Rheumatoid Arthritis: A systematic approach

Syuichi Koarada, Syuichi Koarada

• Publisher: Bentham Science Publishers
• Year: 2018
• ISBN:
  9781681086613
• Topic: Medicine
• Subtopic: Rheumatology, Orthopedics & Prosthetics

Rheumatoid Arthritis: A systematic approach to Arthritis of Rheumatic Diseases provides readers with a simple but high quality diagnostic interpretation of clinical images of rheumatoid arthritis. The authors present a systematic approach to explaining th

B: Bone Mineralization and Shape

Syuichi Koarada^*, Yuri Sadanaga

Division of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan

Abstract

Category B is the mineralization and shape of the bones. This category includes bone mineralization, erosions, bone cysts, and osteophyte formation. In rheumatoid arthritis (RA), marginal erosion is a hallmark of the disease and occurs in the bare areas of the bone. Especially, juxta-articular osteoporosis is the earliest change in plain radiograph of patients with RA.

Keywords: Bone mineralization, Cone cysts, Erosions, Juxta-articular Osteoporosis, Osteopytes, Rheumatoid arthritis.

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^* Corresponding author Syuichi Koarada: Division of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan; Tel: [phone]; E-mail: [email protected]

Bone Density

Normal Mineralization

Bone density is evaluated at the metacarpal shaft of the 2nd or the 3rd digit in PA view of the hand. The sum of the lateral side of cortices of the shaft is more than 50% of width of the bone (Fig. 1).

Fig. (1))
The cortices (white) of the shaft is clearly more than 50% of width of the bone in a normal person.

Decreased Mineralization

Diffuse Osteoporosis (Systemic Osteoporosis)

Diffuse osteoporosis (systemic osteoporosis) is shown in Figs. (2 and 3).

Fig. (2))
Radiograph of the hands of a patient with RA shows that white cortices may be less than 50% of width of the shaft in the 2nd metacarpal bone.

Fig. (3))
Cortices/ width of the 2nd shaft=(1.38+1.26)/7.22= 36.5% < 50%.

Osteoporosis of Lumbar Spine

When the diffuse osteoporosis exists in a patient, the evaluation of bone density should be performed (Fig. 4).

Fig. (4))
Bone densitometry (DEXA; dual energy x-ray absorptiometric scan) shows systemic osteoporosis showing low BMD (bone mineral density) in a 66-year-old female with RA. Bone fractures should be evaluated. ...