Plain-film diagnosis of joint disease

The authors describe a systematic approach to plain-film diagnosis of joint disease. The major radiologic criteria--soft-tissue swelling, joint-space narrowing, bone erosion, bone sclerosis and osteophytosis, and chondrocalcinosis--are considered first. Assessing the involvement of the minor criteria of joint disease--soft-tissue atrophy or calcification, malalignment, osteoporosis, abnormal growth, intra-articular bony ankylosis, bone fragmentation, periostitis, subperiosteal resorption or acro-osteolysis--narrows the probabilities to the more likely diagnoses. Further analysis includes the distribution of joint injury, whether mono- or polyarticular, symmetrical or asymmetrical. Added to clinical information, this approach leads to a specific or refined differential diagnosis.