Approach to joint disease

SOFT TISSUE:

Soft tissue swelling/ nodules:
Gout - lobulated swelling, tophi
RA - earliest sign, very subjective,
PVNS - increased density
Sarcoidosis - rare
Amyloidosis - rare

Soft tissue calcification:
Scleroderma - tip of the fingers
Dermatomyositis - sheets ofdermal calcification

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JOINT SPACE:

Preserved joint space till late:
Early pyogenic – may be wide
Psoriasis
Gout
PVNS
SLE

Increased joint space:
Acromegaly
Septic arthritis - early

Reduced joint space:
RA
Seronegative - late

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EROSIONS:

Extra articular erosions:
Gout
Amyloid

Periarticular erosions = synovial:
RA
SS
SLE
AS
Reiter’s
Psoriatic
Enteropathic
JRA

Subchondral cysts/ erosions:
OA
Neuropathic
Hemophilia
CPPD
Hemochormatosis

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Osteoporosis:
RA, JRA
SS
SLE
Pyogenic arthirtis, TB arthritis
Hemophilia

No osteoporosis:
OA
CPPD
Gout
Psoriasis
AS
Reiter’s
Neuropathic arthorpathy
PVNS

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Perosteal reaction:
JRA
Reiter’s
Pyogenic arthirtis
AS
Psoriatic
Enteopathic
Hemophila
HOA (Pulmonary osteoarthropathy)

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SCLEROSIS:

Subchondral sclerosis:
CPPD
OA
Neuropathic
Loose bodies

Cartilage calcification:
Osteophyte
OA
AS
Psoriasis

New bone formation:
Psoriasis
AS

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Mono/ polyarticular
Septic arthritis
TB
Hemophilia
PVNS
RA
Symmetrical
RA
Asymmetrical
All including RA
Site
1st CMCJ
OA
RA
Radiocarpal
RA
OA
Intercarpal
JCA
RA
Metacarpophalyngeal
RA
Hemochromatosis
PIPJ
RA
DIPJ
Psoriasis
Erosive arthritis
Metatarsophalyngeal joint
RA
Gout
Interphalyngeal jonts
RA
OA
Psoriasis
Acroosteolysis
Psoriasis

History

Arthritis mutilans
RA
JRA
Psoriasis
Leprosy
Neuropathic joint
Reiter’s