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ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx

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Nagasai Pelala

ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS

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ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
SERONEGATIVE ARTHRITIS Inflammatory arthritis that lacks the presence of rheumatoid factor, including ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, and enteropathic arthritis.
FIVE SUBGROUPS OF SERONEGATIVE ARTHRITIS ARE DISTINGUISHED: •ankylosing spondylitis: ~90% HLAB27 positive •psoriatic arthritis: ~60% HLAB27 positive 1 •reactive arthritis: ~85% HLAB27 positive •enteropathic arthritis (i.e. extraintestinal manifestation of IBD) •undifferentiated spondyloarthritis
ANKYLOSING SPONDYLITIS AKA Marie Strumpell’s disease Bechterew’s disease
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
Chronic inflammatory disorder affecting the articulations, ligaments, and tendons of the spine and pelvis Unknown etiology Predominantly affecting younger adult males. Involves the axial skeleton. Characterized by 1. Articular bony ankylosis 2. Ligamentous ossification 3. Enthesopathy.
CLINICAL FEATURES Chronic Low Back Pain In Young Men Initially Involves Sacroiliac Joints Bilaterally, Then Ascends The Spine. Skip Involvement Can Occur Pain And Tenderness Over Bony Protuberances Morning Stiffness Peripheral Involvement Of The Large Joints Occurs In Up To 50% Of Patients, While Up To 30% Will Have Involvement Of The Smaller Joints. Complications Include Iritis, Aortitis, Valvular Incompetence,Aneurysms, Conduction Blocks, Upper Lobe Pulmonary Fibrosis, Inflammatory Bowel Disease, Renal Failure Owing To Secondary Amyloidosis, Carrot-stick Fractures, Andersson’s Lesion, And Prosthesis Ankylosis. Laboratory Findings Will Show Esr Elevation, Depending On Disease Activity, Mild Anemia, Positive Hla-b27 (90%; 6% False Positive), And Negative Rheumatoid Arthritis Latex(Seronegative)
RADIOLOGIC FEATURES Initial changes occur in the sacroiliac joints, then at the thoracolumbar and lumbosacral junctions; spine shows progressive changes, generally in an ascending manner Major signs are osteoporosis, erosions with surrounding sclerosis, and bony ankylosis. Enthesopathy can be seen. Sacroiliac joint: involvement is usually bilateral and symmetric.
Cervical spine: findings include decreased lordosis, body and facet fusion, atlantoaxial instability and odontoid erosions, decreased vertebral body size in lower levels, tapered spinous processes, and intervertebral foramen enlargement and is the most common area for carrot-stick fractures (C5–T1). Thoracic spine: changes include syndesmophytes, facet and costal fusion, increased kyphosis, and osteoporosis. Lumbar spine: changes include decreased lordosis and sacral angle, facet fusion, (trolley track sign), bamboo spine; early involvement (Romanus lesion, shiny corner) common at thoracolumbar junction. Pelvis: abnormalities include symphysis pubis changes, similar and parallel sacroilliac involvement.
Hip: involvement is usually bilateral and reasonably symmetric. Signs include small osteophytes, subchondral cysts, and uniform loss of joint space, with axial migration of the femoral head. May eventually ankylose . Shoulder: involved in 30% of cases and is usually bilateral. Signs include surface erosions and, occasionally, a hatchet erosion at the superolateral aspect of the humerus and uniform loss of joint space. Enthesopathy at coracoclavicular ligamentous attachments at inferior clavicular surface. Foot: manifestations localize to the calcaneus, with enthesopathy, especially at Achilles and plantar insertions. Spurs usually fluffy and irregular compared with degenerative spurs
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
SACROILIAC JOINT. Stage 1. Pseudo-Widening of the Joint Space Stage 2. Erosive and Sclerotic Changes. Stage 3. Ankylosis.
STAGE 1. PSEUDO-WIDENING OF THE JOINT SPACE
STAGE 2. EROSIVE AND SCLEROTIC CHANGES.
STAGE 3. ANKYLOSIS.
STAR SIGN
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROMANUS LESION
SHINY CORNER SIGN
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
SYNDESMOPHYTES AND OSTEOPHYTES
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
BAMBOO SPINE MARGINAL SYNDESMOPHYTES APPEAR AS FINE VERTICAL OSSIFICATIONS IN THE OUTER ANNULUS FIBERS AND LATERAL VERTEBRAL BODY MARGINS. WHEN MULTIPLE CONTIGUOUS SEGMENTS ARE INVOLVED, THE RESULT IS THE BAMBOO SPINE APPEARANCE
END PLATE EROSIONS
TROLLEY TRACK APPEARANCE
DAGGER SIGN.
RARE INVOLVEMENT OF PERIPHERAL JOINTS IN ANKYLOSING SPONDYLITIS.
CARROT-STICK FRACTURE
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
PSORIATIC ARTHRITIS Psoriasis is a common skin disorder associated with joint disease and characterized by peripheral joint destruction and deformity: sacroiliitis and non-marginal syndesmophyte formation
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
CLINICAL FEATURES Age 20–50 years; equal sex ratio. Skin lesions characteristic, usually on extensor surface (knees, elbows, back), also scalp, abdomen, and genital region. Lesions are well-defined, dry, raised, red and silvery, scaly patches Presence of nail changes seen in 80% of arthritis patients. Arthritis is usually in peripheral joints, especially DIP joints Whole finger or toe may show soft tissue swelling (sausage digit). ESR normal (except in acute phase), negative rheumatoid arthritis latex, positive HLA-B27 in 75% of patients with sacroiliac involvement and 30% in peripheral arthritis.
PATHOLOGIC FEATURES • Fundamentally similar to rheumatoid arthritis, but pannus affects cartilage less and erosions are smaller and slower in their development. • Adjacent to erosions, there is often prominent periosteal new bone that is typically fluffy. • Erosions often will progressively taper the end of an entire bone. • Large amount of intra-articular fibrous tissue widens the joint and results in eventual bony ankylosis. • No subcutaneous nodules or rheumatoid factor
RADIOLOGIC FEATURES General features include soft tissue swelling, normal bone mineralization, erosions, and tapered bone ends, prominent juxta-articular fluffy periostitis, and jointspace widening or bony ankylosis. • Hands and feet: asymmetric involvement, ray pattern, most commonly involves DIP joints, no osteoporosis, mouse ears sign, widened joint space owing to fibrous tissue deposition and bone resorption, pencil-in-cup deformity, opera glass hand deformity, no ulnar deviation. • Sacroiliac joint: involved in up to 50% of psoriatic arthritis patients, usually bilateral but asymmetric and unusual to be narrowed and ankylosed. • Spine: atlantoaxial subluxation and dislocation, normal apophyseal joints (except in the cervical spine), syndesmophytes of two types—non-marginal, marginal (non-marginal are the most common)—broad-based and tapered, asymmetric, unilateral, and most common in the upper lumbar and lower thoracic spine
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
FLUFFY AND LINEAR
RAY PATTERN
EARLY DISTAL INTERPHALANGEAL JOINT CHANGES.
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
LATE DISTAL INTERPHALANGEAL JOINT CHANGES.
ARTHRITIS MUTILANS
PSORIATIC SACROILIITIS
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
ENTEROPATHIC ARTHRITIS
ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx
CLINICAL FEATURES Usually begins in young adults. • Peripheral arthralgias, with rapid resolution and no residual sequelae common, especially knee, ankle, elbows and wrists. • Spinal involvement identical to ankylosing spondylitis seen in up to 10% of ulcerative colitis and, to a lesser extent, regional enteritis and may precede onset of intestinal disease. • Increased incidence of HLA-B27.
PATHOLOGIC FEATURES Pathogenesis unknown, but most likely related to formation of immune complexes, resulting in inflammatory joint involvement.
RADIOLOGIC FEATURES Identical to ankylosing spondylitis—bilateral sacroiliitis, leading to ankylosis. • Syndesmophytes and apophyseal ankylosis in the spine. • Occasional peripheral long-bone periostitis (hypertrophic osteoarthropathy).
REITER’S SYNDROME A triad of urethritis, conjunctivitis, and polyarthritis usually following sexual exposure or, less commonly, certain types of dysentery.
CLINICAL FEATURES Affects males 50:1, 18–40 years of age. • Arthritis predominantly of lower extremity, especially foot, calcaneus (lover’s heels), ankle, knee, sacroiliac, and thoracolumbar spine; residual deformities if chronic. • Bilateral conjunctivitis, non-specific urethritis, mucocutaneous lesions (keratodermia blenorrhagicum). • Laboratory signs of inflammation; positive HLA-B27 in 75% of cases.
RADIOLOGIC FEATURES Swelling, osteoporosis, uniform loss of joint space, erosions, periostitis. • Specific target sites: forefoot, calcaneus, ankle, knee, sacroiliac, spine. • Foot: metatarsophalangeal and interphalangeal joints. • Calcaneus: plantar and Achilles insertions. • Ankle: loss of joint space, swelling, periostitis. • Sacroiliac: erosions, sclerosis, loss of joint margin, asymmetric and often unilateral. • Spine: thoracolumbar, asymmetric, skip non-marginal
REITER’S SYNDROME: NON-MARGINAL LUMBAR SYNDESMOPHYTE
SUMMARY
THANK YOU. REFERENCES : YOCHUM AND ROWE’S ESSENTIALS OF SKELETAL RADIOLOGY ARTHRITIS IN BLACK AND WHITE BY ANNE BROWER RADIOLOGY ASSISTANT NEXT CASE PRESENTATION BY DR NAGASAI AND DR RESHMA ON 28/8/24.

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ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS.pptx

  • 1. ROLE OF CONVENTIONAL IMAGING IN SERONEGATIVE SPONDYLOARTHRITIS
  • 5. SERONEGATIVE ARTHRITIS Inflammatory arthritis that lacks the presence of rheumatoid factor, including ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, and enteropathic arthritis.
  • 6. FIVE SUBGROUPS OF SERONEGATIVE ARTHRITIS ARE DISTINGUISHED: •ankylosing spondylitis: ~90% HLAB27 positive •psoriatic arthritis: ~60% HLAB27 positive 1 •reactive arthritis: ~85% HLAB27 positive •enteropathic arthritis (i.e. extraintestinal manifestation of IBD) •undifferentiated spondyloarthritis
  • 11. Chronic inflammatory disorder affecting the articulations, ligaments, and tendons of the spine and pelvis Unknown etiology Predominantly affecting younger adult males. Involves the axial skeleton. Characterized by 1. Articular bony ankylosis 2. Ligamentous ossification 3. Enthesopathy.
  • 12. CLINICAL FEATURES Chronic Low Back Pain In Young Men Initially Involves Sacroiliac Joints Bilaterally, Then Ascends The Spine. Skip Involvement Can Occur Pain And Tenderness Over Bony Protuberances Morning Stiffness Peripheral Involvement Of The Large Joints Occurs In Up To 50% Of Patients, While Up To 30% Will Have Involvement Of The Smaller Joints. Complications Include Iritis, Aortitis, Valvular Incompetence,Aneurysms, Conduction Blocks, Upper Lobe Pulmonary Fibrosis, Inflammatory Bowel Disease, Renal Failure Owing To Secondary Amyloidosis, Carrot-stick Fractures, Andersson’s Lesion, And Prosthesis Ankylosis. Laboratory Findings Will Show Esr Elevation, Depending On Disease Activity, Mild Anemia, Positive Hla-b27 (90%; 6% False Positive), And Negative Rheumatoid Arthritis Latex(Seronegative)
  • 13. RADIOLOGIC FEATURES Initial changes occur in the sacroiliac joints, then at the thoracolumbar and lumbosacral junctions; spine shows progressive changes, generally in an ascending manner Major signs are osteoporosis, erosions with surrounding sclerosis, and bony ankylosis. Enthesopathy can be seen. Sacroiliac joint: involvement is usually bilateral and symmetric.
  • 14. Cervical spine: findings include decreased lordosis, body and facet fusion, atlantoaxial instability and odontoid erosions, decreased vertebral body size in lower levels, tapered spinous processes, and intervertebral foramen enlargement and is the most common area for carrot-stick fractures (C5–T1). Thoracic spine: changes include syndesmophytes, facet and costal fusion, increased kyphosis, and osteoporosis. Lumbar spine: changes include decreased lordosis and sacral angle, facet fusion, (trolley track sign), bamboo spine; early involvement (Romanus lesion, shiny corner) common at thoracolumbar junction. Pelvis: abnormalities include symphysis pubis changes, similar and parallel sacroilliac involvement.
  • 15. Hip: involvement is usually bilateral and reasonably symmetric. Signs include small osteophytes, subchondral cysts, and uniform loss of joint space, with axial migration of the femoral head. May eventually ankylose . Shoulder: involved in 30% of cases and is usually bilateral. Signs include surface erosions and, occasionally, a hatchet erosion at the superolateral aspect of the humerus and uniform loss of joint space. Enthesopathy at coracoclavicular ligamentous attachments at inferior clavicular surface. Foot: manifestations localize to the calcaneus, with enthesopathy, especially at Achilles and plantar insertions. Spurs usually fluffy and irregular compared with degenerative spurs
  • 17. SACROILIAC JOINT. Stage 1. Pseudo-Widening of the Joint Space Stage 2. Erosive and Sclerotic Changes. Stage 3. Ankylosis.
  • 18. STAGE 1. PSEUDO-WIDENING OF THE JOINT SPACE
  • 19. STAGE 2. EROSIVE AND SCLEROTIC CHANGES.
  • 29. BAMBOO SPINE MARGINAL SYNDESMOPHYTES APPEAR AS FINE VERTICAL OSSIFICATIONS IN THE OUTER ANNULUS FIBERS AND LATERAL VERTEBRAL BODY MARGINS. WHEN MULTIPLE CONTIGUOUS SEGMENTS ARE INVOLVED, THE RESULT IS THE BAMBOO SPINE APPEARANCE
  • 33. RARE INVOLVEMENT OF PERIPHERAL JOINTS IN ANKYLOSING SPONDYLITIS.
  • 36. PSORIATIC ARTHRITIS Psoriasis is a common skin disorder associated with joint disease and characterized by peripheral joint destruction and deformity: sacroiliitis and non-marginal syndesmophyte formation
  • 38. CLINICAL FEATURES Age 20–50 years; equal sex ratio. Skin lesions characteristic, usually on extensor surface (knees, elbows, back), also scalp, abdomen, and genital region. Lesions are well-defined, dry, raised, red and silvery, scaly patches Presence of nail changes seen in 80% of arthritis patients. Arthritis is usually in peripheral joints, especially DIP joints Whole finger or toe may show soft tissue swelling (sausage digit). ESR normal (except in acute phase), negative rheumatoid arthritis latex, positive HLA-B27 in 75% of patients with sacroiliac involvement and 30% in peripheral arthritis.
  • 39. PATHOLOGIC FEATURES • Fundamentally similar to rheumatoid arthritis, but pannus affects cartilage less and erosions are smaller and slower in their development. • Adjacent to erosions, there is often prominent periosteal new bone that is typically fluffy. • Erosions often will progressively taper the end of an entire bone. • Large amount of intra-articular fibrous tissue widens the joint and results in eventual bony ankylosis. • No subcutaneous nodules or rheumatoid factor
  • 40. RADIOLOGIC FEATURES General features include soft tissue swelling, normal bone mineralization, erosions, and tapered bone ends, prominent juxta-articular fluffy periostitis, and jointspace widening or bony ankylosis. • Hands and feet: asymmetric involvement, ray pattern, most commonly involves DIP joints, no osteoporosis, mouse ears sign, widened joint space owing to fibrous tissue deposition and bone resorption, pencil-in-cup deformity, opera glass hand deformity, no ulnar deviation. • Sacroiliac joint: involved in up to 50% of psoriatic arthritis patients, usually bilateral but asymmetric and unusual to be narrowed and ankylosed. • Spine: atlantoaxial subluxation and dislocation, normal apophyseal joints (except in the cervical spine), syndesmophytes of two types—non-marginal, marginal (non-marginal are the most common)—broad-based and tapered, asymmetric, unilateral, and most common in the upper lumbar and lower thoracic spine
  • 46. LATE DISTAL INTERPHALANGEAL JOINT CHANGES.
  • 52. CLINICAL FEATURES Usually begins in young adults. • Peripheral arthralgias, with rapid resolution and no residual sequelae common, especially knee, ankle, elbows and wrists. • Spinal involvement identical to ankylosing spondylitis seen in up to 10% of ulcerative colitis and, to a lesser extent, regional enteritis and may precede onset of intestinal disease. • Increased incidence of HLA-B27.
  • 53. PATHOLOGIC FEATURES Pathogenesis unknown, but most likely related to formation of immune complexes, resulting in inflammatory joint involvement.
  • 54. RADIOLOGIC FEATURES Identical to ankylosing spondylitis—bilateral sacroiliitis, leading to ankylosis. • Syndesmophytes and apophyseal ankylosis in the spine. • Occasional peripheral long-bone periostitis (hypertrophic osteoarthropathy).
  • 55. REITER’S SYNDROME A triad of urethritis, conjunctivitis, and polyarthritis usually following sexual exposure or, less commonly, certain types of dysentery.
  • 56. CLINICAL FEATURES Affects males 50:1, 18–40 years of age. • Arthritis predominantly of lower extremity, especially foot, calcaneus (lover’s heels), ankle, knee, sacroiliac, and thoracolumbar spine; residual deformities if chronic. • Bilateral conjunctivitis, non-specific urethritis, mucocutaneous lesions (keratodermia blenorrhagicum). • Laboratory signs of inflammation; positive HLA-B27 in 75% of cases.
  • 57. RADIOLOGIC FEATURES Swelling, osteoporosis, uniform loss of joint space, erosions, periostitis. • Specific target sites: forefoot, calcaneus, ankle, knee, sacroiliac, spine. • Foot: metatarsophalangeal and interphalangeal joints. • Calcaneus: plantar and Achilles insertions. • Ankle: loss of joint space, swelling, periostitis. • Sacroiliac: erosions, sclerosis, loss of joint margin, asymmetric and often unilateral. • Spine: thoracolumbar, asymmetric, skip non-marginal
  • 60. THANK YOU. REFERENCES : YOCHUM AND ROWE’S ESSENTIALS OF SKELETAL RADIOLOGY ARTHRITIS IN BLACK AND WHITE BY ANNE BROWER RADIOLOGY ASSISTANT NEXT CASE PRESENTATION BY DR NAGASAI AND DR RESHMA ON 28/8/24.