0:00

<v ->So we look for other characteristics

0:03

of imaging in patients with spondyloarthropathy.

0:07

And as we do this,

0:08

I've listed some of the most important ones:

0:11

The tendency to form bone,

0:13

that is bone proliferation and osteitis,

0:17

often, or preceded by marrow edema,

0:21

the tendency to develop dactylitis.

0:24

I'll show you an example.

0:25

We've already heard a bit about that.

0:28

Enthesitis, that is inflammation at an enthesis.

0:32

And, of course, involvement of the axial skeleton,

0:35

not just the sacroiliac joint or spine,

0:39

but indeed involvement of the chest wall as well.

0:42

So we go back to those 2 images I showed you before

0:46

where I pointed out the differences

0:49

between rheumatoid on your right here,

0:52

on the left we're looking at psoriasis.

0:54

And I pointed out the bone proliferation or whiskering,

0:58

which typically in part occurs

1:00

where the joint capsule attaches.

1:02

And I show you one of the earlier cases that we had

1:06

of interphalangeal joint and psoriasis.

1:09

They show you the bone proliferation right here,

1:13

looking pretty much like this.

1:15

Indicative we were not dealing with rheumatoid arthritis,

1:19

but we were dealing with a spondyloarthropathy.

1:22

And, of course, knowing that psoriasis affects

1:25

more often the upper extremity,

1:27

and reactive arthritis more often the lower extremity,

1:31

psoriasis would be the best diagnosis in this case.

1:35

So, bone proliferation.

1:37

And we were fortunate to have access to cadavers

1:41

with psoriasis.

1:42

Here's an example of bone proliferation involving

1:46

the posterior aspect of the proximal tibia

1:49

and a sagittal section,

1:51

characteristic whiskering.

1:54

Now whiskers, as you know, can be ill-defined

1:57

or well-defined if you keep them in shape.

2:00

Early on in SpA they are ill-defined,

2:04

but over time they become better defined,

2:07

sharper at their surface and not as ill-defined.

2:11

So in this case, they look a bit well-defined.

2:16

Here's an example of psoriasis,

2:19

sent to me by one of our prior visiting scholars.

2:22

A patient who presented with pain and swelling

2:25

in the distal aspect of the wrist.

2:27

And the major finding in this one,

2:29

shown on the fluid-sensitive sequences,

2:32

is the marrow edema.

2:34

So, although, at least on the images I have here

2:36

we didn't see bone proliferation.

2:39

This probably is predictive

2:40

of subsequent bone proliferation.

2:43

And we can see, of course, that when you have bone formation

2:47

the bone scan will be abnormal.

2:50

And even when you look at a target site classically

2:53

of rheumatoid, as we'll show you later today.

2:56

When even, when we look at that,

2:58

when you look at it in a SpA,

3:00

it may look a little bit different.

3:02

So, yes,

3:03

in rheumatoid we get C1-C2 erosions,

3:08

but you don't get the same degree

3:10

of bone proliferation in rheumatoid.

3:13

Here, is bone proliferation.

3:15

So looking at these images,

3:17

a spondyloathropathy, in this case psoriasis,

3:21

a better diagnosis than rheumatoid.

3:24

And as you look lower in the cervical spine

3:26

you can see there's some additional findings here

3:29

of a spondyloarthropathy.