Reumatoid Artrit

Atrhritis need to know 2016

The metatarsophalangeal joints 

are among the most common and earliest eroded 

joints; and in particular, the plantar aspect of the 

fifth metatarsophalangeal joint can be consid-

ered a good starting point for evaluation

However, normal joints 

typically show an absence of enhancement and 

bone marrow edema, and these findings can help 

to distinguish between normal and truly arthritic 

joints (60).

General estimated prevalences 

of spondyloarthritis have been more than 1% (66), 

which makes this group of diseases more com-

mon than RA. Ankylosing spondylitis is the most 

common spondyloarthritis(bechterew), followed by psoriatic 

arthritis; and enteropathic arthritis and reactive 

arthritis are less common

A. Diagnosis

1. Clinical criteria

 a) Low back pain and stiffness for more than 3 months, which improves with exercise but is not relieved by rest

 b) Limitation of motion of the lumbar spine in both the sagittal and frontal planes

 c) Limitation of chest expansion relative to normal values corrected for age and sex

2. Radiologic criterion (sacroiliitis grade ≥2 bilaterally or sacroiliitis grade 3–4 unilaterally)

 Grade 0: normal

 Grade 1: suspicious changes

 Grade 2: minimal abnormality—small localized areas with erosion or sclerosis, without alternation in the 

 joint width

 Grade 3: unequivocal abnormality—moderate or advanced sacroiliitis with one or more of the following 

 findings: erosions, evidence of sclerosis, widening, narrowing, or partial ankylosis

 Grade 4: Severe abnormality—total ankylosis

B. Grading

1. Definite ankylosing spondylitis if the radiologic criterion is associated with at least one clinical criterion

2. Probable ankylosing spondylitis if:

 a) Three clinical criteria are present.

 b) The radiologic criterion is present without any signs or symptoms satisfying the clinical criteria; other 

 causes of sacroiliitis should be considered.

Sacroiliitis at imaging is strictly defined, 

and either definite subchondral bone marrow 

edema at MR imaging (Fig 7) or fulfillment of the 

radiographic component of the modified New York 

criteria is mandatory