American Board of Internal Medicine (ABIM) Certification Practice Exam

Which imaging findings are associated with rheumatoid arthritis?

1. Joint-space narrowing and subchondral sclerosis

2. Periarticular osteopenia and marginal erosions

3. Osteophyte formation and cystic changes

4. Hypertrophic changes and bony fusion

The correct answer is: Periarticular osteopenia and marginal erosions

The imaging findings commonly associated with rheumatoid arthritis include periarticular osteopenia and marginal erosions. In rheumatoid arthritis, the inflammation leads to bone degradation, which results in the characteristic marginal erosions seen on radiographs. These erosions occur along the edges of the joints where the synovial tissue is inflamed and is an essential criterion for the diagnosis of this disease. Additionally, periarticular osteopenia, or reduced bone density around the joints, is a hallmark finding in rheumatoid arthritis due to the inflammatory processes that disturb normal bone metabolism. The presence of these two findings on imaging helps differentiate rheumatoid arthritis from other forms of arthritis, particularly osteoarthritis, where the joint space might narrow but is typically associated with osteophyte formation and subchondral changes rather than the erosive changes seen in rheumatoid arthritis. Understanding these features is crucial for accurate diagnosis and management of the disease.