Inflammatory Arthritis

Conditions

 

Acro-osteolysis

SLE

Scleroderma

Psoriasis

 

Acro-osteolysis

 

Acro osteolysis

 

Definition

 

Absorption of distal tuft of phalanx

 

DDx

 

Psoriasis

Scleroderma / Raynauds

Frost Bite

Hyperparathyroidism

Diabetes

Vasculitis

Leprosy

RA rarely

Gout

 

SLE

 

Pathology

 

Similar hand appearances to RA

- no joint destruction even in setting gross deformity

 

Pathophysiology

 

Autoimmune disorder

 

Distension of joint from synovitis rather than destruction of joint

 

Pannus not as aggressive as RA

 

Symptoms

 

Migratory poly arthralgia

Flexor tenosynovitis

MP and PIP arthritis

Raynaud's

AVN of carpus

 

Other

- butterfly rash

- lymphadenopathy

- pleuritis / pericarditis / Glomerulonephritis

- haemolytic anaemias

 

Xray

 

Effusions

Juxtacortical osteopenia

Subluxation / dislocation

Bone infarction and abnormal calcification

 

Joint destruction = Co-existent RA

 

Diagnosis

 

ANA 

dsDNA

 

Management

 

Aimed at rebalancing soft tissues

- may be inadequate

- may have to resort to fusion

 

Scleroderma

 

Pathophysiology

 

Hand Sclerodermad Scleroderma Occluded Superficial Palmar Arch

 

Autoimmune disease

Unknown aetiology

Small vessel disease

Fibrosis in multiple organ systems

 

DDx

 

RA

- 40% patients have RF

 

Epidemiology

 

Patients female and middle ages

 

CREST Syndrome

 

1. Calcinosis

2. Raynaud's

3. Esophageal Strictures

4. Sclerodactyly

5, Telangiectasia

 

Hands

 

Stiff shiny digits

Loss of creases

Acral tapering of digits

Autoamputation (acro-osteolysis)

Telangiectasia

Calcium nodules

 

Extraskeletal 

 

Lung fibrosis

CRF

 

X-ray

 

1.  Calcium subcutaneous / extra - articular / occasionally intra-articular 

2.  Acro-osteolysis of the tufts of DP (80% patients)

 

Osteopenia

 

Joint erosion

- RA part of DDx

 

Resorption of thumb CMC

- subsequent radial subluxation of the thumb MC

 

Psoriasis

 

Psoriatic arthritis

 

Pathophysiology

 

Autoimmune disease

- seronegative arthritis

 

5-10% of RA have psoriasis

 

DDx from RA

 

Asymmetrical distribution

Seronegative

Psoriatic rash

Nail changes / pitting

 

Often less aggressive

- typically DIPJ more involved

- may have less synovitis but bone and soft tissue destruction still occur

 

Classification

 

1.  Classic - involvement of DIPJ joints of hands

2.  Deforming - with ankylosis & arthritis mutilans

3.  RA - Like - similar to RA but without RF

4.  Monarthritis

5.  Ankylosing Spondylitis - like

 

Hand X-ray

 

Periarticular phalangeal erosions

- asymmetrical

- no periarticular osteopenia

 

Periosteal new bone formation along MC / MT shafts

 

DIPJ

- typical 'Pencil in cup' deformity of DIPJ

- P3 tuft resorption & whittling

 

DIPJ Pencil in Cup

 

Juvenile Rheumatoid Arthritis

 

Differences from Adult RA

 

Usually much milder course

- 50-70% achieves remission

 

Deformity often opposite of Adult

- short ulna

- ulna hand / MC's

- radial deviation of fingers

 

Hands

 

Boutonniere deformity common

Intrinsic tightness uncommon

 

Extensor tenosynovitis signs uncommon

First sign is usually rupture of tendons with dropped wrist