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