Inflammatory

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Inflammatory InfectiousDisorders

• Denise Ogilvie
• August 2007

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Arthritis

• Inflammation of a joint
• 90 of cases are osteo and rheumatoid arthritis
• Women are 3 times more likely to be affected than
  men
• Average age of onset in adults is 40years of age

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Rheumatoid Arthritis

• A chronic systemic inflammatory disorder
• Characterised by joint destruction
• Also involves muscles, heart, lungs, blood
  vessels and skin.
• Begins as inflammation of synovial membrane that
  lines the joints

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Rheumatoid Arthritis

• As a result of inflammation, erosion of articular
  cartilage and underlying bone.
• Fibrous scarring and bony fusion across the joint
  may occur
• The fusion of joint surfaces and involvement of
  ligaments leads to crippling deformities

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Rheumatoid Arthritis

• Radiographic Appearance
• Earliest evidence is soft tissue swelling caused
  by joint effusion and synovial inflammation
• Disuse and increased blood flow leads to
  osteoporosis of bone near the joint and
  eventually the whole bone

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Rheumatoid Arthritis

• Periarticular Osteoporosis

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Rheumatoid Arthritis

• Small areas of destruction at edges of joint
  where the articular cartilage is absent
• Destruction of articular cartilage causes
  narrowing of joint space
• Bony trabeculae laid down across the joint

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Rheumatoid Arthritis

• Ligamentous involvement causes contraction and
  subluxation causing the common ulna deviation of
  hands

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Osteoarthritis

• A degenerative joint disease as a result of loss
  of joint cartilage and reactive bone formation
• Also as result of wear and tear with age
• Can be secondary form of degeneration as a result
  of trauma

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Osteoarthritis

• Predominantly affects weight bearing joints
  hips, knees, ankles and interphalangeal joints of
  the fingers

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Osteoarthritis

• Radiographic Appearance
• Earliest signs joint space narrowing caused by
  thinning of articular cartilage and development
  of bony spurs osteophytes

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Osteoarthritis

• Joint space narrowing is irregular and more
  pronounced in weight bearing joints

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Osteoarthritis

• Articular ends become increasingly dense
  periarticular sclerosis
• Erosion of the articular cortex may produce
  irregular cyst like lesions with sclerotic
  margins near the joint
• Ossified loose bodies may develop, especially in
  knee and also elbow

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Osteoarthritis

• In fingers often involves distal interphalangeal
  joints

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Infectious Arthritis

• Pus forming organisms enter the joint by direct
  contact with osteomyelitis or from joint trauma
• Bacterial infection high fever, shaking chills,
  some swollen and tender joints
• Most common type is a migratory arthritis from
  Lyme Disease

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Infectious Arthritis

• 6 weeks after onset ofacute staphloccal arthritis
• Pronounced cartilage and bone destruction with
  sclerosis

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Infectious Arthritis

• Radiographic Appearance
• Soft tissue swelling
• In children fluid distension of the joint
  capsule causing widening of the joint space and
  subluxation. Especially hips, shoulders
• Rapid destruction of articular cartilage causing
  joint space narrowing

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Infectious Arthritis

• Earliest bone changes occur 8-10 days after onset
  of symptoms small areas of erosion of articular
  bone
• Untreated causes destruction and loss of cortical
  outline
• Healing sclerotic bone reactions forms
  irregular articular surface

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Treatment of Arthritis

• Aim is to protect affected joints, maintain
  mobility and strengthen muscles
• Rest to minimise inflammation and preserve rang
  of motion
• Medication anti inflammatories to decrease
  inflammation
• Antibiotics may be used to treat infection

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Bursitis

• Inflammation of the bursa
• Small fluid filled sac near joints
• Can be caused by repeated physical activity
• Also trauma, rheumatoid, gout or infection
• Not usually seen on plain film u/s better
• Plain film will exclude other disorders

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Bursitis

• Radiographic Appearance
• Can see deposits of calcification in adjacent
  tendons
• This can cause pain and limitation in movement
• Shoulder supraspinatous tendon
• U/S reveal bursa with fluid

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Bursitis

• Treatment
• Anti inflammatories to reduce swelling and pain
• Cortico steroid injections into the affected
  bursa

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Bacterial Osteomyelitis

• Inflammation of bone and bone marrow caused by
  infectious organisms
• In children the metaphysis of long bones commonly
  affected femur tibia
• Staphlococci and streptococci are most common
  causes

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Bacterial Osteomyelitis

• Experience fever, localised warmth, swelling and
  tenderness
• In adults common in vertebrae causing back pain
  and spasms
• Treated with antibiotics
• Can develop as result of IV drug use

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Bacterial Osteomyelitis

• In diabetic patients soft tissue infection may
  spread skin abscess usually foot causing
  cellulitis and eventually osteomyelitis of nearby
  bone
• Begins as abscess in the bone
• Pus from inflammation spreads down medullary
  cavity and outward to the surface
• It then raises the periostium

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Bacterial Osteomyelitis

• Early stages may not be seen on plain film until
  about 10 days after the onset of symptoms
• Nuclear bone scan best imaging technique for
  early diagnosis
• Plain film earliest evidence in long bones

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Bacterial Osteomyelitis

• Initial bony change appears as subtle areas of
  lucency, leading to ragged moth eaten appearance

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Chronic Osteomyelitis

• Eventually new bone laid over cortex
• After infection subsides bone becomes thickened,
  sclerotic with irregular margins

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Reference

• Eisenberg, R, Johnson, N, Comprehensive
  radiographic pathology, 4th edn
• Scally, P, Medical imaging, OxfordMedical
  Publications