Musculoskeletal X-ray Guide

Non InflammatoryInflammatory
Primary OA: Asymmetrical   There are classically 4 signs of OA on an X-ray: Occurs classically in weight bearing joints e.g. hips& knees. May not be symmetrical. Subchondral bone sclerosis Cystic Change Osteophytes Reduced Joint SpaceGout: Asymmetrical   The classical signs of gout on an X-ray are: Erosions with sclerotic margins. Asymmetrical. A relatively preserved joint space Minimal peri-articular osteoporosis Nodules (these are in fact tophi)
Charcot Joints: Destruction of the joint Disorganisation (bones not arranged in the correct /usual arrangement through gross destruction e.g. cuneiforms of the foot. Increased density (sclerosis) Debris (bony debris from a destroyed joint: often with well defined margins Dislocation  Psoriatic Arthritis: Asymmetrical   The X-ray Changes are similar to rheumatoid but they differ in their distribution, and the formation of pencil in cup deformities along with osteolysis. Asymmetrical distribution of disease Often affects PIP and DIP joints relative absence of peri-articular osteoporosis Erosions seen at the distal inter phalangeal joints Reduced joint space Pencil in cup deformity (arthritis mutilans with telescoping of the fingers)- this is a result of osteolysis Loss of the terminal tufts of the phalanges (acro-osteolysis) Sacroiliac and spondylitic changes (similar to those of Ankylosing Spondylitis.)  
Secondary OA As per primary OA but occurring in a joint that has been previously damaged from any other disease process (fracture/ inflammatory disease etc).  Rheumatoid Arthritis: Symmetrical Erosions  Reduced joint space Peri-articular osteoporosis Nodules  
Septic Arthritis: Asymmetrical Peri-articular osteoporosis Loss of joint space Deformity/subluxation Erosions Effusion Usually just 1 joint