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Radiographic Assessment of Osteoarthritis

DANIEL L. SWAGERTY, JR., M.D., M.P.H., and DEBORAH HELLINGER, D.O.,


University of Kansas Medical Center, Kansas City, Kansas

Am Fam Physician. 2001 Jul 15;64(2):279-287.

Osteoarthritis is one of the most prevalent and disabling chronic conditions affecting older
adults and a significant public health problem among adults of working age. As the bulk of
the U.S. population ages, the prevalence of osteoarthritis is expected to rise. Although the
incidence of osteoarthritis increases with age, the condition is not a normal part of the aging
process. More severe symptoms tend to occur in the radiographically more advanced stage of
the disease; however, considerable discrepancy may exist between symptoms and the
radiographic stage. Roentgenograms of involved joints may be useful in confirming the
diagnosis of osteoarthritis, assessing the severity of the disease, reassuring the patient and
excluding other pathologic conditions. The diagnosis of osteoarthritis is based primarily on
the history and physical examination, but radiographic findings, including asymmetric joint
space narrowing, subchondral sclerosis, osteophyte formation, subluxation and distribution
patterns of osteoarthritic changes, can be helpful when the diagnosis is in question.

Worldwide, osteoarthritis is the most common form of arthritis.1 It is among the most
prevalent and disabling chronic conditions in the United States.2 The prevalence increases
with age, and by the age of 65, approximately 80 percent of the U.S. population is affected.3
5 The functional impairments secondary to osteoarthritis also occur more frequently in older
adults. Pain and limitation of motion restrict the independence of older adults by impairing
their performance of activities of daily living.6,7 As a result, dependence is especially
common for ambulation, stair climbing and other lower-extremity functions.8

Costs directly attributable to osteoarthritis are considerable in the United States, with work
loss accounting for more than one half of the estimated annual expense of $155 billion (in
1994 dollars).9 Another major expense is the number of joint arthroplasties performed in
patients in the advanced stage of the disease.

Osteoarthritis adalah salah satu kondisi kronis yang paling lazim dan menonaktifkan yang
mempengaruhi orang dewasa yang lebih tua dan masalah kesehatan umum yang signifikan
antara kaum dewasa usia kerja. Sebagai usia sebagian besar penduduk AS, prevalensi
Osteoartritis diperkirakan akan meningkat. Meskipun insiden Osteoartritis meningkat dengan
usia, kondisi bukanlah bagian dari proses penuaan normal. Gejala yang lebih parah cenderung
terjadi dalam tahap radiographically yang lebih maju dari penyakit; Namun, perbedaan besar
mungkin ada antara gejala dan tahap radiografi. Roentgenograms terlibat sendi mungkin
berguna dalam mengkonfirmasikan diagnosis Osteoartritis, menilai tingkat keparahan
penyakit, meyakinkan pasien dan tidak termasuk kondisi patologis. Diagnosis Osteoartritis
didasarkan terutama pada sejarah dan pemeriksaan fisik, tetapi radiografi temuan, termasuk
asimetris bersama penyempitan ruang, subchondral sclerosis, osteophyte pembentukan, pola
subluxation dan distribusi osteoarthritic perubahan, dapat membantu ketika diagnosis
bersangkutan.
Di seluruh dunia, osteoarthritis adalah yang paling umum bentuk arthritis.1 itu adalah di
antara yang paling umum dan menonaktifkan kondisi kronis di Inggris States.2 prevalensi
meningkat dengan usia, dan pada usia 65, sekitar 80 persen dari populasi Amerika Serikat
Affected.35 sekunder gangguan fungsional untuk Osteoartritis juga terjadi lebih sering pada
orang dewasa yang lebih tua. Rasa sakit dan keterbatasan gerakan membatasi kemerdekaan
dewasa dengan merusak kinerja mereka kegiatan harian living.6,7 sebagai akibatnya,
ketergantungan ini terutama umum untuk ambulation, memanjat tangga dan functions.8
rendah-ekstremitas lainnya
Biaya langsung berkaitan dengan Osteoartritis cukup besar di Amerika Serikat, akuntansi
untuk lebih dari satu setengah dari biaya tahunan perkiraan $155 miliar (dalam dolar 1994).9
lain kehilangan pekerjaan besar pengeluaran adalah jumlah bersama arthroplasties dilakukan
pada pasien dalam stadium lanjut penyakit.

Etiology and Risk Factors


Although osteoarthritis is especially common in older adults, its pathology of asymmetric
joint cartilage loss, subchondral sclerosis (increased bone density), marginal osteophytes and
subchondral cysts is the same in younger and older adults.1 Primary osteoarthritis is the most
common form and is usually seen in weight-bearing joints that have undergone abnormal
stresses (e.g., from obesity or overuse).1316 The precise etiology of osteoarthritis is
unknown, but biochemical and biomechanical factors are likely to be important in the
etiology and pathogenesis.1 Biomechanical factors associated with osteoarthritis include
obesity, muscle weakness and neurologic dysfunction. In primary osteoarthritis, the common
sites of involvement include the hands, hips, knees and feet13,17 (Figure 1). Secondary
osteoarthritis is a complication of other arthropathies or secondary to trauma. Gout,
rheumatoid arthritis and calcium pyrophosphate deposition disease are correlated with the
onset of secondary osteoarthritis.

Clinical Manifestations
Osteoarthritis is primarily assessed through a history and physical examination. The cardinal
symptom of osteoarthritis is pain that worsens during activity and improves with rest.
Instability of joints is a common finding, especially of the knees and first carpometacarpal
joints. Early morning stiffness is common and characteristically lasts one hour or more,
depending on severity. Stiffness may occur following periods of inactivity. Musculoskeletal
examination may reveal swelling, deformities, bony overgrowth (referred to as Heberden's
nodes when involving the distal interphalangeal joints and Bouchard's nodes when involving
the proximal interphalangeal joints of the hands), crepitus and limitation of motion. Muscle
spasm, and tendon and capsular contractures also may be observed, depending on the site and
duration of involvement.

Etiologi dan faktor risiko


Meskipun osteoarthritis terutama umum pada orang dewasa yang lebih tua, yang patologi
kehilangan tulang rawan sendi yang asimetris, subchondral sclerosis (kepadatan tulang
peningkatan), osteofit marjinal dan subchondral kista adalah sama di tua dan muda adults.1
utama Osteoarthritis adalah bentuk paling umum dan ini biasanya terlihat pada beban sendi
yang telah mengalami tekanan yang abnormal (misalnya, dari obesitas atau berlebihan).13
16 etiologi tepat Osteoartritis tidak diketahui, tetapi faktor-faktor biokimia dan biomekanis
cenderung menjadi penting dalam etiologi dan pathogenesis.1 Biomechanical faktor-faktor
yang terkait dengan osteoarthritis termasuk obesitas, kelemahan otot dan disfungsi
neurologis. Osteoartritis primer, situs umum keterlibatan termasuk tangan, pinggul, lutut, dan
feet13, 17 (gambar 1). Osteoartritis sekunder adalah komplikasi sekunder untuk trauma atau
arthropathies lainnya. Asam urat, rheumatoid arthritis dan penyakit endapan kalsium
pirofosfat berkorelasi dengan onset Osteoartritis sekunder.
Manifestasi klinis
Osteoarthritis terutama dinilai melalui sejarah dan pemeriksaan fisik. Kardinal gejala
Osteoartritis adalah sakit yang memburuk selama kegiatan dan meningkatkan dengan
istirahat. Ketidakstabilan sendi sangat umum, terutama dari lutut dan sendi carpometacarpal
pertama. Pagi kekakuan Umum dan khas berlangsung satu jam atau lebih, tergantung pada
keparahan. Kekakuan dapat terjadi setelah masa non-aktif. Pemeriksaan muskuloskeletal
dapat mengungkapkan pembengkakan, kelainan tulang berlebih (disebut sebagai node
Heberden's ketika melibatkan sendi interphalangeal distal dan node Bouchard's ketika
melibatkan sendi interphalangeal proksimal tangan), krepitus dan keterbatasan gerak. Otot
dan tendon dan kontraktur kapsular juga dapat diamati, tergantung pada situs dan durasi
keterlibatan.

FIGURE 1.

Common sites of involvement in primary osteoarthritis.

Situs umum keterlibatan dalam Osteoartritis primer selalu.

Pain caused by osteoarthritis may develop in any part of the involved joint or tissue.
Typically, pain progresses gradually over time and increases with weight bearing. A patient
with primary osteoarthritis seldom has any attributable systemic symptoms (e.g., fatigue or
generalized weakness). The progression of symptoms in patients with osteoarthritis is fairly
consistent. Mild discomfort first occurs in a joint when it is in high use, but the pain is
relieved by rest. Symptoms progress to constant pain on use of the affected joint and finally,
with more advanced joint involvement, pain occurs at rest and at night. Generally, little
tenderness occurs outside the joint, but pain can occur with extremes in range of motion.
Limitation of motion is often prominent.

Other pathologic processes should not be overlooked when evaluating patients with painful
joints. Osteoarthritis can often be differentiated from other processes by the history and
physical examination (Table 1),6 as well as laboratory studies and radiographic findings.

Cervical and lumbar pain may result from arthritis of the apophyseal joints, osteophyte
formation, pressure on surrounding tissue and muscle spasm. Nerve root impingement causes
radicular symptoms. Cervical and lumbar stenosis develop when facet joints hypertrophy, the
disc degenerates and bulges, and the ligamentum flavum becomes lax and widens. The spinal
canal narrows and compresses the cord. Posterior vertebral osteophytes may also contribute
to cord compression. Patients may develop lumbar pain, extremity weakness, gait ataxia or
abnormal neurologic findings. Pseudoclaudication is a characteristic feature of lumbar
stenosis and is described as pain in the buttocks or thighs occurring with ambulation and
relieved by rest. Hip pain is usually felt in the groin or the medial aspects of the thigh;
however, it can be referred to the knee or buttocks and may be misdiagnosed as lumbar
stenosis.

Radiographic Findings
The diagnosis of osteoarthritis is often suggested on physical examination. Plain film
radiographs are usually adequate for initial radiographic evaluation to confirm the diagnosis
or assess the severity of disease if surgical intervention is being considered. Two views of the
involved joint should be obtained, with the possible exception of the sacroiliac joints and the
pelvis. The two views should be obtained in orthogonal planes to one another (i.e.,
anteroposterior [AP] and lateral). Additional views of weight-bearing joints (knees, hips) may
be necessary. Correlation of radiographic evidence of degenerative joint changes and
symptoms described by patients vary by joint. Abnormalities detected in the knees correlate
with pain in 85 percent of patients, the fingers and carpometacarpal joints in approximately
80 percent and the hips in 75 percent.6

The radiographic hallmarks of primary osteoarthritis include nonuniform joint space loss,
osteophyte formation, cyst formation and subchondral sclerosis. The initial radiographs may
not show all of the findings. At first, only minimal, nonuniform joint space narrowing may be
present. The involved joint spaces have an asymmetric distribution. As the disease
progresses, subluxations may occur and osteophytes may form. Subchondral cystic changes
can occur. These cysts may or may not communicate with the joint space, can occur before
cartilage loss and have a sclerotic border. Subchondral sclerosis or subchondral bone
formation occurs as cartilage loss increases and appears as an area of increased density on the
radiograph. In the advanced stage of the disease, a collapse of the joint may occur; however,
ankylosis does not usually occur in patients with primary osteoarthritis.

Rasa sakit yang disebabkan oleh osteoarthritis dapat mengembangkan dalam setiap bagian
dari terlibat bersama atau jaringan. Biasanya, sakit berlangsung secara bertahap dari waktu
ke waktu dan meningkat dengan berat pada bantalan. Pasien dengan Osteoartritis primer
selalu jarang memiliki gejala sistemik disebabkan (misalnya, kelelahan atau kelemahan
umum). Perkembangan gejala pada pasien dengan osteoarthritis cukup konsisten.
Ketidaknyamanan ringan pertama terjadi di dalam sendi ketika digunakan tinggi, tapi rasa
sakit adalah lega istirahat. Kemajuan gejala sakit konstan penggunaan persendian dan
akhirnya, dengan lebih maju bersama keterlibatan, sakit terjadi dan malam. Umumnya,
kelembutan kecil terjadi di luar sendi, tapi rasa sakit dapat terjadi dengan ekstrem di rentang
gerak. Keterbatasan gerak sering menonjol.
Proses patologis yang lain tidak boleh diabaikan ketika mengevaluasi pasien dengan nyeri
sendi. Osteoarthritis dapat sering dibedakan dari proses lainnya oleh sejarah dan
pemeriksaan fisik (Tabel 1), 6 serta penelitian laboratorium dan radiografi temuan.
Sakit servik dan lumbar mungkin hasil dari radang sendi sendi apophyseal, pembentukan
osteophyte, tekanan pada jaringan di sekitarnya dan kejang otot. Pelampiasan akar saraf
menyebabkan gejala-gejala radicular. Stenosis serviks dan lumbar berkembang ketika sendi
facet hipertrofi, disk bergerak dan tonjolan, dan ligamentum flavum menjadi lemah dan
melebar. Kanal tulang belakang menyempit dan kompres kabelnya. Osteofit vertebralis
posterior juga dapat berkontribusi untuk kompresi saraf. Pasien dapat mengembangkan
nyeri lumbal, kelemahan ekstremitas, kiprah ataxia atau temuan neurologis yang abnormal.
Pseudoclaudication adalah sebuah fitur karakteristik lumbal stenosis dan digambarkan
sebagai rasa sakit di pantat atau paha yang terjadi dengan ambulation dan lega istirahat.
Pinggul sakit biasanya terasa di selangkangan atau aspek-aspek medial paha; Namun, itu
bisa disebut lutut atau pantat dan mungkin misdiagnosed sebagai lumbal stenosis.
Radiografi temuan
Diagnosis Osteoartritis sering disarankan pada pemeriksaan fisik. Radiograph film polos
biasanya cukup untuk awal radiografi evaluasi untuk mengkonfirmasikan diagnosis atau
menilai tingkat keparahan penyakit jika intervensi bedah sedang dipertimbangkan. Dua
pandangan pada sendi yang terlibat harus diperoleh, dengan kemungkinan pengecualian
dari sendi sacroiliac dan panggul. Kedua-dua pandangan harus diperoleh dalam pesawat
ortogonal satu sama lain (yaitu, anteroposterior [AP] dan lateral). Pemandangan tambahan
beban sendi (lutut, pinggul) mungkin diperlukan. Korelasi bukti radiografi perubahan sendi
degeneratif dan gejala yang dijelaskan oleh pasien berbeda-beda bersama. Kelainan yang
terdeteksi di lutut berkorelasi dengan rasa sakit di 85 persen dari pasien, jari-jari dan sendi
carpometacarpal di sekitar 80 persen dan pinggul dalam 75 percent.6
Keunggulan radiografi dari Osteoartritis primer selalu termasuk kehilangan ruang bersama
nonuniform, pembentukan osteophyte, pembentukan kista dan subchondral sclerosis.
Radiograph awal tidak mungkin menunjukkan semua temuan. Pada pertama, hanya sedikit,
nonuniform space bersama penyempitan mungkin hadir. Ruang-ruang bersama yang terlibat
memiliki distribusi asimetris. Sebagai penyakit berlangsung, subluxation dapat terjadi dan
osteofit dapat membentuk. Subchondral kistik perubahan dapat terjadi. Kista ini mungkin
atau mungkin tidak berkomunikasi dengan ruang bersama, dapat terjadi sebelum kehilangan
tulang rawan dan mempunyai perbatasan sclerotic. Pembentukan tulang subchondral
sclerosis atau subchondral terjadi sebagai kehilangan tulang rawan meningkat dan muncul
sebagai daerah peningkatan kepadatan pada radiograf. Pada stadium lanjut penyakit,
runtuhnya sendi dapat terjadi; Namun, ankylosis tidak biasanya terjadi pada penderita
Osteoartritis primer selalu.
Clinical Findings Differentiating Osteoarthritis from Other Causes of Painful Joints
Condition History Physical

Primary Gradual progression of pain Bony enlargement of joints: DIP, PIP,


osteoarthritis Morning stiffness of one hour first carpometacarpal, hips, knees, feet
or more Pain increasing with Usually no wrist, elbow, ankle or
weight bearing Night pain No involvement of MCP
systemic symptoms
Bursitis/tendonitis Pain increased with movement No joint abnormality or swelling
Pain worse at night No Certain passive maneuvers produce
systemic symptoms Pain on pain Pain on resisted active range of
some maneuvers, not others motion of affected muscles
Mechanical intra- Recurrent joint swelling Joint Pain and limitation at certain points of
articular conditions locks Joint gives way flexion or extension Pain on combined
Intermittent pain with pain-free rotation and extension of the knee
intervals
Rheumatoid arthritis Often insidious onset Morning Involvement of MCP, wrist, elbows,
stiffness of one hour or more ankles Synovial thickening Classic
Systemic symptoms deformities: Swan neck Boutonniere
Associated symptoms (e.g., Ulnar deviation Loss of range of
Raynaud's syndrome, skin motion of wrist, elbows
rash)

DIP = distal interphalangeal joint; PIP = posterior interphalangeal joint; MCP = metacarpal
phalangeal joint.

Information from Bagge E, Bjelle A, Eden S, Svanberg A. A longitudinal study of the


occurrence of joint complaints in elderly people. Age Ageing 1992;21:1607.

KNEE

When evaluating patients with osteoarthritis of the knee, AP and lateral radiographs allow an
adequate evaluation of the medial and lateral joint spaces. To adequately assess the joint
space, the AP view should be obtained with the patient in a standing position. The lateral
view also allows evaluation of the patellofemoral joint; however, an additional view, known
as the sunrise view, can offer even more information about this joint space.

LUTUT
Ketika mengevaluasi penderita Osteoartritis lutut, AP dan lateral radiograph memungkinkan
evaluasi memadai medial dan lateral ruang bersama. Untuk secara memadai menilai ruang
bersama, tampilan AP harus diperoleh dengan pasien dalam posisi berdiri. Lateral yang
melihat juga memungkinkan evaluasi sendi patellofemoral; Namun, pandangan tambahan
yang dikenal sebagai pemandangan matahari terbit, dapat menawarkan informasi lebih
lanjut tentang ruang bersama ini.
FIGURE 2.

Osteoarthritis of the knees. (A) Anteroposterior view of the left knee of patient 1 shows
medial joint space narrowing (arrow). (B) Lateral view of the left knee shows sclerosis with
marked osteophyte formation (arrows). The osteophytes are best seen in this view. (C) Patient
2 has marked osteoarthritic changes with medial joint space narrowing (white arrow) causing
a varus deformity of the knee and collapse of the joint space with destruction of the medial
cartilage and the subchondral cortex (open arrowheads). (D) Subchondral cysts (solid
arrowhead) are noted.
Osteoartritis lutut. (A) Anteroposterior pandangan lutut kiri pasien 1 menunjukkan medial
ruang sendi menyempit (panah). (B) lateral yang melihat lutut kiri menunjukkan sclerosis
dengan pembentukan ditandai osteophyte (anak panah). Osteofit terbaik terlihat dalam
pandangan ini. (C) pasien 2 telah menandai osteoarthritic perubahan dengan medial
bersama penyempitan ruang (putih panah) menyebabkan kelainan varus lutut dan runtuhnya
ruang bersama dengan kerusakan tulang rawan medial dan korteks subchondral (terbuka
panah). (D) Subchondral kista (padat arrowhead) dicatat.1

Radiographic findings in patients with osteoarthritis include medial tibiofemoral and


patellofemoral joint space narrowing, as well as subchondral new bone formation.18,19 Next,
lateral subluxation of the tibia occurs, and osteophyte formation is most prominent medially.
Lateral joint space narrowing can also occur but not as prominently as the medial narrowing
(Figures 2a and 2c). Cartilage is lost, and subchondral bone formation occurs. Marked
osteophyte formation also occurs (Figures 2b and 2d), and osteophytes are seen anteriorly and
medially at the distal femur and proximal tibia, and posteriorly at the patella and the tibia.

Radiografi temuan pada pasien dengan osteoarthritis mencakup medial tibiofemoral dan
patellofemoral ruang sendi menyempit, serta formation.18,19 tulang subchondral baru
berikutnya, lateral subluxation tibia terjadi, dan pembentukan osteophyte sebagian
terkemuka medial. Penyempitan ruang bersama lateral juga dapat terjadi tetapi tidak
sebagai jelas sebagai penyempitan medial (2a angka dan 2c). Tulang rawan hilang, dan
pembentukan tulang subchondral terjadi. Pembentukan osteophyte ditandai juga terjadi
(angka 2b dan 2d), dan osteofit dilihat anterior dan medial dan distal femur proksimal tibia,
dan posterior patella dan tibia.

HAND

The hand can be evaluated with AP and oblique views; however, more detail is evident with
magnified views of the entire hand or of a specific joint. Magnification views are particularly
helpful in evaluating the soft tissues and the fine detail of specific bone. The most commonly
involved joints in the hand and wrist are the first carpometacarpal joints, the
trapezionavicular joint and the proximal interphalangeal and distal interphalangeal joints.
Joint space loss is nonuniform and asymmetric (Figure 3). Erosive changes are not seen in
primary osteoarthritis. In cases where an underlying disease process (such as an inflammatory
arthropathy) is present, secondary osteoarthritis can occur. Postmenopausal women may have
a variant of osteoarthritis, known as erosive arthritis.20 Only erosive osteoarthritis has
erosions and ankylosis. The distribution in the hands and the feet is similar to that of
osteoarthritis.

TANGAN
Tangan dapat dievaluasi dengan AP miring; Namun, lebih detail jelas dengan pemandangan
diperbesar seluruh tangan atau gabungan tertentu. Pembesaran pandangan sangat membantu
dalam mengevaluasi jaringan lunak dan detil tertentu tulang. Paling sering terlibat sendi di
tangan dan pergelangan yang pertama carpometacarpal sendi, sendi trapezionavicular dan

1
proksimal interphalangeal dan distal sendi interphalangeal. Badan space bersama nonuniform
dan asimetris (gambar 3). Erosi perubahan tidak terlihat di Osteoartritis primer selalu. Dalam
kasus di mana penyakit yang mendasari proses (seperti arthropathy inflamasi) hadir,
Osteoartritis sekunder dapat terjadi. Wanita postmenopause mungkin memiliki varian
Osteoartritis, dikenal sebagai erosi arthritis.20 hanya erosi Osteoartritis memiliki erosi dan
ankylosis. Distribusi di tangan dan kaki sangat mirip dengan yang Osteoartritis.

HIPS AND PELVIS

AP views of the pelvis can be used to assess arthritic changes in the hips as well as the
sacroiliac joints (Figure 4). Changes associated with the hip include superolateral joint space
narrowing with subchondral sclerosis. The superolateral portion of the joint is the weight-
bearing portion. Cystic changes can occur, and the femoral head can appear to be irregular.

The true synovial joint space of the sacroiliac joint occurs anteriorly and inferiorly. In
osteoarthritis, bridging osteophytes develop and extend from the ilium to the sacrum.
Sclerotic changes are also noted, but ankylosis or erosions do not usually develop as they do
in spondyloarthropathies such as ankylosing spondylitis, psoriasis or Reiter's syndrome.

PINGGUL DAN PANGGUL


Pemandangan AP panggul dapat digunakan untuk menilai perubahan rematik pinggul serta
sendi sacroiliac (gambar 4). Perubahan yang terkait dengan hip termasuk superolateral ruang
sendi menyempit dengan subchondral sclerosis. Bagian superolateral sendi adalah bagian
beban. Kistik perubahan dapat terjadi, dan kepala femoralis dapat tampaknya tidak teratur.
Benar ruang sendi sinovial sendi sacroiliac terjadi anterior dan inferior. Osteoartritis,
menjembatani osteofit mengembangkan dan memperluas dari pasangan sakrum. Sclerotic
perubahan juga dicatat, tetapi ankylosis atau erosi tidak biasanya mengembangkan seperti
yang mereka lakukan di spondyloarthropathies seperti ankylosing spondylitis, psoriasis atau
sindrom Reiter.

SPINE

Lateral and AP lumbar spine radiographs are adequate to allow identification of osteoarthritic
changes in the apophyseal joints. Decreased joint space is noted between the superior and
inferior facets. Sclerosis and cyst formation occur in osteoarthritis of the spine. Neural
foraminal narrowing may result from the osteophyte formation. These changes can be seen on
computed tomographic (CT) scans. Figure 5 illustrates neural foraminal narrowing caused by
facet osteophyte formation. Similar changes are seen in the cervical spine. Primary
osteoarthritic changes are not commonly seen in the thoracic spine. Osteoarthritis of the spine
is often associated with degenerative joint disease.

TULANG BELAKANG
Lateral dan AP lumbar tulang radiograph yang memadai untuk memungkinkan identifikasi
osteoarthritic perubahan dalam sendi apophyseal. Penurunan space bersama diperhatikan
antara aspek superior dan inferior. Sclerosis dan kista pembentukan terjadi di Osteoartritis
pada tulang belakang. Penyempitan foraminal saraf dapat hasil dari pembentukan osteophyte.
Perubahan ini dapat dilihat pada dihitung tomografi terhitung (CT) scan. Gambar 5
mengilustrasikan penyempitan foraminal saraf disebabkan oleh pembentukan osteophyte
segi. Perubahan yang sama terlihat di tulang belakang leher. Perubahan osteoarthritic utama
tidak sering terlihat di tulang belakang dada. Osteoartritis pada tulang belakang ini sering
dikaitkan dengan penyakit persendian degeneratif.

FIGURE 3.

Oblique (left) and AP (right) views of the hand demonstrate decreased joint space and
subchondral sclerosis at the first carpal metacarpal joint (white arrows). There is old joint
space loss at the PIP and DIP joints with relative sparing of the MCP joints. Osteophyte
formation with soft tissue swelling and subchondral sclerosis is noted at the 2nd and 3rd DIP
joints compatible with Heberden's nodes (open arrows). (PIP = proximal interphalangeal; DIP
= distal interphalangeal; MCP = metacarpal phalangeal)

Miring (kiri) dan AP (kanan) pemandangan tangan menunjukkan penurunan bersama ruang
dan subchondral sclerosis pada sendi metacarpal karpal pertama (putih panah). Ada tua
kehilangan space bersama di PIP dan DIP sendi dengan relatif hemat MCP sendi.
Pembentukan osteophyte dengan jaringan lunak pembengkakan dan subchondral sclerosis
dicatatkan di 2nd dan 3rd DIP sendi kompatibel dengan Heberden's node (terbuka panah).
(PIP = proksimal interphalangeal; DIP = distal interphalangeal; MCP = metacarpal
phalangeal)

FOOT

In the foot, AP and lateral radiographs are adequate to assess osteoarthritic changes, but
oblique and magnified views may be helpful if a detailed view of a joint space is required.
The most common joint involved is the first metatarsophalangeal joint. Again, subchondral
sclerosis, osteophyte formation and cystic changes are common. Lateral subluxation of the
great toe results in a hallux valgus deformity. Osteoarthritic changes elsewhere in the foot,
such as the subtalar joint, are usually caused by altered mechanics from congenital or
acquired abnormalities (e.g., pes planus, fusion of two bones) or are secondary to another
underlying arthropathy (e.g., psoriasis, Reiter's syndrome).

KAKI
Di kaki, AP dan lateral radiograph yang memadai untuk menilai osteoarthritic perubahan,
tetapi pemandangan miring dan diperbesar mungkin bermanfaat jika tampilan rinci ruang
bersama yang diperlukan. Sendi paling umum terlibat adalah sendi metatarsophalangeal
pertama. Sekali lagi, subchondral sclerosis, osteophyte pembentukan dan kistik perubahan
yang umum. Lateral subluxation hasil jari di kelainan valgus ibu jari kaki. Osteoarthritic
perubahan di tempat lain di kaki, gabungan subtalar, biasanya disebabkan oleh mekanika
berubah dari kelainan bawaan atau faktor dapatan (misalnya, pes planus, fusi dari dua tulang)
atau sekunder untuk lain yang mendasari arthropathy (misalnya, Psoriasis, sindrom Reiter).
FIGURE 4.

Serial anteroposterior views of the pelvis demonstrating progressive osteoarthritic changes of


the hips. (Top) The first film, obtained in 1997, demonstrates bilateral, superolateral joint
space narrowing (arrows) at the hips that is worse on the left side. Subchondral sclerosis
(solid arrowhead) and cyst (open arrowhead) formation are also noted on the left side.
(Center) The March 1999 film shows the interval increase in joint space loss (arrow) and
sclerosis (solid arrowhead). (Bottom) A third film, obtained in December 1999, reveals left
hip arthroplasty (arrow).

Pemandangan serial anteroposterior panggul menunjukkan perubahan osteoarthritic progresif


pinggul. (Atas) Film pertama, diperoleh pada tahun 1997, menunjukkan bilateral,
superolateral bersama ruang penyempitan (panah) pada pinggul yang buruk pada sisi kiri.
Subchondral sclerosis (padat arrowhead) dan pembentukan kista (terbuka arrowhead) juga
dicatat di sisi kiri. (Pusat) Maret 1999 film menunjukkan peningkatan interval space bersama
kerugian (panah) dan sclerosis (padat arrowhead). (Bawah) Film ketiga, diperoleh pada
Desember 1999, mengungkapkan artroplasti pinggul kiri (panah).
Disease Progression
Follow-up radiographs are unnecessary in evaluating progression of the disease but can be
helpful, especially if surgical intervention is planned or a fracture is suspected. Imaging
beyond plain films is not warranted for routine follow-up; however, in the appropriate clinical
situation, additional types of imaging may be useful. Nuclear medicine bone scans can show
radiopharmaceutical localization but are nonspecific in areas of increased bone production.
Tomography is only helpful if an occult fracture is suspected, but routine tomography is not
indicated to monitor osteoarthritis.

While a CT scan is not indicated for an initial evaluation or as routine follow-up, it may be
helpful in the evaluation of the lumbar spine to check facet hypertrophy in the management
of low back pain and spinal stenosis. This evaluation can also be accomplished with magnetic
resonance imaging (MRI) studies, although the osseous detail is better appreciated with CT
scan. MRI also can be helpful in evaluating cartilage loss but often is unnecessary because
plain films provide adequate information. MRI studies should not be routinely performed in
diagnosing osteoarthritis unless additional pathology is suspected (e.g., post-traumatic
injuries, malignancy, neural foraminal impingement, infectious process). Ultrasonography
can be helpful in diagnosing cystic changes in the soft tissue about the joints but is not useful
in the initial diagnosis of osteoarthritis.

Perkembangan penyakit
Tindak lanjut radiograph tidak perlu dalam mengevaluasi perkembangan penyakit tetapi
dapat berguna, terutama jika intervensi bedah direncanakan atau fraktur diduga. Pencitraan
luar biasa film tidak dibenarkan untuk tindak lanjut rutin; Namun, dalam situasi klinis yang
sesuai, tambahan jenis pencitraan mungkin berguna. Kedokteran nuklir tulang scan dapat
menunjukkan lokalisasi radiopharmaceutical tetapi tidak spesifik di daerah tulang
peningkatan produksi. Tomografi ini hanya membantu jika fraktur okultisme diduga, tetapi
tomography rutin tidak diindikasikan untuk memantau Osteoartritis.
Sementara CT scan tidak diindikasikan untuk evaluasi awal atau sebagai tindak lanjut rutin,
mungkin akan membantu dalam evaluasi lumbalis tulang belakang untuk memeriksa aspek
hipertrofi dalam manajemen nyeri punggung rendah dan stenosis tulang belakang. Evaluasi
ini juga dapat dicapai dengan studi pencitraan Resonansi Magnetis (MRI), meskipun detail
osea lebih dihargai dengan CT scan. MRI juga dapat membantu dalam mengevaluasi
kehilangan tulang rawan tetapi sering tidak perlu karena film polos menyediakan informasi
yang memadai. Studi MRI harus tidak rutin dilakukan dalam mendiagnosis Osteoartritis
kecuali tambahan patologi diduga (misalnya, pasca-traumatic cedera, keganasan, saraf
foraminal pelampiasan, proses infeksi). Ultrasonografi dapat membantu dalam mendiagnosa
kistik perubahan dalam tisu lembut tentang sendi tapi tidak berguna dalam diagnosis awal
osteoarthritis.
FIGURE 5.

(Left) Axial computed tomographic images of the lumbar spine at the level of L45
demonstrating hypertrophy of the facets (solid arrowhead) with sclerosis (black arrow).
(Right) Facet hypertrophy, with or without a disc bulge, can cause stenosis of the neural
foramina (open arrowhead) and nerve root impingement. Subchondral cyst formation (white
arrow) is evident.

Differential considerations are based, in part, on which joint is being examined. In general,
the major differential diagnosis includes rheumatoid arthritis, psoriatic arthritis, calcium
pyrophosphate deposition disease, ankylosing spondylitis and diffuse idiopathic skeletal
hyperostosis

Kiri) Aksial gambar tomografi terhitung dihitung dari tulang belakang lumbal di tingkat L4-5
menunjukkan hipertrofi segi (padat arrowhead) dengan sclerosis (panah hitam). (Kanan) Segi
hipertrofi, dengan atau tanpa tonjolan disc, dapat menyebabkan stenosis pada foramen saraf
(terbuka arrowhead) dan saraf pelampiasan akar. Pembentukan kista subchondral (putih
panah) jelas.
Pertimbangan diferensial, sebagian berdasarkan, yang bersama sedang diperiksa. Secara
umum, diferensial diagnosis utama termasuk rheumatoid arthritis, psoriasis arthritis, kalsium
pirofosfat pengendapan penyakit, spondilitis ankilosa dan menyebar idiopatik kerangka
hyperostosis

Radiographic Findings Differentiating Osteoarthritis from Other Causes of Painful Joints


Bone Joint space
Condition density Erosions Cysts loss Distribution Bone production

Osteoarthriti Normal No, unless Yes, Nonunifor Unilateral Yes; osteophytes;


s overall erosive subchondra m and/or subchondral
osteoarthriti l bilateral; sclerosis
s asymmetri
c
Rheumatoid Decrease Yes Yes, Uniform Bilateral; No
Bone Joint space
Condition density Erosions Cysts loss Distribution Bone production

arthritis d synovial symmetric


Psoriatic Normal Yes No Yes Bilateral; Yes
arthritis asymmetri
c
CPPD Normal No Yes Uniform Bilateral Yes; osteophytes;
chondrocalcinosis
; subchondral
Ankylosing Early Yes No Yes Bilateral; Yes
spondylitis normal symmetric
Late
decreased
DISH Normal No No No Sporadic Flowing
osteophytes;
ossification of
tendon, ligaments

CPPD = calcium pyrophosphate deposition disease; DISH = diffuse idiopathic skeletal


hyperostosis.

Information from Brower AC. Arthritis in black and white. Philadelphia: Saunders, 1998:23
57.

The Authors
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DANIEL L. SWAGERTY, JR., M.D., M.P.H., is associate professor in the Departments of


Family Medicine and Internal Medicine, and associate director (Education) of the Center of
Aging at the University of Kansas School of Medicine, Kansas City, Kan. He received his
medical degree and completed a family practice residency and a fellowship in geriatric
medicine at the University of Kansas School of Medicine....

REFERENCES
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1. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a
view to prevention. Arthritis Rheum. 1998;41:134355....

Coordinators of this series are Mark Meyer, M.D., at the University of Kansas School of
Medicine, Kansas City, Kan., and Walter Forred, M.D., University of Missouri-Kansas City
School of Medicine, Kansas City, Mo.