Rheumatoid arthritis x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]

The hallmark of rheumatoid arthritis is soft tissue swelling, joint space narrowing, and erosions. Hand and wrist findings on xray include subchondral cysts, ulnar deviation of the MCP joints, boutonniere and swan neck deformities, hitchhiker’s thumb deformity, scapholunate dissociation, ulnar translocation, and ankylosis. Feet findings on xray are subtalar joint involvement, posterior calcaneal tubercle erosion, hammer-toe deformity, and hallux valgus. Findings of shoulder such as distal clavicle erosions, erosions of the superolateral aspect of the head of the humerus, and high riding shoulder due to subacromial-subdeltoid bursitis. Knee findings include joint effusions, loss of joint space, and prepatellar bursitis. Hip findings include concentric loss of joint space and acetabular protrusio. Spine findings are atlantoaxial subluxation, atlantoaxial impaction: cephalad migration of C2, osteoporosis, and osteoporotic fractures, and erosion of spinous processes.

The hallmark of rheumatoid arthritis is:^[1]

• Soft tissue swelling:
  • It is an early finding in the course of rheumatoid arthritis.
  • Soft tissue swelling is fusiform and periarticular results from of joint effusion, edema, and tenosynovitis.
• Joint space narrowing:
  • It can be symmetrical or concentric.
• Marginal erosions:
  • These may result from the erosion by pannus of the bone also called as “bare areas”.

Hand and wrist

The common joints involved in a patient with rheumatoid arthritis, include:

• PIP and MCP joints (especially 2nd and 3rd MCP)
• Ulnar styloid
• Triquetrum

The findings may include:^[2][3]

• Subchondral cysts
• Ulnar deviation of the MCP joints
• Boutonniere and swan neck deformities
• Hitchhiker’s thumb deformity
• Scapholunate dissociation, ulnar translocation
• Ankylosis

Feet

Various radiological findings of the feet that may be seen in rheumatoid arthritis include:

• Subtalar joint involvement
• Posterior calcaneal tubercle erosion
• Hammertoe deformity
• Hallux valgus

Shoulder

Various radiological findings of the shoulder joint that may be seen in rheumatoid arthritis include:

• Distal clavicle erosions
• Erosions of the superolateral aspect of the head of the humerus
• High riding shoulder due to subacromial-subdeltoid bursitis

Knee

Various radiological findings of the knee joint that may be seen in rheumatoid arthritis include:^[10]

• Joint effusions
• Loss of joint space
• Prepatellar bursitis

Hip

Various radiological findings of the hip joint that may be seen in rheumatoid arthritis include:

• Concentric loss of joint space
• Acetabular protrusio

Spinal cord

Various radiological findings of the spinal cord joint that may be seen in rheumatoid arthritis include:

• Atlantoaxial subluxation
• Atlantoaxial impaction: cephalad migration of C2
• Osteoporosis and osteoporotic fractures
• Erosion of spinous processes

Template:WH