial Meniscal Tear
Medial Meniscal Tear
Horizontal meniscal tear with meniscal cyst
HIP JOINT ULTRASOUND
• To evaluate:
• Abnormalities of the muscles, such as tears
and soft-tissue masses.
• Foreign bodies, bleeding, infections or other
types of fluid collections.
• Infant ultrasound to check the hips for
developmental dysplasia of the hip (DDH).
Developmental Dysplasia Of The Hip (DDH)
• U/S is the test of choice in infants < 6 months.

• The measurement of Graf angles is made.
• The Alpha angle is formed by the intersection of
baseline and the acetabular roof line. In a normal
mature hip Alpha angle should be more than 60
degrees.
• The Beta angle is be formed by the intersection
of the baseline with the labral line. A normal beta
angle is less than 55 degrees.
Hip Joint Effusion
Ankle Joint ULTRASOUND
Ankle Joint Effusion
ELBOW ULTRASOUND
Tennis Elbow
• Lateral epicondylitis, also known as “tennis
elbow,” is an overuse syndrome of the
common extensor tendon and predominantly
affects the extensor carpi radialis brevis (ECRB)
tendon.
• Epidemiology
• Lateral epicondylitis occurs with a frequency
seven to ten times that of medial epicondylitis.
Ultrasound
• Intratendinous calcification, tendon
thickening, bone irregularity, focal
hypoechogenicity, and diffuse heterogeneity.
And the most common finding in a patient
with lateral epicondylitis is focal areas of low
echogenicity with a background of intrinsic
tendinopathy.
MRI

• The best diagnostic clue for diagnosis of
lateral epicondylitis is abnormal thickening
and increased signal intensity within the
common extensor origin from the lateral
epicondyle
MRI-TENNIS ELBOW
THANK YOU

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ARTHRITIS

• OA or degenerative joint disease (DJD), is the

All joints can be affected, however, the most commonly involved

Normal Knee Arthritic Knee Replaced Knee

Normal Hip Arthritic Hip Replaced Hip

• Patellar tendinosis / patellar tendon tear

• U/S is the test of choice in infants < 6 months.

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