Radiological Approach to Arthritis : Mnemonic

Mnemonic: ABCDES

Arthritis approach


  1. RA: Ulnar and volar subluxation at the MCPJ and boutonniere or swan neck deformities
  2. PsA: Multidirectional
  3. Absent: CPPD and gout

Bone – mineralization

  1. Periarticular osteopenia (hyperemia of inflamed synovium and soft tissues): RA, Septic arthritis, PsA
  2. Subchondral sclerosis: OA, Neuropathic arthritis

Bone – production

  1. Osteophytes (margins of synovial joint): OA, CPPD (with calcification)
  2. Fluffy periostitis: PsA
  3. Spondylophytes (horizontal/perpendicular to spine): Spondylosis
  4. Syndesmophytes (vertical/parallel to spine): Ankylosing spondylitis
  5. Flowing syndesmophytes (atleast 4 vertebra): DISH

Cartilage (Joint space)

  1. Asymmetric narrowing: Degenerative diseases (OA, CPPD, EOA)
  2. Uniform narrowing: Inflammatory diseases
  3. Preserved: Gout


  1. Periarticular soft tissues: Gout
  2. Tendons: HADD (amorphous and globular), CPPD (linear and stippled)
  3. Cartilage: CPPD


  1. OA: 1st CMCJ, STTJ, DIPJ
  2. RA: Symmetric and pancarpal, MCPJ, PIPJ
  3. PsA: Asymmetric and DIPJ, PIPJ
  4. CPPD: 2nd/3rd MCPJ (hooked osteophyte) or SLAC
  5. Hemochromatosis: 4th/5th MCPJ (hooked osteophyte and no chondrocalcinosis)


  1. Marginal erosions (bare area of joint): RA (MCPJ), Psoriatic arthritis (DIP)
  2. Subchondral erosions: Erosive osteoarthritis
  3. Gullwing deformity (Subchondral erosion + Osteophyte): EOA
  4. Pencil-in-cup deformity (marginal erosion + bone proliferation): PsA
  5. Periarticular erosions (eccentric where capsules attach): Gout

Soft tissues

  1. Symmetric fusiform soft tissue swelling: Inflammatory diseases
  2. Asymmetric soft tissue swelling: OA, EOA
  3. Lumpy bumpy pattern: Depositional processes (gout, sarcoid, amyloid, neoplasms)

ABCDES of Arthritis of Wrist and Hand

Alignment (subluxation)UlnarMultidirectionLateralLateralNoneNone
Bone mineralizationOsteopeniaNormalNormalNormalNormalNormal
Bone productionNoneProductiveReparativeReparativeReparativeOverhang
Cartilage (joint narrowing)UniformUniformNonuniformNonuniformNonuniformPreserved
CalcificationNoneNoneNoneNoneCartilageSoft tissue
DistributionProximal, bilateral/symmetricDIPTypicalTypicalAtypicalRandom
ErosionsMarginalMarginal, Pencil-in-cupNoneSubchondral, Gull-wingNoneJuxta-articular
Soft tissueSymmetricSymmetricAsymmetricAsymmetricAsymmetricLumpy-bumpy

References and Further Reading:

  1. 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
  2. The Radiology Assistant : Arthritis

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