Bone proliferation, in the form of enthesitis, is a hallmark of spondyloarthropathies and may occur at any cortical bone, including both tendon and ligament attachments. Soft tissue abnormalities of the extremities that are assessed with imaging include soft tissue crystal deposition and synovial hypertrophy, which may be intraarticular or involve tendon sheaths and bursae. This document discusses 5 variants: 1) Chronic extremity joint pain. Suspect inflammatory (seropositive or seronegative arthritis), crystalline (gout or pseudogout), or erosive osteoarthritis. Initial imaging. 2) Chronic extremity joint pain. Suspect inflammatory arthritis (seropositive or seronegative arthritis). Radiographs normal or inconclusive. Next imaging study. 3) Chronic extremity joint pain. Suspect gout. Radiographs normal or inconclusive. Next imaging study. 4) Chronic extremity joint pain. Suspect calcium pyrophosphate (CPP) dihydrate disease (pseudogout). Radiographs normal or inconclusive. Next imaging study. 5) Chronic extremity joint pain. Suspect erosive osteoarthritis. Radiographs normal or inconclusive. Next imaging study. aCleveland Clinic, Cleveland, Ohio. bResearch Author, Cleveland Clinic Foundation, Cleveland, Ohio. cPanel Chair, Mayo Clinic Arizona, Phoenix, Arizona. dPanel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia. eMayo Clinic, Scottsdale, Arizona, Rheumatologist. fUniversity of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. gMoffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee. hCleveland Clinic Foundation, Cleveland, Ohio, Primary care physician. iMayo Clinic, Rochester, Minnesota. jHospital for Special Surgery, New York, New York. kDuke University Medical Center, Durham, North Carolina.
Chronic Extremity Joint Pain Suspected Inflammatory Arthritis Crystalline Arthritis or Erosive Osteoarthritis PCAs. Bone proliferation, in the form of enthesitis, is a hallmark of spondyloarthropathies and may occur at any cortical bone, including both tendon and ligament attachments. Soft tissue abnormalities of the extremities that are assessed with imaging include soft tissue crystal deposition and synovial hypertrophy, which may be intraarticular or involve tendon sheaths and bursae. This document discusses 5 variants: 1) Chronic extremity joint pain. Suspect inflammatory (seropositive or seronegative arthritis), crystalline (gout or pseudogout), or erosive osteoarthritis. Initial imaging. 2) Chronic extremity joint pain. Suspect inflammatory arthritis (seropositive or seronegative arthritis). Radiographs normal or inconclusive. Next imaging study. 3) Chronic extremity joint pain. Suspect gout. Radiographs normal or inconclusive. Next imaging study. 4) Chronic extremity joint pain. Suspect calcium pyrophosphate (CPP) dihydrate disease (pseudogout). Radiographs normal or inconclusive. Next imaging study. 5) Chronic extremity joint pain. Suspect erosive osteoarthritis. Radiographs normal or inconclusive. Next imaging study. aCleveland Clinic, Cleveland, Ohio. bResearch Author, Cleveland Clinic Foundation, Cleveland, Ohio. cPanel Chair, Mayo Clinic Arizona, Phoenix, Arizona. dPanel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia. eMayo Clinic, Scottsdale, Arizona, Rheumatologist. fUniversity of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. gMoffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; MSK-RADS (Bone) Committee. hCleveland Clinic Foundation, Cleveland, Ohio, Primary care physician. iMayo Clinic, Rochester, Minnesota. jHospital for Special Surgery, New York, New York. kDuke University Medical Center, Durham, North Carolina.