The articular disorders that will be discussed in this chapter, pigmented villonodular synovitis, synovial chondromatosis, and amyloidosis, share some common radiologic imaging characteristics. These entities are more common in large joints, the plain radiographic findings may be subtle, and the magnetic resonance (MR) findings are distinctive. Despite the fact that these conditions are relatively uncommon, most radiologists will see these diagnoses several times during a career…

The joint changes in hemophilia are secondary to chronic repetitive hemarthrosis and intraosseous bleeding. Hemarthrosis occurs in 75 to 90 percent of patients with hemophilia. The first bleed usually occurs between the ages of 2 and 3. Repetitive bleeding episodes occur between the ages of 8 and 13, with 50 percent of patients developing permanent bone changes around the joint. The radiographic change in the joint…

There are a variety of disorders that affect the joints in children. In the past all of the disorders have been lumped together and labeled juvenile rheumatoid arthritis. Although each disorder has different clinical and radiographic manifestations and course, it may be impossible to distinguish one disorder from another at a specific time within the course of the disease. Therefore, the better term “juvenile idiopathic arthritis”…

The collagen vascular diseases (connective tissue diseases) are a group of diseases that have multiple, varied systemic manifestations. Articular symptoms play a minor role in the total clinical picture and usually produce little in the way of radiographic change in the joint. Although each disease has distinct features, there is a tendency toward overlap among the diseases. The diseases to be discussed are systemic lupus erythematosus,…

Three deposition diseases are discussed in this chapter: hemochromatosis, Wilson disease, and ochronosis. Two of these diseases are extremely rare. Each has been associated with radiographic chondrocalcinosis, or calcification of hyaline or fibrous cartilage. However, if chondrocalcinosis is defined as the deposition of calcium pyrophosphate dihydrate (CPPD) crystals into hyaline or fibrous cartilage, then its association with all of these diseases becomes questionable. Whatever substance is…

Hydroxyapatite deposition disease (HADD) is an extremely common disorder causing periarticular disease in the form of tendinitis or bursitis. Only rarely does it cause true articular disease. Calcium hydroxyapatite deposits in muscles, capsules, bursae, and tendon sheaths. Although this deposition is associated with many systemic diseases, such as collagen vascular diseases, renal osteodystrophy, hypervitaminosis D, and milk-alkali syndrome, in many patients it occurs idiopathically with no…

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is a common disorder and the most common crystal arthropathy. In a typical hospital population, one to three patients per week will be observed with some manifestation of this disorder. It typically affects the middle-aged and elderly population. Some estimate the frequency to be 5 percent of this population. The clinical picture varies from the pseudogout syndrome to asymptomatic…

Gout is the oldest recognized arthropathy. It was originally called podagra, from the Greek pous , meaning foot, and agra , meaning attack. In ancient history all arthritis was called gout. Today we know it to be a specific arthropathy secondary to deposition of monosodium urate crystals. It occurs in 0.3 percent of the population, and it accounts for 5 percent of all patients with arthritis.…

Diffuse idiopathic skeletal hyperostosis (DISH), also known as ankylosing hyperostosis or Forestier disease, is not an arthropathy. The articular cartilage, adjacent bone margins, and synovium are not affected. DISH appears to be a bone-forming diathesis in which ossification occurs at skeletal sites subjected to stress, primarily at tendinous and ligamentous attachments. It is a common disorder, occurring in 12 percent of the elderly population. Its radiographic…