Medial clavicle erosion radiology. Erosive osteoarthritis.
Medial clavicle erosion radiology It can be mistaken for other abnormalities such as Friedrich disease, bone island, osteoid osteoma, sternoclavicular osteoarthritis, and even a metastasis and osteosarcoma. 140 Characteristic radiographic findings are a homogeneously dense sclerotic patch in the medial end of the clavicle, limited to the inferior margin, sparing of the sternoclavicular joint and absence of periosteal reaction or bony erosion 168 18 - 1 Makaju et al. Hahnemann MedicalCollegeandHospital,230NorthBroadStreet,Philadelphia. 5. Most sites of involvement have an eponym associated with osteonecrosis of that area (see list below), and these sites are discussed individually, as each site has unique clinical, more easily identified on an angled view, on this view inferior displacement of the medial head of the clavicle is indicative of a posterior dislocation, whereas superior displacement of the clavicle indicates an anterior dislocation 6. In both situations, early lesions may be radiographically occult. clavicle or shoulder pain following trauma; pathophysiology. ADVERTISEMENT: Supporters see fewer/no ads. 12. There may be slight expansion of the medial end of the clavicle and occasionally there is an inferior spur. Patient was 23 year old female with painful lytic lesion in medial end of clavicle. Fractures of the distal clavicle (usually defined as the lateral third) account for 15–30% of clavicle fractures [1,2,3,4]. anterior subluxation of the sternoclavicular joint; Friedrich disease (osteonecrosis of medial clavicle) hypertrophic osteitis; chronic multifocal periosteitis and arthropathy; osteomyelitis; Radiation induced As the medial clavicle epiphysis is the last physis to close at around the age of 25 years, this diagnosis must be considered in a patient below this age who present with traumatic pathology of the medial clavicle. Clinical presentation. post-traumatic: weeks to more commonly months after injury; atraumatic: stress-induced overuse, seen in laborers and THE clavicle is classified as one of the smaller bones of the skeletal framework and is very seldom heard of in tumor pathology. typically the interphalangeal joints, 1 st carpometacarpal joint 6, but not the metacarpophalangeal (MCP) joints and large joints. common: 2. no (this can vary departmentally or based on the patient's age or size) Image technical evaluation. Theradiologic andhistologic similarity ofFniednichdisease tocondensing osteitis [3,7-9]hasledsomeauthorities to believe thatnosignificant differences existbetween these entities [1, 19]. by sclerosis of the inferior margin of the medial clavicle (Fig. The Diagnosis. 1055/b-0034-75799 12 Joint DiseaseBurgener\, Francis A. 2 cm in men to preserve the costoclavicular ligament. Radiology 1986;158(1):139–140. Mnemonics SHORT Pencil. TABLE1 CLAVICLE EROSION INHYPERPARATHYROIDISM 295 116:749-757, 1972 14. Usual presentation is trauma followed by pain, swelling and deformity over the sternoclavicular joint. clavicle tumors. Excessive medial clavicle resection with an injury to the costoclavicular ligament often leads to poor postoperative results. Radiographic features. They are a feature seen in infl medial clavicle: larger of the two. The diaphysial primary ossification centre ossifies by intramembranous ossification, which is unusual for a long bone. See article: Sternoclavicular joint The name ‘clavicle’ is derived from the Latin word clavicula, meaning ‘small key’ which in turn is derived from clavis, ‘key’ that refers to the ‘S’ shape of the bone. Traumatic, inflammatory, neoplastic, metabolic and many other miscellaneous lesions may also affect the bone. The commonest causes are osteoarthritis, infection and condensing osteitis of the clavicle. erosive osteoarthritis. found that on the clavicle, the Condensing osteitis of the clavicle is a benign, often painful disorder, marked by bony sclerosis at the sternal end of the clavicle. S: scleroderma. Erosions at the ends of the clavicles with widening of AC joint. sclerotic clavicle. Study population. Ultrasound. Epiphyseal union of the anterior iliac crest and medial clavicle in an modern Fractures can occur at any part of the clavicle. AP view of the shoulder demonstrates subchondral resorption of the distal clavicle (arrow). Symptoms persisted andfollow-up x-rays6months afterthe injury showed considerable resorption ofthedistal clavicle, erosion oftheacromial surface. Rheumatoid arthritis. acromioclavicular joint injury. Geode, meaning a crystal-lined hollow rock, may be the preferred term over subchondral cyst, meaning epithelial-lined fluid-filled lesion as these two latter features are absent in these lesions, however, it should be noted that both are widely used in the literature 4,7. The terminal tuft is most commonly affected. Understanding specific features of the osseoligamentous anatomy helps the radiologist to medial clavicle: larger of the two. The distal clavicle had subluxed anteriorly in Cases 1 and 3, and superiorly in Case 2. erosion of superior aspects of ribs. MRI. 1) Fig. Figure 8-2. Summary. 86. 3). Patients complain of a relatively acute or subacute onset of morning stiffness in the fingers of both hands. Medial fracture of the clavicle with upward displacement of the lateral fragment (LF) by about one shaft width. It is often involved in congenital and acquired disorders. . It is a common medial to include the sternoclavicular joint; orientation landscape; detector size. Malignant metastases prostate breast cervix ovary urinary bladder carcinoid osteosarcoma osteosarcoma lymphoma primary metastatic Benign osteoma: uncommon, sclerotic, hamartomatous surfac Medial Clavicle Physeal Fractures, also known pseudodislocation of the sternoclavicular joint, are rare injuries to the medial physis of the clavicle in children. Figure 8-3. However, under a systematic review of the skeletal lesions on file in the Surgical Pathological Laboratory of the Johns Hopkins Medical School, we find that there are lesions of all kinds present in the clavicle as elsewhere in other bones. The ACJ is a diarthrodial synovial joint located between the lateral end of the clavicle and the medial acromion (Fig. R: rheumatoid arthritis. It is the most consistent and specific finding of hyperparathyroidism and is virtually pathognomonic of the condition 5. Electronic searches of the MEDLINE, EMBASE and Subperiosteal bone resorption describes bone destruction below the periosteum secondary to osteoclastic activity, resulting in an irregular, lace-like cortical appearance 4,6. Background Medial third clavicle fractures are rare injuries, with limited information available on their characteristics or treatment results. Attheend of14months, the patient was asymptomatic; the final radiographs revealed further osteolysis of the clavicle Osteonecrosis (plural: osteonecroses) is a generic term referring to the ischemic death of the constituents of bone. These fractures are more prone to delayed union and nonunion than mid-shaft or medial clavicle fractures, particularly when they are displaced []. The sternoclavicular joint is typically never involved. Synthetic material has been used in reconstructing the sternoclavicular joint but results have been poor with erosion and non Sclerosis of the inferior aspect of the medial third of the clavicle is seen, typically unilateral. Wasserstein John E. There are useful mnemonics for the causes of tapered osteolysis of the distal clavicle. Subperiosteal bone resorption describes bone destruction below the periosteum secondary to osteoclastic activity, resulting in an irregular, lace-like cortical appearance 4,6. However, the vast majority (~75%; range 69-85%) occur in the midshaft, at or near the junction of the middle and outer third with distal clavicle fractures (15-20%) and medial clavicle fractures (<5%) less common 3,8. Refer to the related articles for a general discussion of rheumatoid arthritis and for the particular discussion of its respiratory and/or cardiac manifestations. 18 cm x 24 cm; exposure 1. The sternoclavicular joint is susceptible to pathology similar to other synovial joints, the most common being osteoarthritis, instability from injury, infection, and rheumatoid arthritis. Seven patients IAllauthors:Department ofDiagnostic Radiology. 140 Characteristic radiographic findings are a homogeneously dense sclerotic patch MRI enables the radiologist to more accurately assess the regional soft-tissue structures in the setting of high-grade acromioclavicular separation, helping to guide the surgeon’s selection of the appropriate management. 10 and 11). Biopsies from the SCJ were obtained using CT guidance in Cases 1 and 3. Typical examples of specific erosion patterns. Wormian bones. Underlying aetiologies include osteoarthritis of the sternoclavicular joint, condensing o Acro-osteolysis (plural: acro-osteolyses), also known as phalangeal osteolysis, refers to resorption of the distal phalanx. Clinical Findings. The study initially enrolled 1,183 consecutive patients (a) whose age ranged from 16 to 30 years old; (b) who did not have any systemic disease potentially affecting the ossification of the medial clavicular epiphysis; and (c) who underwent preoperative chest radiography for local treatment in the department of otorhinolaryngology, ophthalmology, An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive Medial Clavicle Excision and Sternoclavicular Joint Reconstruction David N. 1. e. classic central erosions (gull-wing appearance); possible ankylosis hooked clavicle: Yunis-Varon syndrome, Meier-Gorlin syndrome; Other clavicle abnormalities that can occur in both children and adults. 1976;120:75–7. MF. Sclerotic clavicles:-The clavicle is a benign, often painful disorder of unknown cause, marked by bony sclerosis of the sternal (medial) end of the clavicle with no involvement of the sternoclavicular joint. acro-osteolysis. The periarticular formation of new bone was present, and in Case 2, hyperostosis was detected, which involved the medial aspect of the right clavicle. Resorption of the undersurface of the distal clavicle in rheumatoid arthritis. Ligaments Medial clavicle resection with stabilization to the first rib is usually reserved for chronic dislocation in adults but has been performed in patients as young as 18 years. osteitis, hyperostosis and hypertrophy of the medial ends of the clavicles, sternum and Medial coracoclavicular ligament revisited: Stress-induced osteolysis of the clavicle. There is marked female predilection (F:M ~12:1), typically presenting in the postmenopausal patient. Distal clavicle osteolysis most commonly affects young males. 1148/120. Radiology. A radiograph of the left clavicle showed a defect in the inferior border just lateral to the head of the clavicle Clavicle medial apophysis : Persistence of the medial clavicular apophysis presents as a thin osseous structure that may be confused with a fracture or apical calcification. As for the One patients was diagnosed of giant cell tumor. Aim of this study was to evaluate the clinical and radiological outcome following An asymptomatic enlargement of the medial clavicle is a condition that is often both missed and misdiagnosed. Typical marginal erosions in MCP-joints. While the terminal tufts of the phalanges are the most Endosteal scalloping refers to resorption of the inner surface of bone cortex, i. Fig. CT allows for a reliable evaluation of cortical bone and subchondral bone plate in multiple different planes at various locations and thus the detection of bony erosions. It may be a primary enthesopathy seen on CT as a soft-tissue swelling, erosion and new bone formation; stage 2 is generalized involvement of the ipsilateral sterno-costo-clavicular region with sternoclavicular arthropathy and increased arthropathy of the sternoclavicular joint, osteitis of the medial end of the clavicle, first rib and sternum as well as hypertrophy of the costal cartilages. Distal clavicular erosion:-Erosion or absence of the distal ends of the clavicles may be seen in a wide range of conditions Llike. osteoporosis. 1 Clavicle 5. Site of first erosion is classically base of proximal phalanx of 4th finger; Erosion of the ulnar styloid and narrowing of the distal radioulnar joint; Atlantoaxial subluxation >2. Enchondromas commonly cause endosteal scalloping in the short bones of the hand. Yetosteosclerotic changes inFniednichdis-easeinvolve theentire medial headoftheclavicle, often 10. It has a wide variety of causes and can affect nearly any bone in the body. However, magnetic The epiphyses at the medial and lateral ends of the clavicle are small, ossify relatively late, and may not fuse until early adulthood. Clinically the presentation mimics inflammatory arthropathies such as psoriatic arthritis (PsA) or rheumatoid arthritis (RA). Para-articular soft tissue masses such as synovial cysts and abscesses are readily depicted by CT (Fig. Frank Smithuis sr, who is a professor at Oxford university and happens to be the brother of Robin Background Treatment of medial clavicle fractures is still controversially discussed in the community of upper extremity surgeons. Prior history and clinical question: A 21-year-old man was examined radiologically for multiple injuries. Ligaments clavicular fracture: the weakest part of clavicle is the junction of lateral one third and medial two-third and this is the most common site of fracture. It is also known as aseptic enlarging osteosclerosis of the medial end of clavicle. Its clinical and radiographic presentation can frequently Unlike the congenital and genetic disorders described in Chapter 9, the anatomic variants and miscellaneous skeletal anomalies described here are encountered daily in the practice of radiology. synovial joints, tendons, and bursae. 81 The radiological changes Radiology 1996;198:193–198 Erosive arthritis has a broad differential:. doi: 10. Computed tomography (CT) is useful to assess the extent of both bone and soft tissue involvement. osteolysis of distal clavicle. SHIRT Pocket. More advanced imaging studies such as CT scans or MRI demonstrate expansion of the medial clavicle, increased bone density in the area and edema . Diagnosis can be made with serendipity radiographic views but CT scan is the study of choice to differentiate from sternoclavicular dislocations. difficult to determine anterior or posterior dislocation. 19 Medial fracture of the clavicle. Google Scholar. 1 Department of Radiology, Boston Children's Terminology. In musculoskeletal radiology Condensing osteitis of the clavicle was first described as a disease entity in 1974. Bone marrow oedema of the distal clavicle more than the acromion with subchondral cystic change +/- subchondral fracture, and distal clavicle periostitis 1,2. It is associated with a heterogeneous group of pathological entities, some of Osteonecrosis is a relatively common condition, which may be idiopathic or secondary to a variety of clinical situations. For more information, you can read a more in-depth reference article: clavicle fracture. 44 Safe resection of the medial end of the clavicle is 1 cm in women and 1. Sternoclavicular joint involvement may be diff cult to appreciate on radiographs and may require Laboratory findings are usually normal, but there might be an increase in white blood cell count and ESR. Aspirate from this mass yielded a Nearly all the entities on the differential diagnosis for distal clavicle erosion (mnemonic: SHIRT Pocket) are included in other differentials in this article. 100 cm; grid. Nini Tun and Dr. 6. Case study, Radiopaedia. 1). osteolysis. Frontal radiograph of the left clavicle demonstrates an expansile lucent lesion in the medial clavicle (arrow) with mild periosteal reaction. Introduction. Eccentric erosion with an overhanging edge. On CT, the sclerosis and consequent marrow cavity obliteration are seen affecting only the inferomedial part of the clavicle (Figs. Pennsylvania 19i02. Erosive osteoarthritis. The diagnosis of articular disorders is primarily made by conventional radiography. 9). in 1974 [1]. Hyperparathyroidism. 1 a, b Tumor? Excisional biopsy? Case description Referring physician: orthopedist. There are two distinct forms of distal clavicle osteolysis although these have identical histopathologic and imaging findings 1,2:. The Erosive changes at the acromial articular surface and distal clavicle are Niwayama G. 14). Subchondral erosions in DIP- and PIP-joints. Lee et al. The CT scan showed erosions of the left sternoclavicular joint and clavicle (Fig. 1. 1 Case 78 (Fig. distal clavicular erosions Condensing osteitis of the clavicle is a rare, benign, usually painful condition leading to sclerosis of the medial end of the clavicle. Coronal (4a and 4b) STIR images of the pelvis at the time of presentation show multifocal marrow edema involving the left medial and supra-acetabular ilium centered near the ischioilial synchondrosis (arrows), the right inferior ramus near the right ischiopubic Gaillard F Bilateral distal clavicular erosion. org/10. Pain and swelling of the medial end of the clavicle may be associated with radiographic sclerosis. The articular surfaces are covered with fibrocartilage (rather than hyaline cartilage as in most other synovial joints). Others include Clavicle tumors may be malignant or benign. Costal cartilage calcification (Figs. distal clavicular erosions A prominent medial clavicle in anterior dislocation and a palpable defect next to the sternum in posterior dislocation are usually apparent on inspection and palpation. They are as follows: SHORT Pencil. 53347/rID-36009 hooked clavicle: Yunis-Varon syndrome, Meier-Gorlin syndrome; Other clavicle abnormalities that can occur in both children and adults. Clinical presentation Chest radiograph was normal. Age Determination by Medial End of Clavicle- Radiology Study The study conducted by Ufuk F 5 et al showed Stage I last appeared in females at 14 years of age clavicular fracture: the weakest part of clavicle is the junction of lateral one third and medial two-third and this is the most common site of fracture. In the English language literature, this has only been reported in women since its original description by Brower et al. 45 Lastly, to manage persistent pain after compromise ofthemedialend clavicle. It is a disease that primarily affects synovial tissues, i. Erosion or absence of the distal ends of the clavicles may be seen in a wide range of conditions. 10. There were no calcification in the matrix. Congenital. May be normal early in the disease course. Unlike bone cysts, the cortical or subchondral bone is also affected. Materials and methods We performed a systematic review according to PRISMA guidelines to evaluate the demographics, clinical profile, management and treatment outcome. Plain radiography frequently reveals scler-osis at the medial end of the clavicle and in this clinical setting the three principal causes are osteoarthritis (OA), sternoclavicular pyoarthrosis and Sclerotic clavicles have many causes: trauma: fractured clavicle arthritis: osteoarthritis, seronegative arthritides osteitis condensans of the clavicle 1 SAPHO syndrome clavicular tumors metastases osteosarcoma lymphoma osteoblastoma b THE clavicle is classified as one of the smaller bones of the skeletal framework and is very seldom heard of in tumor pathology. These changes may or may not be associated with Sclerosis of the medial end of the clavicle may persist. T: trauma Subligamentous and subtendinous resorption in hyperparathyroidism is most frequent along the femoral trochanters, ischial tuberosities , and inferior aspect of the distal clavicle. 1). 5-10%; bimodal age and sex distribution; presentation. Progressive disease can manifest with cortical irregularity, subchondral cysts and erosion/tapering of the distal clavicle 1,3. The 99 Tc scan showed increased uptake in the left SCJ and the medial clavicle (Fig. We review the most common causes of an isolated and asymptomatic enlargement of the medial clavicle. All the profits of the Radiology Assistant go to Medical Action Myanmar which is run by Dr. clavicle tumours. Figure 4: An 8 year-old female complaining of pelvic pain, diagnosed with CRMO and psoriasis with erosive sacroiliitis. Epidemiology. clinically an acute inflammatory attacks (swelling, erythema, pain) in postmenopausal women. 3 cm, maximum width is 1. 3 cm. Medial clavicle excision is a rarely indicated procedure and may be performed in different pathologies affecting the medial clavicle. 7-142 and 7-143) Calcification of the costal cartilages is common. Erosion: Pressure by the subclavian artery. Atrophy and tear of the rotator cuff with attendant superior Calcific tendinitis, also known as calcific tendinopathy or tendonitis, is a self-limiting condition due to the deposition of calcium hydroxyapatite within tendons, usually of the rotator cuff. H: hyperparathyroidism O: osteomyelitis. the endosteum. Because of this unique anatomy, pediatric and young adult injuries that involve the clavicle often differ from the patterns typically seen in older adults. clavicular notch of the sternum: smaller of the two. The exact surgical treatment used in this kind of pathology when conservative treatment is unsuccessful remains The 873 plain chest radiographs taken between 1995 and 2002 at the Radiology Unit of the University Hospital Charité in Berlin at the request of the staff medical officer, most of them in conjunction with new staff appointments, were evaluated retrospectively. Bone Erosive changes of the sternal ends of the clavicles have been observed in patients with primary or secondary hyperparathyroidism. sternoclavicular joint dislocation. there is concentric erosion of the glenoid accompanied by medial migration of the humeral head. The concurrent formation of osteophytes results in a gull-wing deformity. almost always traumatic; most erosion or destruction of adjacent bone; This image is of a 20 year old patient with a sclerotic expansile lesion in the clavicle. Gout. 4 Sternoclavicular Joint. The synovium-lined SC joint is formed by the medial clavicle, the clavicular notch of the manubrium, and the cartilage of the first rib (Fig. Bone marrow edema of the distal clavicle more than the acromion with subchondral cystic change +/- subchondral fracture, and distal clavicle periostitis 1,2. 1 The joint lies in a subcutaneous position and thus swelling of the joint or expansion of the medial Condensing osteitis of the clavicle is a rare benign disease first described in 1974 as an increase in bone density at the medial end of the clavicle [1]. The clinical symptoms include edema and medial clavicle pain that worsens with abduction of the arm [1]. Septic sternoclavicular joint with clavicular and manubrial osteomyelitis. 4), and the MRI scan additionally showed an associated soft tissue mass extending into the anterior mediastinum. Laboratory findings are usually normal, but there might be an increase in white blood cell count and ESR. Kuhn DEFINITION The most common pathologic disorder affecting the medial clavicle is osteoarthritis. paediatric clavicle abnormalities. Cave reported that the average length is 1. The joint space is divided into two separate recesses by a fibrocartilage articular disc 1,2. pediatric clavicle abnormalities. anatomy. Erosion of the inferior aspect of the clavicle in secondary hyperparathyroidism. Interposed between the fibrocartilaginous joint surfaces is a usually complete fibrocartilaginous disc, which acts to reduce the incongruities between the articulating joint surfaces, and as a shock The ACJ is a diarthrodial synovial joint located between the lateral end of the clavicle and the medial acromion . An increasing number of symptomatic non-unions following conservative treatment of displaced fractures led to the development of various surgical approaches. We report a clavicular lesion occurring in a man that is clinically, radiographically, and histologically identical to The acromioclavicular joint, clavicle and scapula are not individually covered. Pathology. Clinical, radiologic, scintigraphic, and histologic features of this erosion ofthelateral rightclavicle (fig. This disease presents in women of childbearing age, although male and pediatric patients have been described [2, 3]. It can sometimes be associated with a small osteophyte, but should never be associated with subchondral cysts, joint space narrowing or erosions. Condensing osteitis of the clavicle is a rare benign disease described as an increase in bone density at the medial end of the clavicle. Clavicular trauma that affects the acromioclavicular joint laterally or Osteolysis in the distal clavicle--manifested radiographically by erosions, resorption of the subchondral cortical bone, and an increased space between the acromion and clavicle--may occur in patients who experience repeated stress or microtrauma to the shoulder. There is pain And often localised swelling of the medial third of the clavicle, with increased radio-density. org (Accessed on 26 Dec 2024) https://doi. The clavicle is demonstrated in its entirety with no foreshortening. bony erosion and degeneration of the intra-articular disc in one-third of patients with this systemic disease. It is bilateral in ~20% 1. A general familiarity with Expansile lytic bone lesions without cortical destruction can result from various benign and malignant neoplastic pathologies, causes include 1: unicameral bone cyst aneurysmal bone cyst (eccentric) enchondroma chondromyxoid fibroma (eccentri The clavicle is an unusual long bone with many unique embryologic features. The clavicle is the first bone to ossify in the human skeleton at 5 weeks gestation. Potentially easy to remember because the diseased clavicle looks similar to a sharpened pencil. 1055/b-0035-121603 5. 9 cm, and average thickness is 1. Benign expanding intramedullary lesions promote bone remodeling and endosteal scalloping over time. 2). Diagnosis via radiographic imaging studies exhibits sclerosis and expansion at the medial end of the clavicle, a highly unspecific finding sometimes misdiagnosed as a bone malignancy [1,6]. Plain radiograph showed a epiphysio-metaphyseal lytic area on medial aspect of clavicle. While the terminal tufts of the phalanges are the most The epiphyses at the medial and lateral ends of the clavicle are small, ossify relatively late, and may not fuse until early adulthood. 75. The lesion was geographic type and showed no periosteal reaction. See article: Sternoclavicular joint 10 Pediatric Radiology. 63-66 kVp; 2-4 mAs; SID. A prominent medial clavicle in anterior dislocation and a palpable defect next to the sternum in posterior dislocation We discuss the key anatomy and imaging features of various ACJ lesions. Distinguishing between these The dimensions of the costoclavicular ligament have also been described. It may involve the subarticular region of a joint, when it is commonly referred to as ischaemic necrosis, or the metaphyseal regions of long bones, when it is referred to as bone infarction. anterior subluxation of the sternoclavicular joint; Friedrich disease (osteonecrosis of medial clavicle) hypertrophic osteitis; chronic multifocal periosteitis and arthropathy; osteomyelitis; Radiation induced more easily identified on an angled view, on this view inferior displacement of the medial head of the clavicle is indicative of a posterior dislocation, whereas superior displacement of the clavicle indicates an anterior dislocation 6. rib notching periarticular soft tissue calcification premature atherosclerotic vascular calcification History and etymology medial endoftheclavicle inonecase. However, the sternoclavicular Bone erosions, or simply, erosions, refer to focal bony defects in the subchondral bone plate or cortical bone and the adjacent trabecular bone. normal clavicle anatomy; normal acromioclavicular joint anatomy; epidemiology. 5 mm (in >6%) Giant synovial cysts; Late signs; Diffuse loss of interosseous space; Flexion and extension contractures with ulnar subluxation and dislocation Rheumatoid arthritis (RA) is a chronic multisystem disease with predominant musculoskeletal manifestations. and soft tissue calcifications. ppfjw sgdzz coi cjhbeso nhano kpgt mxbl zkgt swwhe ndqokk