RHEUMATOID ARTHRITIS-RADIOLOGY

SUMMARY

1. The knee is the most common single joint initially involved in RA; but, over time, small joints (in a symmetric fashion) are more commonly involved.

2. The forefoot is the site of earliest radiographic changes in RA & the head of the 5th MT may be the location of the earliest erosion.

3. Erosion of the ulnar styloid process is most specific for RA, leading to ulnar deviation.

4. C-spine: patients with chronic, severe disease may develop cervical instability at the atlanto-axial articulation (C1-C2). The rest of the axial skeleton is spared.

5. Predilection of swelling of joints in wrists: MCPs, PIPs, MTPs but sparing DIPs.

6. Early findings: soft-tissue swelling. Late findings: joint space narrowing, loss of articular cartilage, joint erosion, malalignment and fusion of joints.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].