Disease A = alignment B = bone mineralization C = cartlidge D = distribution S = soft tissue
(sublux? Dislocation?) (osteopenic?) (MOST IMPORTANT) Where? Symmetrical? Uni/bi- Swelling?
Joint spaces lateral? Erosions? Calcification?
RA Ulnar deviation Periarticular osteopenia (+) narrowing Bilat symmetrical Periarticular swelling
(+) erosions MCP joints
Wrists
SPARES DIP
Psoriatic arthritis Periostitis / osteophytes Asymmetrical
(remodeling – PIP + DIP
pathognomonic) SI + Spine
Ankylosing Proximal / large joints / spine
spondylylitis “bamboo spine” d/t productive
changes that bridge vertebrae
(fixed)
SLE Joint and ligament laxity Periarticular osteopenia Joint space PRESERVED Diffuse
Subluxs + dislocations (to check diffuse do BONE
SCAN)
Scleoderma Joint spaces preserved Very erosive Calcification
Distal distribution
Acro-osteolysis (erosion of tufts of
distal phalanges)
Gout Classic Gout: “podagra” (big toe) Swelling
ST swelling + calcification + Elbow Calcium deposits
periarticular erosions with Periarticular erosions with
overhanging edges overhanging edges
Bones Lesions Monostotic → 1 lesion / 1 bone o Zone of transition Types of Lesions Aggressive
Polystotic: multi lesions/bones (MOST IMPORTANT) Do biopsy to DDx o Wide zone of transition
Lytic (dark) destroys bone o Well demarcated? o Non-aggressive o “moth eaten” lytic pattern
Blastic (white) makes bone o Hard to find ends? o Aggressive o Aggressive periosteal
Chondroid matrix: broken rings and o Run pencil around? reaction (trying to make new
arcs o Cortical breakthrough: bone)
Osteoid matrix: clouds on XR aggressive lesions o “sunburst”
Evaluation: o Periosteal reactions Non-aggressive o “hair on end”
o Age / gender o Soft tissue masses DON’t TOUCH ME LESIONS o “onion skinned” if
o Hx trauma / surgery / fever / (MRI) Narrow zone of transition multiple layers
pain Benign periosteal reaction o Osteomyelitis
o Lytic or blastic? Non-ossifying fibroma o Osteoid osteoma
o Matrix and type?
- Location and # of lesions (isolated
or multiple?)