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Juxta-articular osteopenia (also called periarticular osteopenia) refers to localized loss of bone mineral density adjacent to joints. It appears on X-ray as relative lucency of bone around articular margins compared to more distant bone.

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Pathophysiology

• Due to increased local blood flow (hyperemia) and inflammatory cytokines from synovitis → enhanced osteoclastic activity.
• Leads to osteopenia confined to periarticular bone (not generalized).
• Seen in inflammatory arthritis (not degenerative).

Radiology

• Localized radiolucency near joint margins.
• Preserved trabecular pattern initially, progressing to generalized periarticular bone rarefaction.
• Often symmetric in systemic inflammatory arthritides.
• Distribution: Most commonly in small joints of hands and feet.

Conditions Associated

1. Rheumatoid arthritis (RA) – hallmark early sign (even before erosions).
2. Juvenile idiopathic arthritis.
3. Psoriatic arthritis and Reactive arthritis (may be seen, but less prominent).
4. Tubercular arthritis (chronic granulomatous arthritis).
5. Other chronic inflammatory arthritides.

Absent in osteoarthritis (OA) → OA shows subchondral sclerosis instead.