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lazybonezzz · Credits: 54675 My Scrapbook

distal interphalangeal joint is not involved in---
1.rheumatoid arthritis
2.osteoarthritis
3.psoriatic arthritis
4.multiple histocytosis

i know it can't be 2 or 3
im confused b/w 1 & 4 coz i couldnt find multiple histocytosis anywhere

drprashg · Credits: 3232 My Scrapbook

answer is multiple histiocytosis. all the others show DIP jt involvement.

X RAY FINDINGS IN HISTICYTOSIS

Findings:

* In the descending order of frequency, sites involved with monostotic osseous disease include the calvarium, mandible, ribs, long bones of the upper extremity, pelvis, and vertebrae.

* When tubular bones are involved, diaphyseal and metaphyseal localization is more frequent than epiphyseal localization. Epiphyseal lesions may cross the open physeal plate.

* The skull is affected in one half of patients.

o The diploic space of the parietal and temporal bones are usually involved.

o Skull lesions are lytic, with a beveled edge or sharp and serrated margins and the absence of sclerosis in calvarial lesions.

o Sclerosis may occur around orbital lesions.

o Marginal sclerosis may occur during the healing phase in up to 50% of patients with a calvarial lesion.

o A hole-within-a-hole appearance may occur as a result of uneven erosion of the inner and outer tables of the skull.

o A soft tissue mass overlying the skull defect may be obvious and, often, clinically palpable.

o A soft tissue mass is occasionally seen with orbital lesions, with or without underlying bone erosion.

o A button sequestrum is seen because a central bone opacity within a lytic lesion is an unusual presentation.

* Mandibular lesions may be associated with gingival and soft tissue swelling and floating teeth

* The ribs show lytic expansile lesions, which may be associated with pathologic fractures.

* Long bones below the knees and distal to the elbows are rarely involved.

o Lesions are lytic, round or oval, and expansile, with ill-defined or sclerotic margins.

o The medullary cavity may be expanded and associated with cortical thinning, intracortical tunneling, and erosion of the cortex and an adjacent soft-tissue mass.

o Laminated periosteal new bone formation is common around the involved segment of bone.

o Spread across growth plates is unusual.

o Tubular long bone lesions may appear rapidly over 3 weeks.

* The scapulae and pelvis show destructive lesions.

* Periosteal elevation is minimal, and some lesions show sclerotic margins, particularly lesions occurring in the supra-acetabular regions.

* Vertebral destruction may lead to flattening of the vertebral body, which is termed vertebra plana and is a finding that is much more common in children than in adults.

o Vertebra plana is more common in the dorsal spine.

o Associated kyphosis has not been described, but scoliosis can occur.

o EG can produce expansile lytic lesions of the vertebral bodies and the posterior vertebral elements.

o An associated paraspinal mass may occasionally occur.

o Involvement of the second cervical vertebra is an extremely rare occurrence, but it may cause atlantoaxial instability.

* Lung involvement is seen in as many as 20% of patients, with an incidence of 0.05-0.5 per 100,000 patients annually.

o Lung lesions are seen in an older subset of patients, ie, those aged 20-40 years.

o Plain radiographic findings may demonstrate an alveolar pattern in an early stage, which may be followed by nodular shadows (3-10 mm) and/or a reticulonodular pattern with a predilection for the apices.

o Eventually, fibrosis and a honeycomb lung may ensue.

o Recurrent pneumothoraces occur in 20% of patients.

o Hilar lymphadenopathy and pleural effusions are rare.

lazybonezzz · Credits: 54675 My Scrapbook

hi thanx a ton 4 the reply but any references?
ur taking multiple histocytosis 2 b the same as langerhans cell histiocytosis?

drprashg · Credits: 3232 My Scrapbook

this is from emedicine dot com. lots of good stuff there, check it out.

DRATKINS · Credits: 8535 My Scrapbook

this a lenthy & nice explanation, but i am still standing,where i started,what i read in my mbbs that RA has nothing to do with DIP& OA has nothing to do with MP. help me out??

contagious · Credits: 818 My Scrapbook

yeah i agree with dratkins

even i was told that if dip joint is involved then
RA is ruled out

any more views yaar?

lazybonezzz · Credits: 54675 My Scrapbook

hello ppl
well
i feel the answer shud b RA coz multiple histocytosis i guess is langerhans cell histiocytosis & robbins says it can occur in any bone of the body
plus mudit khanna & amit ashish insist zat DIP is characteristically spared in RA

harrison says DIP is rarely involved in RA so goin by these 2 references the answer works out 2b RA

bondgaurav · Credits: 121 My Scrapbook

ya its RA. THOUGH deformities do occur in dip they r due to tendinitis

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