{"id":8426,"date":"2021-11-25T19:22:33","date_gmt":"2021-11-25T17:22:33","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/rheumatology\/imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders\/"},"modified":"2022-04-19T18:34:22","modified_gmt":"2022-04-19T16:34:22","slug":"imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders\/","title":{"rendered":"Imaging techniques and laboratory diagnostic methods for musculoskeletal disorders"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Imaging<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Rheumatologic disorders often present with radiological changes well before any clinical symptoms are apparent. It is important to detect these changes as early as possible, because proper diagnosis and early treatment improves the prognosis of most rheumatic diseases.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rheumatoid arthritis is one of the most well-studied disorders, presenting with pathognomonic changes such as <strong>joint-space narrowing<\/strong> (JSN),<strong> bone and cartilage erosions<\/strong>, and <strong>periarticular osteopenia<\/strong>.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title2\">Imaging techniques<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li><strong>X-ray<\/strong>. A cheap and accessible examination used for the majority of musculoskeletal diseases (such as RA, osteoarthritis, and spondyloarthritides). <ul><li>It can visualize anatomical abnormalities and pathological changes in the bones, joints, and soft tissues, such as bone and cartilage erosions, joint-space narrowing, soft-tissue calcification or swelling, as well as osteopenia and gross malignancies.<\/li><li>Proper imaging techniques are important, to allow visualization of the lesions, which sometimes require specific angles to be visualized, as X-ray captures only a single projection.<\/li><\/ul><\/li><li><strong>Ultrasound<\/strong>. Additional cheap and accessible examination, used for evaluating joints and soft tissues such as muscles, ligaments, and tendons.<ul><li><strong>Joins. <\/strong>US is particularly useful for the diagnosis of joint effusion, synovitis, erosions, Baker&#8217;s cysts, bursitis, and crystal-induced arthropathies (seen as chondrocalcinosis).<\/li><li><strong>Soft tissues<\/strong>. US can visualize muscle and tendon trauma and edema, tendonitis, and tissue calcifications.<\/li><\/ul><ul><li>Doppler-ultrasound can be used for the detection of increased blood flow (seen in inflammatory diseases).<\/li><li>A skilled examiner along with a high-quality ultrasound device may achieve performance similar to that of a CT or MRI.<\/li><\/ul><\/li><li><strong>Computed tomography<\/strong>. Compared to X-ray, CT offers a much more precise assessment and visualization of skeletal structures and pathologies such as erosions, and degenerative and inflammatory processes.<ul><li>The drawback of CT scans is the high radiation load, especially in abdominal and lumbar scans.<\/li><li>CT-angiography can be used for the detection of vascular diseases (vasculitis).<\/li><\/ul><\/li><li><strong>MRI<\/strong>. MRI is superior to CT for the demonstration of soft tissues, providing a higher resolution and more details, creating cross-section images, but is more expensive and time-consuming.<ul><li>Useful for the demonstration of arthritis, sacroiliitis, synovitis, hemarthrosis, synovial cysts, discopathies, and bone marrow pathologies.<\/li><li>T1-weighted sequencing is best for displaying anatomical details, while T2-weighted sequencing is better for displaying edema, inflammation, and neoplasms.<\/li><\/ul><\/li><li><strong>Nuclear imaging<\/strong>. Nuclear imaging presents the biological functions of tissues. One of the most common modalities include<strong> bone scintigraphy<\/strong> for the evaluation of inflammatory processes and tumors, with a relatively high sensitivity, but low specificity. PET-CT and PET-MRI examinations are also available, combining both functional and anatomical imaging.<ul><li>Tc-99 labeled bisphosphonates are used for the detection of bony lesions (osteoarthritis, tumors)<\/li><li>In-111 or Ga-67 labeled WBCs are used for the detection of inflammation.<\/li><li>FDG for the detection of tumors.<\/li><\/ul><\/li><li><strong>DEXA scan<\/strong>. An x-ray absorption test, for the diagnosis of osteopenia and osteoporosis based on bone density.<ul><li>The result is compared to the average healthy population, and based on the T-score (measured in SD), a result of -1 means osteopenia, while -2.5 means osteoporosis.<\/li><li>Advanced spondyloarthritides can provide a false negative result.<\/li><\/ul><\/li><li><strong>Fluoroscopy<\/strong>. &#8220;Real-time X-ray&#8221; is used for localization during joint injections or aspirations.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h3 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Laboratory examinations<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Quantitative blood tests<\/strong>. These tests measure the quantity of cells in the blood. They are highly non-specific.<ul><li>Anemia can be present in chronic inflammation<\/li><li>Leukocytosis and thrombocytosis are common in inflammatory diseases<\/li><li>Thrombocytopenia can occur in autoimmune diseases<\/li><li>Leukopenia can be present in Felty&#8217;s syndrome and SLE<\/li><\/ul><\/li><li><strong>Qualitative blood tests<\/strong>. These tests measure certain molecules and markers in the blood. They are used for differential diagnosis.<ul><li>Reduced albumin and elevated immunoglobulin is seen in arthritis<\/li><li>Elevated IL-6 and acute-phase proteins (CRP, ceruloplasmin, SAA, haptoglobin, hepcidin, fibrinogen) are a sign of inflammation<\/li><li>Elevated ESR is a sign of inflammation (CRP is more sensitive)<\/li><li>Elevated CK, LDH, and GOT are a sign of myositis<\/li><li>Elevated alkaline phosphatase are a sign of osteomalacia, bone metastasis, and Paget&#8217;s disease<\/li><li>Procalcitonin is an indicator for infection. Elevated CRP, IL-6 and procalcitonin together indicate an inflammatory process as a response to infection.<\/li><li>Markers of bone and cartilage breakdown such as COMT may indicate joint destruction.<\/li><\/ul><\/li><li><strong>Serology<\/strong>. These are tests for the presence (and quantity) of certain antibodies that participate in autoimmune diseases.<ul><li>Rheumatoid factor (RF) IgM for rheumatoid arthritis (highly sensitive but not specific)<\/li><li>Anti-citrullinated antibodies for RA<\/li><li>Antinuclear antibodies (SLE, scleroderma, and many other autoimmune diseases)<\/li><\/ul><\/li><li><strong>Genetic tests<\/strong><ul><li>HLA-B27 is common in patients with spondyloarthritis<\/li><li>HLA-DR4 is common in patients with RA<\/li><li>HLA-DR3 is common in patients with SLE<\/li><\/ul><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Imaging<\/h3><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Imaging techniques<\/h4><h3 class=\"wp-block-heading\" class=\"wp-block-heading\">Laboratory examinations<\/h3><\/div>","protected":false},"excerpt":{"rendered":"<p>Imaging Rheumatologic disorders often present with radiological changes well before any clinical symptoms are apparent. It is important to detect these changes as early as possible, because proper diagnosis and early treatment improves the prognosis of most rheumatic diseases. Rheumatoid arthritis is one of the most well-studied disorders, presenting with pathognomonic changes such as joint-space [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":8424,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8426","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Imaging techniques and laboratory diagnostic methods for musculoskeletal disorders &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/rheumatology\/imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/rheumatology\\\/imaging-techniques-and-laboratory-diagnostic-methods-for-musculoskeletal-disorders\\\/\",\"name\":\"Imaging techniques and laboratory diagnostic methods for musculoskeletal disorders &#8211; 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