Ankylosing Spondylitis

Reiter syndrome: hand and ankle acute arthritis in 19 yo man with chlamydia infection

Reiter syndrome: balanitis and elbow effusion (arthritis) in 19 yo man with chlamydia infection

Ulcerative colitis. A section of the colonic mucosa from a patient with active ulcerative colitis shows purulent exudate on the surface, ulceration (center), diffuse inflammation superficial to the muscularis mucosae, and numerous crypt abscesses (arrows).

Rheumatoid arthritis. (A) The hyperplastic synovium from a patient with rheumatoid arthritis shows numerous finger-like projections, with focal pale areas of fibrin deposition. The brownish color of the synovium reflects hemosiderin accumulation derived from old hemorrhage. (B) A microscopic view reveals prominent lymphoid follicles (Allison - Ghormley bodies), synovial hyperplasia and hypertrophy, villous folds, and thickening of the synovial membrane by fibrosis and inflammation. (C) A hi...

Rheumatoid nodule. (A) A patient with rheumatoid arthritis has a mass on a digit. (B) A microscopic view of a rheumatoid nodule shows a central area of necrosis surrounded by palisaded macrophages and a chronic inflammatory infiltrate.

FIGURE 50.4 Rheumatoid arthritis. (A) Early. (B) Advanced.

Radiographs of the MCP joints of a patient with rheumatoid arthritis demonstrate loss of joint space and some overlap of the metacarpal head on the proximal phalanx, indicating early palmar subluxation of the proximal phalanx. These findings are usually seen in a progressive fashion, with the radial side being worse.

Swan-neck deformity of the index finger in a patient with rheumatoid arthritis. Hyperextension of the proximal interphalangeal (PIP) joint and flexion deformities of the metacarpophalangeal (MCP) and distal interphalangeal (DIP) joints.

A: A 55-year-old female with a type III deformity secondary to rheumatoid arthritis.

FIGURE 3.34 Psoriatic arthritis. "Sausage finger deformity" of the distal interphalangeal joint. Note onycholysis.

FIGURE 3.35 Psoriatic arthritis ("arthritis mutilans"). This patient has severe psoriatic arthritis with marked deformities and subluxations of the small bones of the hands. Note also the characteristic onycholysis on the nails.

FIGURE 26.4. Gross appearance of chronic interstitial pneumonia in rheumatoid arthritis. Zones of honeycombing can be seen in the posterior subpleural regions. Some contraction and thickening of the lung also are noted, along with pleural thickening.

FIG. 2.62. Crohn disease. <bold>A:</bold> Fat-suppressed T2-weighted image of lower abdomen demonstrates thickening and increased signal intensity of left colon (<italic>arrow</bold>) in patient with active Crohn disease. <bold>B:</bold> Non–fat-suppressed coronal HASTE image of same patient as <bold>(A)</bold> demonstrates colon wall thickening (<italic>arrow</bold>), but lack of fat suppression limits assessment of edema and fluid.

<bold>FIG. 129.1.</bold> Psoriatic arthritis in a patient with human immunodeficiency virus disease.

<bold>FIG. 63.2.</bold> Anteroposterior radiograph of the upper pelvis and lumbar spine. Both sacroiliac joints (<italic>large arrows</bold>) are fused (grade IV sacroiliitis), and there are bilateral, symmetric syndesmophytes (<italic>small arrow</bold>), resulting in the typical "bamboo" appearance of ankylosing spondylitis.

<bold>FIG. 63.3.</bold> Lateral radiograph of the lumbar spine in ankylosing spondylitis with "shiny corners" or Romanus lesions (<italic>large arrows</bold>) due to marginal erosions of verte al bodies and typical marginal syndesmophytes (<italic>small arrows</bold>).

<bold>FIG. 63.4.</bold> Lateral radiograph of the cervical spine in ankylosing spondylitis. Bony fusion of apophyseal joint between C2 and C3 (<italic>large arrow</bold>) and all other apophyseal joints below this level also are fused. A marginal syndesmophyte is also shown (<italic>small arrow</bold>).

<bold>FIG. 65.2.</bold> Asymmetric polyarthritis resembling rheumatoid arthritis in a patient with psoriasis.

<bold>FIG. 65.4.</bold> Psoriatic arthritis involving the metacarpophalangeal and proximal interphalangeal joints of the index finger with an associated flexor tenosynovitis. This combination gives rise to the "sausage" digit.

<bold>FIG. 65.7.</bold> Family study in which psoriasis, ulcerative colitis, and ankylosing spondylitis showed a "clustering" phenomenon. Patients DB and FB have psoriasis in addition to ankylosing spondylitis.

<bold>FIG. 65.9.</bold> "Whittling" of the middle phalanx and expansion of the base of the distal phalanx—the "pencil-in-cup" deformity.

<bold>FIG. 65.10.</bold> Bony ankylosis of distal interphalangeal joints in a patient with psoriatic arthritis.

<bold>FIG. 65.12.</bold> Destructive arthritis of an isolated distal interphalangeal joint with osteolysis of the proximal phalanx.

<bold>FIG. 65.15.</bold> Psoriatic arthritis with axial involvement. The patient was HLA-B27^﹢ and had no radiologic evidence of sacroiliitis, but atypical syndesmophytes are observed.

FIGURE 93.5. Crohn’s disease of the terminal ileum demonstrated by severe narrowing of the terminal ileum (as shown between the two <italic>arrows</bold>). The cecum is represented by the “C.”

Balanitis in Reiter syndrome

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

<bold>Fig B 10-9. Psoriatic arthritis.</bold> Views of both hands and wrists demonstrate ankylosis across many of the interphalangeal joints with scattered erosive changes involving several interphalangeal joints, most of the metacarpophalangeal joints, and the interphalangeal joint of the right thumb. Note the striking asymmetry of involvement of the carpal bones, an appearance unlike that expected in rheumatoid arthritis.

<bold>Fig B 10-12. Ankylosing spondylitis.</bold> Bilateral symmetric obliteration of the sacroiliac joints with prominent syndesmophytes in the lower lumbar spine.

<bold>FIGURE 68.2</bold> (<italic>A</bold>) Loss of normal vascular pattern (colonoscopic photo) (<italic>B</bold>) Contact bleeding (<italic>C</bold>) Granularity (<italic>D</bold>) Ulceration and friability (<italic>E</bold>) Colonic stricture.

<bold>FIG. 65.3.</bold> Long-standing psoriatic arthritis with a symmetric distribution. This patient had a "claw deformity" due to bony ankylosis of the proximal and distal interphalangeal joints.

<bold>FIG. 65.11.</bold> Complete destruction of middle proximal interphalangeal joint. Also note bony ankylosis of corresponding distal interphalangeal joint.

<bold>FIG. 65.14.</bold> Prominent metatarsophalangeal joint involvement with subluxation and cupping of the base of the proximal phalanges. The big toe distal interphalangeal joint shows characteristic marginal erosions.

<bold>FIGURE 68.2</bold> (<italic>A</bold>) Loss of normal vascular pattern (colonoscopic photo) (<italic>B</bold>) Contact bleeding (<italic>C</bold>) Granularity (<italic>D</bold>) Ulceration and friability (<italic>E</bold>) Colonic stricture.

<bold>FIGURE 68.2</bold> (<italic>A</bold>) Loss of normal vascular pattern (colonoscopic photo) (<italic>B</bold>) Contact bleeding (<italic>C</bold>) Granularity (<italic>D</bold>) Ulceration and friability (<italic>E</bold>) Colonic stricture.

<bold>FIGURE 68.2</bold> (<italic>A</bold>) Loss of normal vascular pattern (colonoscopic photo) (<italic>B</bold>) Contact bleeding (<italic>C</bold>) Granularity (<italic>D</bold>) Ulceration and friability (<italic>E</bold>) Colonic stricture.

<bold>FIGURE 68.2</bold> (<italic>A</bold>) Loss of normal vascular pattern (colonoscopic photo) (<italic>B</bold>) Contact bleeding (<italic>C</bold>) Granularity (<italic>D</bold>) Ulceration and friability (<italic>E</bold>) Colonic stricture.

<bold>Fig GI 19-6 Crohn's disease.</bold> Severe postbulbar narrowing with distal fold thickening.

<bold>Fig GI 27-14 Crohn's disease.</bold> Multiple polypoid lesions in the distal jejunum and proximal ileum show both smooth and lobulated contours.³¹

FIGURE 19-11.?Advanced rheumatoid arthritis. The hands show swelling of the joints and deviation of the fingers.

Figure 6-200 <bold>ANKYLOSING SPONDYLITIS: SACROILIAC JOINTS. Bone Window CT, Axial Sacrum.</bold> Note the widening of the left sacroiliac joint resulting from erosions along the articular surfaces of the ilium and sacrum (<italic>arrow</bold>). <bold><italic>COMMENT:</bold></bold> The early changes associated with the inflammatory arthropathies affecting the sacroiliac joints are better evaluated using CT because of its superior sensitivity over plain film radiography. CT is the imaging modality of choice for evalua...

Figure 10-5 <bold>INFLAMMATORY VERSUS DEGENERATIVE ARTHRITIS.A. Inflammatory Arthritis (Rheumatoid Arthritis).</bold> The most prominent feature is the uniform bicompartmental loss of joint space.<bold> B. Degenerative Arthritis (Degenerative Joint Disease).</bold> In contrast, selective loss of a single compartment joint space in a non-uniform manner is apparent.<bold><italic>COMMENT:</bold></bold> This is an important differential feature between inflammatory and degenerative joint changes.

Figure 10-140 <bold>ANKYLOSING SPONDYLITIS: LUMBAR SPINE. A and B. Bamboo Spine.</bold> Note that complete interbody ankylosis by marginal syndesmophytes produces this distinctive undulating spinal contour.

Figure 10-154 <bold>SKELETAL DISTRIBUTION OF PSORIATIC ARTHRITIS.</bold>

<bold>FIGURE 39-4</bold> Crohn disease. The mucosal surface of the colon displays a "cobblestone" appearance owing to the presence of linear ulcerations and edema and inflammation of the intervening tissue.

<bold><italic>Figure 12.11</bold></bold>. Technique for sacroiliac compression test. Excellent first-line test to assess for ankylosing spondylitis.

Fig. 6. Anteroposterior view of the lumbar spine in a patient with psoriatic arthritis. There is paravertebral ossification with bulky bridging syndesmophytes in a bilateral, asymmetric distribution. Contrast this to the symmetric pattern in Figure 5.

<bold>FIGURE 51.1</bold> Mucosal ulcerations (<italic>arrows</bold>) in Crohn disease of the small bowel.

<bold>FIGURE 51.2</bold> Islands of edematous mucosa surrounded by linear ulceration showing the classic "cobblestone" appearance of Crohn disease.

<bold>FIGURE 51.3</bold> Severe Crohn disease affecting the terminal ileum (<italic>white arrow</bold>) with normal ileum for comparison (<italic>black arrow</bold>).

<bold>FIGURE 51.12</bold> Crohn disease of the ileum (<italic>arrow</bold>) as seen laparoscopically.

<bold><italic>Figure 15-23</bold> The colon in chronic ulcerative colitis.</bold> Polypoid islands of intact mucosa are surrounded by mucosal ulcers.

<bold>FIGURE 26-56. Ankylosing spondylitis.</bold> The vertebrae have been cut longitudinally. The vertebral bodies are square and have lost most of their trabecular bone, owing to osteoporosis from disuse. Bone bridges fuse one vertebral body to the next across the intervertebral disks. Portions of the intervertebral disk are replaced by bone marrow. Bony bridges also fuse the posterior elements <bold><i>(ankylosis)</i></bold>.