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Current Medical Imaging


ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Review Article

A Systematic Approach to Diagnosing Arthritis Based on Radiological Imaging

Author(s): Kyu-Chong Lee, Kyung-Sik Ahn*, Chang Ho Kang, Suk Joo Hong, Baek Hyun Kim and Euddeum Shim

Volume 18, Issue 11, 2022

Published on: 05 July, 2022

Article ID: e280422204165 Pages: 20

DOI: 10.2174/1573405618666220428100951

Price: $65


Radiology plays a key role in the diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive, and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis, while productive disease includes osteoarthritis and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically, while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologists in diagnosing arthritis.

Keywords: Infectious arthritis, Pigmented villonodular synovitis, Synovial chondromatosis, Rheumatoid arthritis, Osteoarthritis, Spondylarthritis, Crystal Arthropathies.

Graphical Abstract
American college of rheumatology ad hoc committee on clinical guidelines. Guidelines for the initial evaluation of the adult patient with acute musculoskeletal symptoms. Arthritis Rheum 1996; 39(1): 1-8.
[] [PMID: 8546717]
Jameson JL. Harrison’s principles of internal medicine. 20th ed. New York: McGraw-Hill Education 2018.
Ory PA. Radiography in the assessment of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2003; 17(3): 495-512.
[] [PMID: 12787514]
Backhaus M. Ultrasound and structural changes in inflammatory arthritis: Synovitis and tenosynovitis. Ann N Y Acad Sci 2009; 1154(1): 139-51.
[] [PMID: 19250235]
D’Agostino MA, Terslev L. Imaging evaluation of the entheses: Ultrasonography, MRI, and scoring of evaluation. Rheum Dis Clin North Am 2016; 42(4): 679-93.
[] [PMID: 27742021]
Karchevsky M, Schweitzer ME, Morrison WB, Parellada JA. MRI findings of septic arthritis and associated osteomyelitis in adults. AJR Am J Roentgenol 2004; 182(1): 119-22.
[] [PMID: 14684523]
Jacobson JA, Girish G, Jiang Y, Resnick D. Radiographic evaluation of arthritis: Inflammatory conditions. Radiology 2008; 248(2): 378-89.
[] [PMID: 18641245]
Shetty AK, Gedalia A. Septic arthritis in children. Rheum Dis Clin North Am 1998; 24(2): 287-304.
[] [PMID: 9606760]
Lin HM, Learch TJ, White EA, Gottsegen CJ. Emergency joint aspiration: A guide for radiologists on call. Radiographics 2009; 29(4): 1139-58.
[] [PMID: 19605662]
Tarkowski A. Infection and musculoskeletal conditions: Infectious arthritis. Best Pract Res Clin Rheumatol 2006; 20(6): 1029-44.
[] [PMID: 17127195]
Engin G. Acunaş B, Acunaş G, Tunaci M. Imaging of extrapulmonary tuberculosis. Radiographics 2000; 20(2): 471-88.
[] [PMID: 10715344]
Al Attar ASR, Al Azreg SA, Abdouslam OE. Pigmented villonodular synovitis (PVNS) in human and animals: A mini review article and conclusive view. Int Clin Pathol J 2017; 5(2): 233-6.
Dorwart RH, Genant HK, Johnston WH, Morris JM. Pigmented villonodular synovitis of synovial joints: Clinical, pathologic, and radiologic features. AJR Am J Roentgenol 1984; 143(4): 877-85.
[] [PMID: 6332499]
Masih S, Antebi A. Imaging of pigmented villonodular synovitis. Semin Musculoskelet Radiol 2003; 7(3): 205-16.
[] [PMID: 14593562]
Yang PY, Wang CL, Wu CT, Wang TG, Hsieh FJ. Sonography of pigmented villonodular synovitis in the ankle joint. J Clin Ultrasound 1998; 26(3): 166-70.
[<166:AID-JCU11>3.0.CO;2-9] [PMID: 9502041]
Derek Stensby J, Fox MG, Kwon MS, Caycedo FJ, Rahimi A. Primary synovial chondromatosis of the subtalar joint: Case report and review of the literature. Skeletal Radiol 2018; 47(3): 391-6.
[] [PMID: 28932921]
McKenzie G, Raby N, Ritchie D. A pictorial review of primary synovial osteochondromatosis. Eur Radiol 2008; 18(11): 2662-9.
[] [PMID: 18491106]
Murphey MD, Vidal JA, Fanburg-Smith JC, Gajewski DA. Imaging of synovial chondromatosis with radiologic-pathologic correlation. Radiographics 2007; 27(5): 1465-88.
[] [PMID: 17848703]
Wittkop B, Davies AM, Mangham DC. Primary synovial chondromatosis and synovial chondrosarcoma: A pictorial review. Eur Radiol 2002; 12(8): 2112-9.
[] [PMID: 12136332]
Kramer J, Recht M, Deely DM, et al. MR appearance of idiopathic synovial osteochondromatosis. J Comput Assist Tomogr 1993; 17(5): 772-6.
[] [PMID: 8370833]
Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62(9): 2569-81.
[] [PMID: 20872595]
Colebatch AN, Edwards CJ, Østergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis 2013; 72(6): 804-14.
[] [PMID: 23520036]
Scutellari PN, Orzincolo C. Rheumatoid arthritis: Sequences. Eur J Radiol 1998; 27(Suppl. 1): S31-8.
[] [PMID: 9652499]
Resnick D, Kransdorf MJ. Bone and joint imaging. 3rd ed. Philadelphia: Elsevier Saunders 2005.
Vyas S, Bhalla AS, Ranjan P, Kumar S, Kumar U, Gupta AK. Rheumatoid arthritis revisited - Advanced imaging review. Pol J Radiol 2016; 81: 629-35.
[] [PMID: 28105245]
Østergaard M, Pedersen SJ, Døhn UM. Imaging in rheumatoid arthritis--status and recent advances for magnetic resonance imaging, ultraso-nography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2008; 22(6): 1019-44.
[] [PMID: 19041075]
Sommer OJ, Kladosek A, Weiler V, Czembirek H, Boeck M, Stiskal M. Rheumatoid arthritis: A practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 2005; 25(2): 381-98.
[] [PMID: 15798057]
Cross S, Vaidya S, Fotiadis N. Hemophilic arthropathy: A review of imaging and staging. Semin Ultrasound CT MR 2013; 34(6): 516-24.
[] [PMID: 24332203]
Kerr R. Imaging of musculoskeletal complications of hemophilia. Semin Musculoskelet Radiol 2003; 7(2): 127-36.
[] [PMID: 12920650]
Kilcoyne RF, Nuss R. Radiological evaluation of hemophilic arthropathy. Semin Thromb Hemost 2003; 29(1): 43-8.
[] [PMID: 12640564]
Siakallis L, Tziakouri-Shiakalli C, Georgiades CS. Amyloidosis: Review and imaging findings. Semin Ultrasound CT MR 2014; 35(3): 225-39.
[] [PMID: 24929263]
Georgiades CS, Neyman EG, Barish MA, Fishman EK. Amyloidosis: Review and CT manifestations. Radiographics 2004; 24(2): 405-16.
[] [PMID: 15026589]
Sheldon PJ, Forrester DM. Imaging of amyloid arthropathy. Semin Musculoskelet Radiol 2003; 7(3): 195-203.
[] [PMID: 14593561]
Llauger J, Palmer J, Rosón N, Bagué S, Camins A, Cremades R. Nonseptic monoarthritis: Imaging features with clinical and histopathologic correlation. Radiographics 2000; 20(Spec No)(Suppl. 1): S263-78.
[] [PMID: 11046178]
Jacobson JA, Girish G, Jiang Y, Sabb BJ. Radiographic evaluation of arthritis: Degenerative joint disease and variations. Radiology 2008; 248(3): 737-47.
[] [PMID: 18710973]
Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-lawrence classification of osteoarthritis. Clin Orthop Relat Res 2016; 474(8): 1886-93.
[] [PMID: 26872913]
Braun HJ, Gold GE. Diagnosis of osteoarthritis: Imaging. Bone 2012; 51(2): 278-88.
[] [PMID: 22155587]
Papakonstantinou O, Mohana-Borges AV, Campell L, Trudell D, Haghighi P, Resnick D. Hip arthropathy in a patient with primary hemo-chromatosis: MR imaging findings with pathologic correlation. Skeletal Radiol 2005; 34(3): 180-4.
[] [PMID: 15316682]
Jäger HJ, Mehring U, Götz GF, et al. Radiological features of the visceral and skeletal involvement of hemochromatosis. Eur Radiol 1997; 7(8): 1199-206.
[] [PMID: 9377500]
Proft F, Poddubnyy D. Ankylosing spondylitis and axial spondyloarthritis: Recent insights and impact of new classification criteria. Ther Adv Musculoskelet Dis 2018; 10(5-6): 129-39.
[] [PMID: 29942364]
Rudwaleit M, van der Heijde D, Landewé R, et al. The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II): Validation and final selection. Ann Rheum Dis 2009; 68(6): 777-83.
[] [PMID: 19297344]
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984; 27(4): 361-8.
[] [PMID: 6231933]
Navallas M, Ares J, Beltrán B, Lisbona MP, Maymó J, Solano A. Sacroiliitis associated with axial spondyloarthropathy: New concepts and latest trends. Radiographics 2013; 33(4): 933-56.
[] [PMID: 23842966]
Rudwaleit M, van der Heijde D, Landewé R, et al. The assessment of spondyloarthritis international society classification criteria for pe-ripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis 2011; 70(1): 25-31.
[] [PMID: 21109520]
Paparo F, Revelli M, Semprini A, et al. Seronegative spondyloarthropathies: What radiologists should know. Radiol Med (Torino) 2014; 119(3): 156-63.
[] [PMID: 24272481]
Canella C, Schau B, Ribeiro E, Sbaffi B, Marchiori E. MRI in seronegative spondyloarthritis: Imaging features and differential diagnosis in the spine and sacroiliac joints. AJR Am J Roentgenol 2013; 200(1): 149-57.
[] [PMID: 23255756]
Bennett DL, Ohashi K, El-Khoury GY. Spondyloarthropathies: Ankylosing spondylitis and psoriatic arthritis. Radiol Clin North Am 2004; 42(1): 121-34.
[] [PMID: 15049527]
Robinson PC, Sengupta R, Siebert S. Non-Radiographic Axial Spondyloarthritis (nr-axSpA): Advances in classification, imaging and thera-py. Rheumatol Ther 2019; 6(2): 165-77.
[] [PMID: 30788779]
Bourikas LA, Papadakis KA. Musculoskeletal manifestations of inflammatory bowel disease. Inflamm Bowel Dis 2009; 15(12): 1915-24.
[] [PMID: 19408334]
Atzeni F, Defendenti C, Ditto MC, et al. Rheumatic manifestations in inflammatory bowel disease. Autoimmun Rev 2014; 13(1): 20-3.
[] [PMID: 23774109]
Huang M, Schweitzer ME. The role of radiology in the evolution of the understanding of articular disease. Radiology 2014; 273(25): S1-S22.
[] [PMID: 25340431]
Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating rheumatoid and psoriatic arthritis of the hand: Multimo-dality imaging characteristics. Radiographics 2020; 40(5): 1339-54.
[] [PMID: 32735474]
Schoellnast H, Deutschmann HA, Hermann J, et al. Psoriatic arthritis and rheumatoid arthritis: Findings in contrast-enhanced MRI. AJR Am J Roentgenol 2006; 187(2): 351-7.
[] [PMID: 16861537]
Teh J, McQueen F, Eshed I, Plagou A, Klauser A. Advanced imaging in the diagnosis of gout and other crystal arthropathies. Semin Musculoskelet Radiol 2018; 22(2): 225-36.
[] [PMID: 29672810]
Jacques T, Michelin P, Badr S, et al. Conventional radiology in crystal arthritis: Gout, calcium pyrophosphate deposition, and basic calcium phosphate crystals. Radiol Clin North Am 2017; 55(5): 967-84.
[] [PMID: 28774457]
Schlee S, Bollheimer LC, Bertsch T, Sieber CC, Härle P. Crystal arthritides - gout and calcium pyrophosphate arthritis: Part 2: Clinical fea-tures, diagnosis and differential diagnostics. Z Gerontol Geriatr 2018; 51(5): 579-84.
[] [PMID: 28233118]
Neogi T, Jansen TL, Dalbeth N, et al. 2015 gout classification criteria: An American College of rheumatology/european league against rheu-matism collaborative initiative. Arthritis Rheumatol 2015; 67(10): 2557-68.
[] [PMID: 26352873]
Omoumi P, Zufferey P, Malghem J, So A. Imaging in gout and other crystal-related arthropathies. Rheum Dis Clin North Am 2016; 42(4): 621-44.
[] [PMID: 27742018]
Magarelli N, Amelia R, Melillo N, Nasuto M, Cantatore F, Guglielmi G. Imaging of chondrocalcinosis: Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease -- imaging of common sites of involvement. Clin Exp Rheumatol 2012; 30(1): 118-25.
[PMID: 22325558]
Rana RS, Wu JS, Eisenberg RL. Periosteal reaction. AJR Am J Roentgenol 2009; 193(4): W259-72.
[] [PMID: 19770293]

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