IS Case 586: Rheumatoid arthritis of the shoulders
Imaging Sciences URMC 2010
Publication Date: 2011-11-17
History
Patient is an 83-year-old female with periodic chest radiographs for underlying medical disease.
Findings
Marked progression of rheumatoid arthritis over 5 years as demonstrated by a typical feature of distal clavicular resorption and erosive changes. Other related findings shown here include humeral deformity with glenoid flattening, joint space narrowing, and subchondral sclerosis.
Diagnosis
Rheumatoid arthritis of the shoulders
Discussion
Rheumatoid arthritis is a systemic inflammatory condition involving the synovial tissues of the joints followed by secondary cartilage and bone destructive changes leading to deformity. It clinically manifests as a symmetric polyarthritis of three or more joints, typically involving the wrist, MCP joints, proximal IP joints, or shoulders. There is usually associated morning stiffness and abnormal serum rheumatoid factor levels. Rheumatic nodules may occur over bony prominences, extensor surfaces, or juxta-articular locations.
Radiographic findings include juxta-articular demineralization and erosive changes. In the shoulders, there is joint space narrowing, flattening of the glenoid fossa, joint effusions, and bony erosion, possibly with joint destruction. In this patient, there are several of these changes as well as other known prominent features, particularly distal clavicular resorption and elevation of the humeral head. The radiographs (Figs 1-4) showcase progression of rheumatoid disease over 5 years with strikingly increased clavicular and acromial erosion, nearly to a point. Though not shown here, MRI is the best imaging tool which can reveal enhancing inflamed synovium on top of the aforementioned bony erosion and deformity.
References
- Brant W, Helms C. Fundamentals of Diagnostic Radiology. Lippincott Williams & Wilkins, June 2006: 1497.
- Levine RB, Sullivan KL. Rheumatoid arthritis: skeletal manifestations observed on portable chest roentgenograms. Skeletal Radiol. 1985;13(4):295-303. PMID: 4001974
4 images
