Mnemonic: ABCDES
Alignment
- RA: Ulnar and volar subluxation at the MCPJ and boutonniere or swan neck deformities
- PsA: Multidirectional
- Absent: CPPD and gout
Bone – mineralization
- Periarticular osteopenia (hyperemia of inflamed synovium and soft tissues): RA, Septic arthritis, PsA
- Subchondral sclerosis: OA, Neuropathic arthritis
Bone – production
- Osteophytes (margins of synovial joint): OA, CPPD (with calcification)
- Fluffy periostitis: PsA
- Spondylophytes (horizontal/perpendicular to spine): Spondylosis
- Syndesmophytes (vertical/parallel to spine): Ankylosing spondylitis
- Flowing syndesmophytes (atleast 4 vertebra): DISH
Cartilage (Joint space)
- Asymmetric narrowing: Degenerative diseases (OA, CPPD, EOA)
- Uniform narrowing: Inflammatory diseases
- Preserved: Gout
Calcification
- Periarticular soft tissues: Gout
- Tendons: HADD (amorphous and globular), CPPD (linear and stippled)
- Cartilage: CPPD
Distribution
- OA: 1st CMCJ, STTJ, DIPJ
- RA: Symmetric and pancarpal, MCPJ, PIPJ
- PsA: Asymmetric and DIPJ, PIPJ
- CPPD: 2nd/3rd MCPJ (hooked osteophyte) or SLAC
- Hemochromatosis: 4th/5th MCPJ (hooked osteophyte and no chondrocalcinosis)
Erosions
- Marginal erosions (bare area of joint): RA (MCPJ), Psoriatic arthritis (DIP)
- Subchondral erosions: Erosive osteoarthritis
- Gullwing deformity (Subchondral erosion + Osteophyte): EOA
- Pencil-in-cup deformity (marginal erosion + bone proliferation): PsA
- Periarticular erosions (eccentric where capsules attach): Gout
Soft tissues
- Symmetric fusiform soft tissue swelling: Inflammatory diseases
- Asymmetric soft tissue swelling: OA, EOA
- Lumpy bumpy pattern: Depositional processes (gout, sarcoid, amyloid, neoplasms)
ABCDES of Arthritis of Wrist and Hand
| Features | RA | PsA | OA | EOA | CPPD | Gout |
| Alignment (subluxation) | Ulnar | Multidirection | Lateral | Lateral | None | None |
| Bone mineralization | Osteopenia | Normal | Normal | Normal | Normal | Normal |
| Bone production | None | Productive | Reparative | Reparative | Reparative | Overhang |
| Cartilage (joint narrowing) | Uniform | Uniform | Nonuniform | Nonuniform | Nonuniform | Preserved |
| Calcification | None | None | None | None | Cartilage | Soft tissue |
| Distribution | Proximal, bilateral/symmetric | DIP | Typical | Typical | Atypical | Random |
| Erosions | Marginal | Marginal, Pencil-in-cup | None | Subchondral, Gull-wing | None | Juxta-articular |
| Soft tissue | Symmetric | Symmetric | Asymmetric | Asymmetric | Asymmetric | Lumpy-bumpy |
References and Further Reading:
- A Systematic Approach to Radiographic Evaluation of Arthritis of the Hand and Wrist. Contemporary Diagnostic Radiology 44(11):p 8, May 31, 2021. | DOI: 10.1097/01.CDR.0000751608.63997.3a
- The Radiology Assistant : Arthritis