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<v ->Now let's go ahead and look more

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at what happens to the synovium in rheumatoid.

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There are three particular findings

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that I'd like to concentrate on.

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The first is fatty infiltration.

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Let's call it secondary lipoma arborescens again.

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In common with osteoarthrosis

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indeed, one may get fatty infiltration

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into the synovial membrane in patients with rheumatoid

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as shown here, showing you areas of high signal.

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The second and perhaps most frequent

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is fibrovascular proliferation of the synovia.

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We get a feathery appearance with intermediate signal.

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As shown in this example.

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And the third are those fibrous nodules

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that we talked about earlier.

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We indicated that these generally do not enhance.

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They are low signal and they are well defined.

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As in this case, these are the rice bodies

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They can simulate cajal bodies within the joint.

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Here, a sagittal view of a glenohumeral joint.

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Now the distribution of abnormalities

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in rheumatoid arthritis is distinctive

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and differs from the distribution

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in other particular diseases.

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This was known with conventional radiography,

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and to be frank about it,

1:28

that is the way I tell most articulate diseases apart

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by their distribution.

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In rheumatoid arthritis, early on,

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radiocarpal joint involvement is characteristic.

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This was a slide that was shown yesterday

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during the lectures and case discussion.

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But this is the characteristic involvement

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with extensive involvement of the distal ulna.

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And then over a short period of time,

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what I like to indicate

1:55

is pretty much all of the compartments of the wrist

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are involved.

1:59

Distal radioulnar, radiocarpal, midcarpal

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common carpal, metacarpal, intermetacarpal.

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First you can go on and on,

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pretty soon the disease involves

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all of the compartments of the wrist

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as in this case.

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When you look to the knee,

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the classic distribution of rheumatoid arthritis

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in the knee is symmetrical medial femoral tibial

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and lateral femoral tibial joint disease.

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With or without similar involvement

2:29

of the patella femoral compartment.

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Here's an example by plain film.

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And I'm already showing you pretty symmetric changes

2:38

in the knee on both the medial and lateral compartments.

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It was mentioned yesterday that we certainly

2:45

can see subchrondal cysts in rheumatoid arthritis.

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A couple of things about 'em you should know.

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They're more common in men than women,

2:53

more common in those people who are physically active

2:56

and more common in the joints of the lower extremity.

3:00

In my experience, the largest cysts are seen about the knee

3:04

in the femur or tibia or in both bones,

3:07

occasionally in the fibula.

3:09

In this case, multiple, but in some cases,

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solitary looking like a bone tumor.

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This patient also had a popliteal ulnar cyst.

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Here's an example

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less likely you'll see these cysts being prominent

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in the upper extremity, but here's rheumatoid arthritis

3:27

of the glenohumeral joint with cartilage loss,

3:29

bone erosions,

3:31

a large subchondral cyst with synovium within it

3:35

in the humeral head.

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And I can tell you although it's not certain

3:39

in these two images, but most of the time,

3:41

cysts like this communicate with the joint

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and it's the synovium invading the bone.

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So, but occasionally, as I just mentioned,

3:50

people believe it starts in the bone

3:52

and then extends into the synovial membrane.