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Radiograph of the
knee showingmoderate to
severe
osteoarthritis.
Note the marked
joint space
narrowing of the
medialcompartment.
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Distribution of disease activity in rheumatoid arthritis.Delayed image of the hands from 99mTc-MDP scintigraphy
showing distribution of active disease in a patient with
rheumatoid arthritis.
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Psoriatic arthritis. There is extensive destruction of the interphalangeal
joint of the great toe with resorption of the terminal tuft. A similar lesion
may be seen in Reiters syndrome. Note severe destructive changes in
the terminal interphalangeal joint of the fifth digit and the lack of
osteoporosis. The lesions in the feet in this patient were symmetric.
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Photomicrographs of fresh preparation of synovial fluidobtained from the inflamed knee of a 45 year-old man with
acute gouty arthritis. Note numerous small and large needle-
shaped crystals of monosodium urate monohydrate that have
been engulfed by neutrophilic leukocytes.
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Reactive arthritis (Reiters syndrome)
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Epidemiologic Characteristics of the Connective Tissue Disease
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Epidemiologic Characteristics of the Connective Tissue Disease
Cases/yr/
1,000,000 ~500 ~30 ~12 ~20
PopulationBlack to White 5:1 2:1 2:1
% diagnosedin childhood 5%-10% 5%-10%
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RNAseANA ENA
RNP
Sm
MCTD
SLE(Speckled pattern)
(high titer)
(+)(-)
Laboratory differentiation MCTD/SLE
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Summary and Laboratory Test for
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1. Osteoarthritis (OA)
2. Rheumatoid arthritis (RA)
3.
Sjgrens syndrome4. Systemic lupus erythematosus (SLE)
5. Psoriatic arthritis
6.
Reactive arthritis (Reiters syndrome)7. Gout
y y
Rheumatic Diseases
Testing for Rheumatic Diseases
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Testing for Rheumatic Diseases
1.
Osteoarthritis (OA)Plain films*
MRI
Arthroscopy
No blood test or laboratory analysis toconfirm the diagnosis
2. Rheumatoid arthritis (RA)CBC
Acute phase reactantsRheumatoid factor*
Biopsy of rheumatoid nodules
X-ray
Testing for Rheumatic Diseases
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3.
Sjgrens SyndromeSalivary gland biopsy*
Parotid sialography
ANA speckled pattern
Antibody to Ro/ss-A or La/ss-B antigens
4. Systemic Lupus ErythematosusHematologic disorder-complement
ANA (Anti dsNA or SM)
Antiphospholipid antibodies
Biopsy*
X-ray
g(cont.)
Testing for Rheumatic Diseases
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5.
Psoriatic arthritisX-ray
Characteristic skin involvement*
6. Reactive ArthritisX-ray
CBC
Acute phase reactantsHLA-B27*
Synovial fluid
(cont.)
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