Rheumatoid arthritis

Dr/ Hytham Nafady

Definition

• Generalized CT disorder of unknown etiology involving the synovial tissue.

Incidence

• Age: 20-60 with a peak between 40 & 50.

• Juvenile rheumatoid arthritis onset below 16 years.

• Sex: F > M (3:1).

Rheumatoid nodules

Pathology

Pannusvascularized granulation tissue

Bare areas

Distribution: bilateral & symmetrical.

Location:

Rheumatoid arthritis Osteoarthritis

Hand

• PIP joint.

• MCP joint.

The distal interphalangeal (DIP) joint is spared, in contrast with

•seronegative arthropathies, •degenerative arthirits & •erosive arthritis.

Periarticular soft tissue swelling

Juxtaarticualr osteoporosis

Marginal bone erosions

Narrowing of the joint space

Juxta-articular periostitis

Subcortical cysts

Subluxation

• Loss of parallel articular surfaces.

Dislocation

Boutonnière deformity

Swan neck deformity

Mallet finger

• Flexion at the DIJ usually due to extensor tendon injury.

Ulnar deviation & palmar subluxation at MCP joints

Zigzag deformity

Arthritis mutilans

• Sever polyarticular joint deformity

Wrist

• Distal ends of radius & ulna.

• Capral bones (specilly triquetrium & pisiform).

RA of the wrist

RA of the wrist

Erosion of the ulnar styloid processPathology:

Pannus formation in • The prestyloid recess, • Extensor carpi ulnaris tendon sheath or• Radioulnar joint.

Erosion of the radial styoid process

Erosion of the carpal bones

Spotty carpal sign

• Multiple carpabl bone erosions

Sudek’s atrophy

• Demineralizatio of bone.

• Joint space preserved.

• Soft tissue atrophy.

TB

RA of the foot

• Interphalangeal joint of the big toe.

• Meta-tarso-phalangeal joints from the 5th to the 1st in decreasing order of frequency.

RA of the foot

RA of the foot

Marginal bone erosions

Lanios deformity

RA of the large joints

• Elbow.

• Hip.

RA of the elbow

Olecranon bursitis

RA of the hip

Protrusio acetabulae

• P R O T R usio:

• Paget

• Rheumatoid arthritis (& other inflammatory arthritides).

• Osteogenesis imperfecta, Osteomalacia, osteoporosis

• Traumatic

• Rickets.

RA of the cervical spine

• Atlanto-occipital joint.

• Atlanto-axial joint.

• Sub-axial joints.

RA of the cervical spine

Rotatory atlanto-axial subluxationType 1 Type 2 Type 3 Type 4

Incidence Most common Rare Rare

neurological deficit

Most benign high risk high risk

Facet joint Unilateral facet subluxatioin

Unilateral facet subluxation

Bilateral facet subluxation

Bilateral facet subluxation

C1 ant / post displacement

No anterior displacement

Anterior displacement

Anterior displacement

Posterior displacement.

Transverse ligament

Intact injured injured

Anterior subluxation

Lateral view Flexion view Open mouth view

Bone erosions

Anterior atlanto-axial subluxation

Lateral atlanto-axial subluxation

Vertical atlanto-axial subluxation(basilar invagination)