A conventional report beside a RheumaView™ structured read — one longitudinal, multi-modality musculoskeletal survey (axial and peripheral), with report-derived MRI placed alongside the radiographs.
Why this is a representative multi-modality case
A low overall structural burden with no measurable radiographic progression across the comparable timepoints. The structured read separates a subtle inflammatory-type sacroiliac component from degenerative change, quantifies laterality per region, and places report-derived knee MRI (effusion / a focal stress-type event) next to plain films that cannot show soft-tissue activity. See how case complexity scales ↓.
De-identified · Male · 37 · longitudinal monitoring. Spondyloarthropathy with predominantly peripheral involvement — knees initially significant, now minimal and only occasional; intermittent hand and wrist symptoms; minor axial involvement. Several years of biologic therapy, with agents changed over time. Currently clinically well; radiographs obtained for monitoring.
De-identified case · Male · 37 · 2026
Comparison: prior radiographs on file.
Findings
Cervical spine (AP, lateral, open-mouth odontoid). Alignment is anatomic with a maintained cervical lordosis. Vertebral body heights are preserved. Intervertebral disc spaces are grossly maintained. The odontoid process and atlantoaxial articulation are unremarkable, with a preserved atlantodental interval. The visualized posterior elements are intact. No prevertebral soft-tissue swelling. No fracture. No significant degenerative change for age.
Hands and wrists (bilateral PA and oblique). Bone mineralization is grossly preserved without periarticular osteopenia. The metacarpophalangeal, interphalangeal and carpal joint spaces are maintained. No definite aggressive or marginal erosion is identified. No subluxation. The soft tissues are unremarkable, with no focal periarticular swelling.
Pelvis and hips (AP and oblique views). The sacroiliac joints appear grossly symmetric, with no obvious erosion or ankylosis. The hip joints are preserved without significant joint-space narrowing. No subchondral cyst or aggressive osseous lesion. The pubic symphysis is unremarkable. No acute fracture or dislocation.
Thoraco-lumbar spine (AP and lateral). Alignment is maintained without significant scoliosis or listhesis. Vertebral body heights and intervertebral disc spaces are preserved. The visualized posterior elements appear intact. Minor degenerative changes. No acute bony abnormality.
Knees (bilateral standing AP, PA flexion, lateral). The medial, lateral and patellofemoral compartment joint spaces are maintained on the weight-bearing views. No significant degenerative change or marginal osteophytosis. No joint effusion is appreciated. No aggressive osseous lesion, subchondral cyst or fracture. Alignment is anatomic. Appearances are stable compared with prior examinations.
Impression
- Cervical spine: no acute abnormality; no significant degenerative change for age.
- Hands and wrists: no aggressive erosive process identified; joint spaces maintained.
- Pelvis, hips and sacroiliac joints: unremarkable; no acute abnormality.
- Thoraco-lumbar spine: minor degenerative changes; no acute abnormality.
- Knees: maintained joint spaces; no joint effusion; no significant abnormality.
- No significant interval change across the available studies over the past several years.
DOB / Age: 1989-xx-xx / 37 years
Sex: Male
Study Date: 2026-xx-xx
Prior Studies:
Bilateral knees: 2024-xx-xx (~1 yr 4 mo before current study), 2024-xx-xx (~1 yr 8 mo before current study), 2022-xx-xx (~3 yr 4 mo before current study)
Thoracic spine / lumbar spine / pelvis with sacroiliac joints: 2023-xx-xx (~2 yr 4 mo before current study)
No direct prior cervical spine or hand radiographs available for comparison
Examined Regions & Projections:
Cervical spine: AP, lateral, right oblique, left oblique, open-mouth odontoid
Thoracic spine: AP, lateral
Lumbar spine: AP, lateral, right oblique, left oblique, lumbosacral spot lateral
Pelvis / sacroiliac joints / hips: AP pelvis, dedicated AP sacroiliac joints, right sacroiliac oblique, left sacroiliac oblique, right frog-leg lateral hip, left frog-leg lateral hip
Right hand: PA, oblique, lateral
Left hand: PA, oblique, lateral
Knees: bilateral AP standing, bilateral PA flexion standing, right lateral, left lateral
Image Quality / Adequacy: Adequate for clinical interpretation. No critical projection deficiency for the declared regions. Patellofemoral grading is mildly limited by absence of dedicated axial sunrise/Merchant views.
Findings — Axial Skeleton
Cervical spine
Five-view cervical series provided. Mild straightening of the normal cervical lordosis is present. Tiny non-bridging anterior marginal osteophytes are seen at C4-C5 and C5-C6, with trace similar spurring at C6-C7; affected level count 3, lower-cervical distribution, anterior marginal morphology, extent mild/grade 1. Minimal disc-space loss is present at C5-C6 and C6-C7, approximately grade 1. No definite syndesmophyte formation, ankylosis, vertebral body height loss, fracture, or destructive osseous lesion is identified on this series. Mild lower-cervical uncovertebral/facet hypertrophic change is suggested, greatest around C4-C5/C5-C6, low-grade. Tiny nonspecific calcific density projects anterior to the mid cervical spine near C4-C5. Confidence: high for lower-cervical spondylotic change; moderate for the minimal disc-height loss and posterior element hypertrophy.
Thoracic spine
Two-view thoracic series provided. Alignment is preserved without focal listhesis or compression deformity. Minimal multilevel endplate spurring is present in the mid/lower thoracic spine, greatest approximately from T7 through T10; affected level count about 4, multilevel central/anterior marginal morphology, extent mild/grade 1. Mild multilevel endplate irregularity accompanies this spurring. No definite ankylosis, syndesmophyte formation, vertebral body collapse, or focal erosive endplate destruction is seen. Confidence: high.
Lumbar spine
Five-view lumbar series provided. Mild levoconvex lumbar curvature is present. Small multilevel marginal endplate osteophytes are present from approximately L1-L2 through L4-L5; affected level count 4, marginal non-bridging morphology, extent mild/grade 1. Mild lower-lumbar posterior element hypertrophic/sclerotic change is present at L4-L5 and L5-S1; affected level count 2, bilateral distribution, extent mild. Trace anterior marginal spurring is present at L5-S1. Disc-space preservation is overall maintained, with no more than minimal low-grade narrowing. No syndesmophytes, ankylosis, compression deformity, or destructive osseous lesion is identified. Confidence: high.
Sacroiliac joints
Dedicated AP and oblique sacroiliac views provided. Mild bilateral inferior iliac-sided subchondral sclerosis is present, slightly greater on the left; bilateral distribution, inferior one-third predominance, extent mild. Minimal inferior articular margin irregularity is present bilaterally. No definite erosive widening, ankylosis, or complete joint-space obliteration is seen. Overall sacroiliac structural change is subtle and low-grade. Confidence: moderate to high.
Findings — Peripheral Joints
Hips / pelvis
AP pelvis and bilateral frog-leg lateral hip views provided. Small superolateral acetabular rim osteophytes are present bilaterally, slightly greater on the right; bilateral distribution, marginal morphology, extent mild/grade 1. Hip joint spaces are otherwise preserved without meaningful superior joint-space narrowing (JSN grade 0 to trace 1 at most). Mild reduction in femoral head-neck offset / subtle anterosuperior cam-type contour prominence is present bilaterally, greater on the right. No femoral head collapse, fracture, or aggressive osseous lesion is seen. Small sclerotic focus in the left supra-acetabular iliac bone has benign bone-island-type appearance. Confidence: high.
Right hand / wrist
Three-view right hand series provided. Mild non-erosive interphalangeal degenerative change is present with low-grade joint-space narrowing and marginal spurring at the thumb interphalangeal joint, index DIP joint, and ring DIP joint; affected joint count 3, distal/interphalangeal distribution, marginal osteophytic morphology, extent mild/JSN grade 1. Subtle irregularity at the small-finger PIP joint is present, low-grade/low-confidence. No cortical erosions, fluffy periostitis, acro-osteolysis, ankylosis, carpal collapse, or malalignment is identified. Mild possible irregularity/narrowing at the ulnar carpometacarpal articulation is present, low-confidence, without advanced collapse. Symmetry pattern is roughly mirrored by the left hand in the DIP-predominant low-grade degenerative component. Confidence: high for the thumb/index/ring interphalangeal change; low to moderate for the small-finger PIP and ulnar carpometacarpal irregularity.
Left hand / wrist
Three-view left hand series provided. Mild non-erosive interphalangeal degenerative change is present with low-grade joint-space narrowing and marginal spurring at the thumb interphalangeal joint, index DIP joint, and ring DIP joint; affected joint count 3, distal/interphalangeal distribution, marginal osteophytic morphology, extent mild/JSN grade 1. Subtle low-grade narrowing/irregularity is also present at the small-finger interphalangeal joints, greatest at the PIP, approximately JSN grade 0 to 1. No cortical erosions, ankylosis, acro-osteolysis, periostitic proliferation, or carpal collapse is identified. Mild possible irregularity at the ulnar carpometacarpal articulation is present, low-confidence. Confidence: high for the thumb/index/ring interphalangeal change; low to moderate for the small-finger and ulnar carpometacarpal findings.
Knees
Four knee images provided including bilateral AP standing, bilateral PA flexion standing, and bilateral lateral views. Minimal bilateral sharpening/spurring of the intercondylar tibial eminences is present. Tiny marginal spurring is present at the left lateral femorotibial compartment, with possible lesser trace lateral compartment irregularity/spurring on the right; extent mild, JSN grade 0 medially and 0 to trace 1 laterally. No advanced femorotibial narrowing is seen. Trace low-grade patellofemoral marginal spurring is present bilaterally on the lateral views, without advanced patellofemoral narrowing (grade 0 to trace 1). No radiographic fracture or destructive periarticular erosion is identified. No large effusion is evident on the provided lateral views. Overall knee osteoarthritic burden remains minimal (KL/OARSI approximately grade 1 bilaterally).
Proximal fibulae
Chronic-appearing asymmetric cortical remodeling is present in both proximal fibulae, greater on the left. The left proximal fibular shaft/metadiaphysis shows fusiform cortical thickening with focal proximal cortical buttressing/expansion. The right proximal fibula shows milder chronic cortical thickening/remodeling. No acute periosteal reaction, aggressive lysis, or interval destabilizing change is visible on the current study. Confidence: high.
Comparison
Cervical spine
No prior cervical spine radiographs are available for direct region-matched comparison. Current study establishes baseline cervical structural status.
Thoracic spine / lumbar spine / sacroiliac joints / pelvis / hips
Compared with 2023-xx-xx (~2 yr 4 mo before current study), the mild multilevel thoracic and lumbar spondylotic spurring remains overall stable, without measurable interval increase in osteophyte burden or alignment abnormality (thoracic/lumbar Δosteophytes 0; Δalignment 0; Δankylosis 0; Δerosions 0; disc-space narrowing delta 0). Mild bilateral inferior iliac-sided sacroiliac sclerosis and minimal inferior articular irregularity are also stable, without new erosive change or ankylosis (SI Δsclerosis 0; Δerosions 0; Δankylosis 0). Mild bilateral acetabular rim spurring and subtle bilateral head-neck offset reduction remain unchanged (hip Δosteophytes 0; ΔJSN 0; Δalignment 0). The small left supra-acetabular bone island remains stable.
Hands / wrists
No prior hand radiographs are available for direct region-matched comparison. Current hand study shows mild bilateral non-erosive DIP/thumb IP-predominant degenerative change without radiographic erosive inflammatory arthropathy.
Knees / proximal fibulae
Compared with 2024-xx-xx (~1 yr 4 mo before current study) and 2024-xx-xx (~1 yr 8 mo before current study), and with longer baseline reference 2022-xx-xx (~3 yr 4 mo before current study), the minimal bilateral knee degenerative change is stable. No measurable interval femorotibial or patellofemoral joint-space loss is identified (ΔJSN 0 bilaterally), and there is no measurable increase in osteophyte burden or alignment abnormality (Δosteophytes 0; Δalignment 0; Δankylosis 0). Bilateral knee KL/OARSI grade remains unchanged at approximately grade 1 on both sides (ΔKL-OARSI 0 right, 0 left). Chronic proximal fibular cortical remodeling, greater on the left, also remains stable in extent and configuration.
Impression
- Low-burden mixed structural pattern. Subtle chronic bilateral sacroiliac structural change is present, consisting of mild inferior iliac-sided sclerosis and minimal inferior joint-margin irregularity, slightly greater on the left, without radiographic ankylosis or definite erosive widening.
- Mild multilevel cervical, thoracic, and lumbar spondylotic change, greatest in the lower cervical and lower lumbar regions, without syndesmophytes, ankylosis, compression deformity, or aggressive osseous lesion.
- Mild bilateral hip degenerative/structural contour change with small acetabular rim osteophytes and subtle bilateral cam-type head-neck contour prominence, right greater than left, without advanced hip joint-space loss.
- Mild bilateral non-erosive hand osteoarthritic change centered at the DIP joints and thumb interphalangeal joints. No radiographic hand erosions, ankylosis, or osseous dactylitic sequelae identified on this study.
- Minimal bilateral knee osteoarthritic change, approximately KL/OARSI grade 1 bilaterally, with stable chronic asymmetric proximal fibular remodeling, left greater than right.
- No measurable interval structural progression is demonstrated across the knee series relative to 2022/2024 priors or across the thoracolumbar/sacroiliac/pelvic structures relative to 2023. Overall radiographic progression tag: stable.
EMR Summary
Pattern: mixed, low-burden structural pattern with subtle chronic bilateral sacroiliac change, mild cervical/thoracolumbar spondylosis, mild bilateral acetabular rim spurring with cam-type head-neck contour prominence, mild bilateral DIP/thumb IP osteoarthritic hand change, and minimal bilateral knee osteoarthritic change. Progression: no measurable radiographic progression in the knees versus 2022/2024 or in the thoracolumbar/SI/pelvic structures versus 2023; no direct prior cervical or hand study. Inflammatory features: low-grade bilateral SI joint sclerosis/irregularity without ankylosis; no hand erosions, no syndesmophytes, no osseous dactylitic sequelae. DISH absent. Fracture absent.
DOB / Age: 1989-xx-xx / 37 years
Sex: Male
Study Date: 2026-xx-xx
Prior Studies:
Bilateral knees: 2024-xx-xx (~1 yr 4 mo before current study), 2024-xx-xx (~1 yr 8 mo before current study), 2022-xx-xx (~3 yr 4 mo before current study)
Thoracic spine / lumbar spine / pelvis with sacroiliac joints: 2023-xx-xx (~2 yr 4 mo before current study)
No direct prior cervical spine or hand radiographs available for comparison
Findings
Cervical spine
Five-view cervical series obtained. Mild straightening of the normal cervical lordosis. Tiny non-bridging anterior marginal osteophytes at C4-C5 and C5-C6, with trace similar spurring at C6-C7; affected level count 3, lower-cervical distribution, anterior marginal morphology, extent mild/grade 1. Minimal disc-space loss at C5-C6 and C6-C7, approximately grade 1. Mild low-grade lower-cervical uncovertebral/facet hypertrophic change is suggested, greatest around C4-C5/C5-C6. No syndesmophytes, ankylosis, compression deformity, fracture, or destructive osseous lesion identified. Tiny nonspecific calcific density projects anterior to the mid cervical spine near C4-C5. Confidence high for lower-cervical spondylotic change; moderate for the minimal disc-height loss and posterior element hypertrophy.
Thoracic spine
Two-view thoracic series obtained. Alignment preserved. Minimal multilevel endplate spurring in the mid/lower thoracic spine, greatest approximately T7-T10; affected level count about 4, multilevel central/anterior marginal morphology, extent mild/grade 1. Mild associated endplate irregularity. No syndesmophytes, ankylosis, compression deformity, or destructive osseous lesion.
Lumbar spine
Five-view lumbar series obtained. Mild levoconvex lumbar curvature. Small multilevel marginal endplate osteophytes from approximately L1-L2 through L4-L5; affected level count 4, marginal non-bridging morphology, extent mild/grade 1. Mild lower-lumbar posterior element hypertrophic/sclerotic change at L4-L5 and L5-S1; affected level count 2, bilateral distribution, extent mild. Trace anterior marginal spurring at L5-S1. No more than minimal disc-space loss. No syndesmophytes, ankylosis, compression deformity, or destructive lesion.
Sacroiliac joints / pelvis / hips
Dedicated sacroiliac and pelvic/hip views obtained. Mild bilateral inferior iliac-sided subchondral sclerosis with minimal inferior articular margin irregularity, slightly greater on the left; bilateral distribution, inferior one-third predominance, extent mild. No erosive widening or ankylosis. Small superolateral acetabular rim osteophytes bilaterally, slightly greater on the right; marginal morphology, extent mild/grade 1. Mild reduction in femoral head-neck offset / subtle cam-type contour prominence bilaterally, greater on the right. Hip joint spaces preserved without meaningful superior narrowing (grade 0 to trace 1 at most). Small benign-appearing bone-island-type sclerotic focus in the left supra-acetabular iliac bone.
Hands / wrists
Three-view bilateral hand series obtained. Mild non-erosive interphalangeal degenerative change bilaterally, involving the thumb interphalangeal joints, index DIP joints, and ring DIP joints; affected joint count 3 per side, distal/interphalangeal distribution, marginal osteophytic morphology, extent mild/JSN grade 1. Additional subtle low-grade irregularity/narrowing at the small-finger PIP joints, greater on the left, and possible mild low-confidence irregularity at the ulnar carpometacarpal articulations. No cortical erosions, ankylosis, acro-osteolysis, fluffy periostitis, carpal collapse, or malalignment.
Knees / proximal fibulae
Bilateral AP standing, bilateral PA flexion standing, and bilateral lateral knee views obtained. Minimal bilateral tibial spine/intercondylar eminence sharpening/spurring. Tiny marginal spurring at the left lateral femorotibial compartment with possible trace lesser lateral compartment irregularity on the right; extent mild, JSN grade 0 medially and 0 to trace 1 laterally. Trace low-grade patellofemoral marginal spurring bilaterally without advanced patellofemoral narrowing (grade 0 to trace 1). No fracture, destructive erosion, or large effusion identified on the provided views. Chronic asymmetric proximal fibular cortical remodeling is present bilaterally, greater on the left: fusiform cortical thickening with focal proximal cortical buttressing/expansion on the left and milder chronic cortical thickening on the right. Overall knee osteoarthritic burden remains minimal, approximately KL/OARSI grade 1 bilaterally.
Comparison
Cervical spine
No prior cervical spine radiographs are available for direct region-matched comparison.
Thoracic spine / lumbar spine / sacroiliac joints / pelvis / hips
Compared with 2023-xx-xx (~2 yr 4 mo before current study), mild thoracic and lumbar spondylotic spurring is stable without measurable interval increase in osteophyte burden, ankylosis, erosive change, or alignment abnormality (Δosteophytes 0; Δalignment 0; Δankylosis 0; disc-space narrowing delta 0). Mild bilateral inferior iliac-sided sacroiliac sclerosis and minimal inferior articular irregularity are stable without new erosive change or ankylosis (Δsclerosis 0; Δerosions 0; Δankylosis 0). Mild bilateral acetabular rim spurring and subtle bilateral head-neck contour prominence are stable (Δosteophytes 0; ΔJSN 0; Δalignment 0). Left supra-acetabular bone island is unchanged.
Hands / wrists
No prior hand radiographs are available for direct region-matched comparison.
Knees / proximal fibulae
Compared with 2024-xx-xx (~1 yr 4 mo before current study) and 2024-xx-xx (~1 yr 8 mo before current study), with longer baseline reference 2022-xx-xx (~3 yr 4 mo before current study), minimal bilateral knee degenerative change is stable. No measurable interval femorotibial or patellofemoral joint-space loss is identified (ΔJSN 0 bilaterally), and no measurable increase in osteophyte burden or alignment abnormality is seen (Δosteophytes 0; Δalignment 0). Bilateral knee KL/OARSI grade remains approximately 1 on both sides (ΔKL/OARSI 0 right, 0 left). Chronic proximal fibular cortical remodeling, greater on the left, is stable in extent and configuration.
Impression
- Low-burden mixed structural pattern with subtle chronic bilateral sacroiliac change, consisting of mild inferior iliac-sided sclerosis and minimal inferior joint-margin irregularity, slightly greater on the left, without ankylosis or definite erosive widening.
- Mild multilevel cervical, thoracic, and lumbar spondylotic change, greatest in the lower cervical and lower lumbar regions, without syndesmophytes, ankylosis, compression deformity, or aggressive osseous lesion.
- Mild bilateral hip degenerative/structural contour change with small acetabular rim osteophytes and subtle bilateral cam-type head-neck contour prominence, right greater than left, without advanced hip joint-space loss.
- Mild bilateral non-erosive hand osteoarthritic change centered at the DIP joints and thumb interphalangeal joints. No radiographic hand erosions, ankylosis, or osseous dactylitic sequelae identified.
- Minimal bilateral knee osteoarthritic change, approximately KL/OARSI grade 1 bilaterally, with stable chronic asymmetric proximal fibular remodeling, left greater than right.
- No measurable interval structural progression in the knees relative to 2022/2024 priors or in the thoracolumbar/sacroiliac/pelvic structures relative to 2023. Overall radiographic progression status: stable.
DOB / Age: 1989-xx-xx / 37 years
Sex: Male
Study Date: 2026-xx-xx
Prior Studies:
Bilateral knees: 2024-xx-xx (~1 yr 4 mo before current study), 2024-xx-xx (~1 yr 8 mo before current study), 2022-xx-xx (~3 yr 4 mo before current study)
Thoracic spine / lumbar spine / pelvis with sacroiliac joints: 2023-xx-xx (~2 yr 4 mo before current study)
No direct prior cervical spine or hand radiographs available for comparison
Declared / Examined Regions: Cervical spine, thoracic spine, lumbar spine, sacroiliac joints, pelvis/hips, bilateral hands, bilateral knees
Modality: XR
Findings
Cervical spine
- Five-view series.
- Mild straightening of cervical lordosis.
- Tiny anterior non-bridging osteophytes at C4-C5 and C5-C6, trace at C6-C7.
- Minimal disc-space narrowing at C5-C6 and C6-C7, grade 1.
- Mild low-grade lower-cervical uncovertebral/facet hypertrophic change, greatest around C4-C5/C5-C6.
- Tiny nonspecific calcific density anterior to mid cervical spine near C4-C5.
- No syndesmophytes, ankylosis, compression deformity, or destructive osseous lesion.
Thoracic spine
- Two-view series.
- Minimal multilevel mid/lower thoracic endplate spurring and slight endplate irregularity, greatest in the lower thoracic region.
- No compression deformity, ankylosis, or destructive lesion.
Lumbar spine
- Five-view series.
- Mild levoconvex lumbar curvature.
- Small multilevel marginal osteophytes from approximately L1-L2 through L4-L5.
- Mild lower-lumbar posterior element hypertrophic/sclerotic change at L4-L5 and L5-S1.
- Trace anterior spurring at L5-S1.
- Disc-space loss no more than minimal, grade 0-1.
- No syndesmophytes, ankylosis, compression deformity, or destructive lesion.
Sacroiliac joints / pelvis / hips
- Mild bilateral inferior iliac-sided subchondral sclerosis with minimal inferior articular margin irregularity, slightly greater on the left.
- No erosive widening or ankylosis.
- Small bilateral superolateral acetabular rim osteophytes, slightly greater on the right.
- Mild bilateral cam-type head-neck contour prominence / reduced femoral head-neck offset, greater on the right.
- Hip joint-space narrowing absent to trace only, grade 0-1.
- Small benign-appearing left supra-acetabular bone island.
Hands / wrists
- Mild bilateral non-erosive interphalangeal degenerative change involving thumb IP, index DIP, and ring DIP joints.
- Mild JSN at these joints, grade 1.
- Additional subtle small-finger interphalangeal irregularity/narrowing, greater at the PIP on the left.
- Possible mild low-confidence irregularity at the ulnar carpometacarpal articulations.
- No erosions, ankylosis, acro-osteolysis, periostitic proliferation, carpal collapse, or malalignment.
Knees / proximal fibulae
- Minimal bilateral tibial spine/intercondylar eminence spurring.
- Tiny left lateral femorotibial marginal spurring; trace lesser lateral compartment irregularity on the right.
- Femorotibial JSN: medial grade 0 bilaterally; lateral grade 0 to trace 1.
- Trace bilateral patellofemoral marginal spurring; patellofemoral narrowing grade 0 to trace 1.
- No fracture, erosive change, or large effusion on provided views.
- Chronic asymmetric proximal fibular cortical remodeling bilaterally, greater on the left, with fusiform cortical thickening and focal proximal cortical buttressing/expansion on the left and milder chronic thickening on the right.
Comparison
Cervical spine
- No prior cervical radiographs for comparison.
Thoracic spine / lumbar spine / sacroiliac joints / pelvis / hips
- Compared with 2023-xx-xx (~2 yr 4 mo before current study): stable mild thoracolumbar spondylotic change, stable mild bilateral sacroiliac inferior iliac-sided sclerosis/irregularity, and stable mild bilateral acetabular rim spurring with subtle cam-type contour prominence. No interval ankylosis or new erosive change.
Hands / wrists
- No prior hand radiographs for comparison.
Knees / proximal fibulae
- Compared with 2024-xx-xx (~1 yr 4 mo before current study), 2024-xx-xx (~1 yr 8 mo before current study), and 2022-xx-xx (~3 yr 4 mo before current study): minimal bilateral degenerative knee change remains stable. Chronic proximal fibular remodeling, greater on the left, is stable in extent and configuration.
Impression
Pattern: Low-burden mixed structural pattern with subtle chronic bilateral sacroiliac change, mild multilevel cervical/thoracic/lumbar spondylotic change, mild bilateral hip contour/degenerative change, mild bilateral non-erosive hand osteoarthritic change, and minimal bilateral knee osteoarthritic change with stable chronic proximal fibular remodeling left greater than right.
Confidence: High overall; moderate for the subtle sacroiliac inflammatory-type structural component and low-confidence minor ulnar carpometacarpal irregularity.
Progression: No measurable interval structural progression in knees versus 2022/2024 priors or in thoracolumbar/sacroiliac/pelvic structures versus 2023.
Age Context: Overall structural burden remains mild for age, with low-grade mixed degenerative and subtle inflammatory-type radiographic features.
excerpt · image-derived semiquantitative · not formal central-read scores
1) Quantitative Radiologic Measures
1A. Current XR structural burden table
| Region | Current extracted burden | Severity class | Quantitative summary |
|---|---|---|---|
| Cervical spine | Mild | Low | Spur-bearing levels 3; disc-height loss levels 2; ankylosis 0 |
| Thoracic spine | Mild | Low | Spur-bearing levels ~4; compression deformities 0 |
| Lumbar spine | Mild | Low | Spur-bearing levels 4–5; posterior-element hypertrophic levels 2 |
| Sacroiliac joints | Mild bilateral chronic structural change | Low | Structural grade proxy L2 / R2 / sum 4 of 8 |
| Hips | Mild bilateral contour/degenerative change | Low | Rim osteophytes 1 / 1; superior JSN 0–1 / 0–1; contour offset reduction 1 / 1 |
| Right hand / wrist | Mild non-erosive OA-pattern change | Low | Definite OA-pattern joints 3; probable additional low-grade joints 1; erosions 0 |
| Left hand / wrist | Mild non-erosive OA-pattern change | Low | Definite OA-pattern joints 3; probable additional low-grade joints 1–2; erosions 0 |
| Knees | Minimal bilateral OA burden | Low | KL/OARSI 1 / 1; medial JSN 0 / 0; lateral JSN 0–1 / 0–1 |
| Proximal fibulae | Chronic stable remodeling | Low–moderate asymmetry | Remodeling grade R1 / L2 |
1B. Cross-modality knee structural table
| Study year | Modality | Side | Effusion | Meniscus tear | Ligament injury | Cartilage loss | Osteochondral / marrow stress-type signal | Patellofemoral morphology note | Other |
|---|---|---|---|---|---|---|---|---|---|
| 2011 | MRI report-derived | Right | 1 small suprapatellar | 0 | 0 | 0 grossly | 0 | 1 elongated lateral patellar facet | Small posterolateral tibial bone island |
| 2020 | MRI report-derived | Right | 2 moderate | 0 | 0 | 0 | 0 subchondral edema/fracture | 0 | Posterior Hoffa fat-pad edema 1 |
| 2024 | MRI report-derived | Left | Not clearly stated | 0 definable | 0 cruciate/collateral | Not stated as loss | 1 mild lateral femoral condyle osteitis / possible small SIF-stress reaction | 0 | Typed indication “chronic pain”; handwritten correction partially legible |
| 2026 | XR image-derived | Bilateral | No large effusion on provided lateral radiographs | N/A | N/A | No advanced loss | No XR fracture/collapse | N/A | Minimal OA only |
1C. MRI event counts
| MRI-derived feature | Positive studies / total MRI studies |
|---|---|
| Effusion present | 2 / 3 definite |
| Meniscal tear present | 0 / 3 |
| Cruciate/collateral ligament injury present | 0 / 3 |
| Gross compartment cartilage loss present | 0 / 2 explicitly described |
| Subchondral / osteitic stress-type lesion present | 1 / 3 |
| Patellofemoral morphologic predisposition note present | 1 / 3 |
| Loose body present | 0 / 1 explicitly addressed |
| Baker cyst present | 0 / 1 explicitly addressed |
2) Longitudinal & Temporal Metrics
2A. Whole-course modality timeline
| Year | Data type | Side / region | Key extract |
|---|---|---|---|
| 2010 | Clinical context | Right knee | Symptom onset: pain, stiffness, swelling; gradual progression; partial NSAID response |
| 2011 | MRI report | Right knee | Small suprapatellar effusion; no meniscal or ligament tear; elongated lateral patellar facet |
| 2011–2016 | Clinical context | Right knee | Multiple aspirations/injections; arthroscopy with cartilage resurfacing / bursitis treatment; symptomatic improvement |
| 2016 | Clinical context | Right knee | Recurrence; injection; later arthroscopy with lateral release |
| 2020 | Clinical context + MRI report | Right knee predominant, later left | Right recurrence then milder left; right MRI moderate effusion without internal derangement; left aspiration WBC ~6000, crystals/infection negative |
| 2022 | XR | Knees | Minimal bilateral OA; stable chronic proximal fibular remodeling, left greater than right |
| 2023 | XR | Axial / SI / pelvis | Low-burden thoracolumbar spondylotic change; mild chronic bilateral SI structural change |
| 2024-07 | XR | Knees | Minimal bilateral OA; no measurable progression |
| 2024-11 | XR + MRI report | Knees / left knee MRI | XR stable; left MRI with lateral femoral condyle osteitis / possible small insufficiency-stress lesion |
| 2026 | XR | Axial + peripheral | Low-burden mixed structural phenotype; no measurable radiographic progression |
2B. XR temporal stability
| Region group | Comparable XR timepoints | Changed tracked features | Total tracked features | Temporal Stability Score |
|---|---|---|---|---|
| Knees / proximal fibulae | 4 | 0 | 10 | 1.00 |
| Thoracic + lumbar + SI + hips | 2 | 0 | 11 | 1.00 |
| Whole comparable XR set | — | 0 | 21 | 1.00 |
2C. MRI temporal phenotype course
| MRI phenotype axis | 2011 right | 2020 right | 2024 left | Trajectory readout |
|---|---|---|---|---|
| Effusion | Small | Moderate | Not clearly stated | Fluctuating inflammatory-fluid signal |
| Meniscal injury | Absent | Absent | Absent definable | Stable negative |
| Ligament injury | Absent | Absent | Absent | Stable negative |
| Cartilage structural damage | Not grossly present | Not present | Not emphasized | No documented major MRI cartilage failure |
| Osteochondral stress signal | Absent | Absent | Present / probable | New focal left-sided stress-type event by 2024 |
| Patellofemoral morphologic predisposition | Present | Not described | Not described | Single documented right-sided predisposition feature |
2D. Knee chronology-derived event counters
| Event class | Right knee | Left knee | Whole course |
|---|---|---|---|
| MRI reports available | 2 | 1 | 3 |
| Arthroscopies reported in context | 2 | 0 | 2 |
| Aspirations / IA procedures reported in context | 4+ before 2011–2016 era + 2016 IASI | 1 aspiration + IASI in 2020 | Multiple bilateral, right-dominant |
| MRI-documented internal derangement | 0 | 0 | 0 |
| MRI-documented effusion | 2 | 0 explicit | 2 definite |
| MRI-documented stress-type osseous event | 0 | 1 | 1 |
3) Age-Adjusted Reference Values
| Domain | Absolute burden | Age-context flag | Research readout |
|---|---|---|---|
| Axial XR burden | Low | Mild early structural signal | Low absolute burden for age; no syndesmophyte/ankylosis pattern |
| SI structural burden | Low | Not primarily age-normalized | Mild chronic inflammatory-type structural component |
| Hand burden | Low | Early distal OA-pattern signal | Mild DIP/thumb-IP OA-pattern burden without erosive inflammatory remodeling |
| Knee XR burden | Low | Early low-grade OA signal | Minimal bilateral OA burden despite long symptom history |
| Hip contour/degenerative burden | Low | Early contour-based morphology flag | Mild bilateral cam-type contour prominence |
| MRI fluid / stress burden | Episodic | Age-context supportive of active but structurally low-burden course | Recurrent symptoms out of proportion to persistent XR damage |
4) Symmetry & Balance Metrics
4A. Current XR symmetry
| Region | Right | Left | Symmetry readout |
|---|---|---|---|
| SI joints | 2 | 2 | Near-symmetric; slight left inferior sclerosis excess qualitatively |
| Hips | 1 | 1 | Near-symmetric; right contour prominence slightly greater |
| Hands definite OA-pattern joints | 3 | 3 | Symmetric definite burden |
| Knee OA grade | 1 | 1 | Symmetric overall OA class |
| Knee lateral marginal prominence | Trace | Trace–mild | Mild left excess |
| Proximal fibular remodeling | 1 | 2 | Persistent left excess |
4B. Clinical-course lateralization map
| Feature | Side dominance |
|---|---|
| Earliest and longest symptomatic burden | Right |
| Historical procedures / arthroscopies | Right |
| 2020 aspiration-proven inflammatory fluid event described | Left |
| 2024 MRI stress-type lesion | Left |
| Chronic fibular remodeling on XR | Left > Right |
| Current XR knee OA burden | Near-symmetric |
Interpretive research note:
Clinical/procedural dominance is right-sided, whereas the later focal stress-type MRI event and stronger fibular remodeling are left-weighted. This represents a cross-lateralized course, not a simple single-compartment or single-side progression pattern.
5) Cross-Modality Correlation Summary
5A. XR–MRI knee concordance table
| Domain | XR signal | MRI signal | Correlation status |
|---|---|---|---|
| Major structural OA | Minimal bilateral OA only | No major cartilage-loss pattern documented | Concordant low structural burden |
| Internal derangement | No XR surrogate | No meniscal/ligament tear across MRI reports | Concordant negative |
| Effusion activity | No large effusion on 2026 XR | Small/moderate effusions documented on prior MRI reports | XR-insensitive / MRI-positive historical fluid activity |
| Osteochondral stress injury | No collapse/fracture on XR | 2024 left lateral femoral condyle osteitis / possible insufficiency-stress lesion | MRI-positive focal event not mirrored by advanced XR change |
| Chronic remodeling | Stable proximal fibular remodeling | Not the main MRI target | XR-dominant chronic extra-articular remodeling signal |
5B. Modality coverage table
| Modality | Count of usable studies | What it contributes |
|---|---|---|
| XR | 5 study dates | Longitudinal structural stability, axial/peripheral patterning, OA burden, SI change |
| MRI report-derived | 3 study dates | Effusion burden, internal derangement exclusion, focal stress-type marrow/subchondral event |
| Aspiration context | 1 clearly described left-knee event | Inflammatory fluid profile: crystals/infection negative, WBC ~6000 |
| DEXA | 0 | Not available |
5C. DEXA–Radiograph Correlation Summary
| Field | Status |
|---|---|
| DEXA dataset available | No |
| Cross-linkable bone-density metrics | Not computable |
| Bone-health fusion score | Not issued |
| Research implication | 2024 left-knee stress-type MRI event cannot be densitometrically contextualized from current dataset |
6) Composite Structural Metrics
6A. XR-only composite metrics
| Metric | Value | Interpretation |
|---|---|---|
| Composite Structural Burden Index | 0.25 | Low whole-study XR burden |
| Composite Stability Index | 1.00 | No measurable XR progression in comparable regions |
| Axial region share | 4/7 = 0.57 | Slight axial predominance by region count |
| Peripheral region share | 3/7 = 0.43 | Mild peripheral contribution |
| Definite inflammatory-type structural share | 1/7 = 0.14 | SI-centered |
| Definite degenerative / contour-based share | 6/7 = 0.86 | Dominant visible XR burden class |
6B. Multimodal composite metrics
| Multimodal metric | Value | Meaning |
|---|---|---|
| MRI Internal Derangement Negativity Index | 1.00 (3/3 MRI studies negative) | Repeated MRI reports did not document meniscal or ligament tear |
| MRI Effusion Positivity Fraction | 0.67 (2/3 definite positive) | Historical fluid activity documented despite low current XR burden |
| MRI Stress-Lesion Fraction | 0.33 (1/3) | One focal left-sided osteitic / insufficiency-stress event documented |
| XR–MRI Structural Discordance Index | Moderate | Symptoms/fluid activity exceed fixed structural damage on XR |
| Cross-Modality Stability Class | Structurally stable, clinically episodic | XR stable across years; MRI/context show recurrent episodic inflammatory or overload-type events |
7) QA / Reliability Indicators
7A. Source integrity table
| Source class | Quality status | Limitation |
|---|---|---|
| XR images | High | Direct image-based extraction |
| MRI reports | Moderate | Derived from screenshots of written reports, not from MRI sequence review |
| Handwritten 2024 MRI annotation | Low–moderate | Partially legible only |
| 2020 clinical note | Moderate-high | Narrative context supplied by treating physician; not part of report text |
7B. Confidence-weighted adequacy
| Domain | Adequacy ratio | Confidence-weighted status |
|---|---|---|
| Current XR whole-study dataset | 0.95 | 0.91 |
| Longitudinal XR knees | 0.94 | 0.91 |
| Longitudinal XR axial/pelvic set | 0.95 | 0.90 |
| MRI report extraction layer | 0.82 | 0.76 |
| Multimodal synthesis layer | 0.88 | 0.82 |
7C. QCL-style concordance summary
| Domain | Concordance readout |
|---|---|
| Clinical history vs XR | Moderate concordance |
| Clinical history vs MRI reports | High concordance |
| XR vs MRI | Moderate concordance with structure–activity dissociation |
| Whole-case multimodal concordance | Moderate-high |
Experimental Research Addendum
1) Prototype Composite Metrics
| Prototype metric | Value | Meaning |
|---|---|---|
| Structure–Activity Dissociation Index | High-moderate | Recurrent symptoms / effusions / procedures with persistently low XR damage burden |
| Procedure–Damage Mismatch Index | Elevated | Two right-knee arthroscopies and multiple aspirations/injections with minimal subsequent XR OA burden |
| Cross-Lateralization Index | Positive | Right-dominant historical clinical course; left-dominant later focal MRI stress event / fibular remodeling |
| MRI–XR Event Asymmetry Vector | Right fluid / Left stress | Different sides dominate different event types |
| Whole-Course Volatility Index | Moderate | Symptoms and fluid events fluctuate; fixed radiographic progression absent |
2) Extended Bone-Health / Stress Models
| Field | Status |
|---|---|
| Subchondral stress-vulnerability flag | Triggered on left knee (2024 MRI report-derived) |
| Densitometric corroboration | Unavailable |
| XR collapse/remodeling consequence of the 2024 left stress event | Not demonstrated by 2026 XR |
| Working research interpretation | Focal stress-type event without downstream radiographic collapse over available interval |
3) Infection / Oncologic Advanced Operators
| Trigger domain | Result |
|---|---|
| Aggressive osseous destruction pattern | Negative |
| MRI-reported septic-type destructive pattern | Negative in available report text |
| Crystals / infection in 2020 aspiration context | Negative by supplied note |
| Oncologic destructive trigger | Negative |
| Cross-modality safety escalation trigger | Not activated |
4) Advanced Symmetry Maps
| Symmetry layer | Result |
|---|---|
| Static XR symmetry | High overall |
| Dynamic symptom symmetry over time | Low |
| Procedure symmetry | Low, right-dominant |
| MRI event symmetry | Low, cross-lateralized |
| Final research symmetry class | Static symmetry with dynamic asymmetry |
5) Developmental / Mechanical Modulation Signals
| Feature | Research interpretation |
|---|---|
| 2011 elongated lateral patellar facet | Developmental patellofemoral morphology that may contribute to maltracking/instability susceptibility |
| Bilateral cam-type head-neck contour prominence | Developmental contour contribution outside the knee axis |
| Stable proximal fibular remodeling, left greater than right | Long-standing benign modeling / prior stress-remodeling pattern plausible; etiology not determined radiographically |
| 2024 lateral femoral condyle stress-type lesion | Possible mechanical overload or bone-stress superimposition rather than progressive chronic erosive arthropathy |
6) External Clinical-Context Integration
Non-report contextual chronology supplied by treating physician; not image-derived.
| Context element | Research linkage |
|---|---|
| Symptom onset in 2010 with gradual progression | Supports long disease duration despite low fixed XR burden |
| Multiple aspirations / IA steroid injections | Supports recurrent inflammatory-fluid phenotype |
| Right arthroscopy with resurfacing / later lateral release | Explains right-sided procedural history not visible as major fixed radiographic damage |
| 2020 left-knee aspirate WBC ~6000, crystals/infection negative | Supports inflammatory but non-septic, non-crystalline episodic synovitis |
| Indocin response | Supports inflammatory responsiveness but is not imaging evidence |
| Current remission on biologic with one mild dactylitis flare | Clinically compatible with stable 2026 XR structural status |
7) Harmonized Multicenter / Trial-Style Export Summary
| Field | Value |
|---|---|
| Subject timeline depth | 2011–2026 |
| Modalities used | XR + MRI-report + aspiration-context |
| Primary structural phenotype | Low-burden mixed phenotype |
| Primary kinetic phenotype | Episodic recurrent knee inflammation / effusion with minimal fixed damage progression |
| Structural progression class | Stable |
| Internal derangement class | Repeatedly negative on available MRI reports |
| Cross-modality discordance class | Activity exceeds damage |
| Candidate phenotype label | Peripheral episodic inflammatory knee phenotype with low structural accrual |
8) Missingness / Data Integrity Extensions
| Missing element | Effect |
|---|---|
| No direct MRI image sequences | MRI layer limited to report-text extraction |
| No MRI of both knees at all timepoints | Side-to-side MRI chronology incomplete |
| No DEXA | Bone-stress / density linkage incomplete |
| No foot / ankle radiographs in this case package | Peripheral phenotype not fully whole-limb mapped |
| No serial knee MRI after 2024 | Resolution/persistence of the left lateral femoral condyle stress event not directly MRI-tracked |
9) Research-Layer Conclusion
This expanded multimodal case remains best characterized as a low-burden, structurally stable, mixed peripheral/axial phenotype on radiographs, with minimal measurable fixed progression across all comparable XR timepoints. The added MRI chronology materially changes the research profile by showing that the knee course is not dominated by recurrent internal derangement, but instead by episodic effusive/inflammatory activity and one later left-sided focal stress-type osteochondral event. The strongest whole-case research signal is therefore structure–activity dissociation: recurrent clinical and fluid events over many years with persistently low radiographic damage accumulation.
RheumaView™ research tiers duplicate quantitative and longitudinal analytics without modifying the clinical core, and the full experimental layer remains isolated from the READY+ narrative.
report-derived · compiled from prior MRI report text · not a re-read of MRI sequences
Compiled from uploaded report screenshots. Oldest study first.
De-identification applied: patient name, date of birth, patient/account identifiers, accession numbers, institution names, and clinician names were removed. Exact study dates were reduced to year only to preserve chronology while limiting identifiers.
Chronology summary
| Study | Year | Region | Key MRI impression |
|---|---|---|---|
| 1 | 2011 | Right knee | Small suprapatellar effusion. No meniscal tear or ligament injury. Elongated lateral patellar facet noted. |
| 2 | 2020 | Right knee | Moderate joint effusion. Small posterior Hoffa fat pad edema. No discrete internal derangement. |
| 3 | 2024 | Left knee | Mild osteitis in the lateral femoral condyle. Possible small subchondral insufficiency fracture / stress reaction. No definable meniscal tear. |
Study 1 — 2011
| Region | Right knee MRI |
|---|---|
| Clinical history | Knee pain; instability. |
Technique: MR imaging of the knee was acquired with sagittal PD and STIR, coronal T1 and STIR, and axial T2.
Findings
Normal anatomic alignment.
Small suprapatellar effusion.
Articular surface of the patella is intact.
Elongated lateral facet of the patella, which can predispose to medial subluxation.
ACL and PCL are intact.
Extensor mechanism is intact.
Lateral meniscus and medial meniscus are intact.
Small bone island noted in the posterolateral tibial region (wording partly limited by source legibility).
Medial and lateral stabilizers of the knee are intact.
No gross articular cartilage abnormalities identified.
No osteophyte formation.
No compartment narrowing.
Impression
No meniscal tear.
No ligament injury.
Small suprapatellar effusion.
Study 2 — 2020
| Region | Right knee MRI |
|---|---|
| History | Right knee pain. Swelling. |
Technique: Routine multiplanar imaging through the right knee was obtained without contrast.
Findings
Cartilage along the medial compartment is intact and well maintained.
No subchondral edema.
No fracture.
Medial meniscus is intact.
MCL is intact and unremarkable.
Cartilage along the lateral compartment is well maintained and within normal limits.
Lateral meniscus is intact.
Lateral collateral ligament complex is intact and unremarkable.
Posterolateral corner is unremarkable.
Popliteus is within normal limits.
No Baker’s cyst.
Patellofemoral cartilage is intact and well maintained.
Extensor mechanism and retinaculum are unremarkable.
Moderate joint effusion.
Cruciate ligaments are intact.
No discrete intra-articular loose body.
Small amount of edema within the posterior aspect of Hoffa’s fat pad.
Impression
Joint effusion.
No discrete internal derangement.
Study 3 — 2024
| Region | Left knee MRI |
|---|---|
| Indication | Typed indication on report: chronic pain. |
Technique: MR imaging was acquired with multiplanar T1/PD and fat suppression.
Findings
Mild osteitis in the lateral femoral condyle.
Possible small subchondral insufficiency fracture is difficult to confirm in all planes.
No definable tear of the menisci.
Cruciate ligaments are intact.
Collateral ligaments are intact.
Quadriceps and patellar tendons are intact.
Impression
Stress reaction or insufficiency fracture of the lateral femoral condyle.
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demo · full-res by requestFull-resolution de-identified radiographs available by request · more in each per-date composite PDF.
Single-date, one modality. A single structured read of one study.
Multiple timepoints establish a baseline and let stability be tracked region by region. This case spans five radiographic timepoints.
More than one modality compounds the read: report-derived knee MRI is correlated with the longitudinal radiographs, surfacing activity that plain films do not capture.
This demonstration is part of the public RheumaView™ case library. The full library is available for professional use.
Request accessDe-identified MRI reports
Research Analytic Addendum, cross modality (X rays and MRIs)
X rays only vs X rays + MRI discrepancy audit
RV-009 illustrates a longitudinal peripheral spondyloarthritis case in which the disease was initially dominated by recurrent knee inflammation rather than by early fixed radiographic damage. The clinical course began in 2010 with atraumatic right-knee pain, stiffness, swelling, partial NSAID response, repeated aspirations and intra-articular steroid injections, and eventually right-knee arthroscopy with cartilage resurfacing–type intervention and later lateral release. Symptoms improved for prolonged intervals, then recurred, including bilateral knee activity in 2020 with inflammatory synovial fluid but no crystals or infection, and later evolved into a broader peripheral-SpA phenotype. By 2026, the patient was clinically well controlled on secukinumab, with only one mild dactylitis flare over the prior interval and otherwise no significant active joint complaints.
What makes the case valuable is the separation between historical inflammatory burden and present structural burden. Serial radiographs show only a low-burden mixed pattern: subtle chronic bilateral sacroiliac change, mild cervical/thoracolumbar spondylotic change, mild hip contour/rim-spur change, mild non-erosive hand OA-pattern change, and minimal knee OA-pattern change, without measurable interval progression. The added MRI chronology does not overturn the XR phenotype, but it adds activity-sensitive context: recurrent effusions, exclusion of major internal derangement on prior studies, and a focal left stress-type bone event. The discrepancy audit therefore supports a multimodal reading in which XR captures structural trajectory, while MRI contributes interval inflammatory/mechanistic detail.
For clinicians, this is a practical follow-up case showing how treated peripheral SpA can have a substantial historical inflammatory footprint yet remain structurally stable on serial imaging. For research and pharma-facing audiences, it demonstrates how RheumaView can integrate clinical chronology, serial radiography, MRI history, and cross-modality audit into a reproducible, analysis-ready case narrative without blurring structure, activity, and progression.