Hand arthritis

Nguyễn Duy Hùng

Case 1
Case 2
Case 3
Case 4
Case 5
• Mono-articular: 1 joint
• Oligo-articular: < 5 joints
• Polyarticular: > 5 joints
• Marginal erosions
- Occur at the bare area of the
joint, where the bone is not
covered by articular cartilage
within the joint capsule.
- These areas are often first to
be eroded in inflammatory
arthropathies
• Central erosions
- Occur at the area where the
bone is covered by articular
cartilage

• Juxta-articular erosions
- Occur further away from the
joint
• Alignment
• Bone mineralization
• Cartilage
• Distribution
• Erosions
• Soft tissue swelling
 Septic arthritis
• Alignment
- +/- subluxation
• Bone mineralization
- Indistinct subcortical bone
• Cartilage
- Joint space narrowing
• Distribution
- Monoarticular
• Erosions
- Bone destruction on both side
• Soft tissue swelling
 Rheumatoid arthritis
• Alignment

Swan neck Boutonierre Hitchhiker

• hyperextension of PIP • flexion of PIP • flexion of MCP
• flexion of DIP • extention of DIP • extention of IP
Rheumatoid arthritis

• Bone mineralization
- Periarticular osteopenia
• Cartilage
- Joint space loss:
symmetrical or concentric
Rheumatoid arthritis
• Distribution
- Symmetric and polyarticular
- PIP and MCP joints (especially
2nd and 3rd MCP)
- ulnar styloid
- triquetrum
- The DIP joints are spared.
• Erosions
- Marginal: well-demarcated
Rheumatoid arthritis
• Soft tissue swelling
- Around joint deformity
- Rheumatoid nodules
Psoriatic arthropathy
• Alignment
- Bony ankylosis
• Bone mineralization
- Normal
• Cartilage
- Joint space narrowing
Psoriatic arthropathy
• Distribution
- Asymmetrical oligo-arthritis
Symmetrical poly-arthritis
- Distal distribution
Interphalangeal >> metacarpophalangeal
Psoriatic arthritis
• Erosions
- Marginal: fuzzy
- Bone proliferation
• Soft tissue swelling
- Dactylitis – sausage shape
fingers (periosteal reaction)
 Osteoarthritis
• Alignment
- Subluxation/dislocation
• Bone mineralization
- Normal
- Subchondral cysts
- Subchondral sclerosis
 Osteoarthritis
• Cartilage
- Joint space loss
- Osteophyte formation
• Distribution
- Symmetrical
- DIP
- PIP
- 1st CMC
- Triscaphe
 Osteoarthritis
• Erosions
- None
• Soft tissue swelling
- Heberden’s nodes (DIP)
- Bouchard’s nodes (PIP)
 Erosive osteoarthritis
• Features of OA + central erosions
- Gull-wing appearance
 Gout
• Alignment
• Bone mineralization
- Normal
• Cartilage
- Late joint space loss
• Distribution
- Proximal
- Asymmetric
 Gout
• Erosions
- Juxta-articular: well-defined,
punched-out
- Overhanging edges
- Sclerotic margins
 Gout
• Soft tissue swelling
- Tophi
Calcified
Non-calcified
 Approach
Septic RA Psoriatic OA Gout
arthritis arthritis
Mono- Symmetrical Asymmetrical Symmetrical Asymmetrical
articular Poly-articular Oligo-articular

Finger MCP Proximal Distal Distal Proximal

Joint Marginal erosions: Marginal erosions: Osteophytes Juxta-articular

destruction well-demarcated fuzzy Subchondral erosions: well
Bone proliferation cyst, sclerosis demarcated,
overhanging edges
Periarticular Pencil- in- cup Gull-wing Soft tissue mass
osteopenia Sausage shape appearance
fingers (erosive)
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6