Monday, November 11, 2019

Extra - articular manifestations of RA ( Notes and mnemonic )

Hi!

Extra- articular manifestations of Rheumatoid arthritis :

( mnemonic - NOVELA is FrickiN' Hot! )

- Nodules
- Osteoporosis
- Vasculitis
- Eye pathologies
- Lungs involvement
- Association of splenomegaly and neutropenia ( Felty's syndrome )
- Neurologic manifestations
- Haematologic manifestations.

1) Rheumatoid Nodules -
- in 25% of persons with RA
- firm, round masses
- felt in the subcutaneous tissues,
eg., the olecranon bursa, proximal ulna, Achilles tendon, the occiput.
- clinical predictors of more severe arthritis

2) Osteoporosis- aggravated by intensive corticosteroid therapy, and immobilization.

3) Rheumatoid Vasculitis -
- in patients with a high titre of circulating Rheumatoid Factor.
- results in:
(i) Polyneuropathy and mononeuritis multiplex
(ii) cutaneous ulcerations, palpable purpura, and distal gangrene.
(iii) Visceral infarction - stroke, AMI, mesenteric arteritis.

4) Eye pathologies - 
- Scleritis, Episcleritis, and scleromalacia performans
- Sicca complex, comprising
(i) Keratoconjunctivitis sicca,
(ii) Xerostomia,
(iii) Salivary gland enlargement
- Glaucoma

5) Lungs involvement
- pleural effusions with low levels of glucose ( less than 10 mg/dL )
- interstitial fibrosis
- Caplan's syndrome ( multiple nodules and Interstitial lung disease due to pneumoconiosis )

6) Felty's syndrome ( Association of splenomegaly and neutropenia with RA )

7) Neurologic manifestations 
- Nerve entrapment syndromes : carpal and tarsal tunnel syndromes
- spinal compression due to atlanto- axial subluxation
- peripheral neuropathy

8) Heart and Blood
- pericarditis ( CCP )
- Premature Atherosclerosis 
- Valvular involvement
- Conduction defects
- Anemia ( normocytic, normochromic )
- Thrombocytosis
- Eosinophilia and mild leucocytosis.


That's all
Hope it helps
- Jaskunwar Singh

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