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FELTY SYNDROME- 2-4% RA patients develop
Characterized by:
1. RA (RF+)(nodules, vasculitis)
2. splenomegaly
3. granulocytopenia
Pathophysiology
- splenic sequestration and subsequent granulocyte destruction
- granulocyte surface antigen autoantibodies
- autoantibodies against granulocyte growth factor G-CSF
RA – vasculitis
Felty syndrome – vasculitis
Systemic JRA (Still’s d.)
15 month female presented with rash and chronic recurring fever for 3 weeks.
PSORIATIC ARTHRITIS
● Autoimmune disease
►An inflammatory arthritis associated with psoriasis, usually RF-neg.
●slightly over 1 million in US. (about 10% of those that have psoriasis)
●men and women affected equally
●mostly develops in persons aged 35-55 years
●more common in white persons than other races
● characterized by flares and remissions.
●psoriasis usually preceeds arthritis ---sometimes by up to 20 years ---in 15%...arthritis appears before psoriasis ●80% with PA have nail changes - pitting - lines - yellow spots - onycholysis (loosening of nail)●psoriasis – mild (few spots) to severe (all over body)●30% develop eye involvement (inflammation)
PSORIATIC ARTHRITIS (PA)
PSORIATIC ARTHRITIS
►Psoriatic arthritis affects the ligaments, tendons, fascia, and joints. The most common patterns are:
■ assymetric oligoarticular type○Usually, the digits of the hands and feet are affected first, with inflammation of the flexor tendon and synovium occurring simultaneously, leading to the typical "sausage" appearance (dactylitis). ○Usually, fewer than 5 joints are affected at any one time.
Comparison between psoriatic arthritis and rheumatoid arthritis in both hands and feet.
■ Symmetrical polyarthritis type ○ rheumatoidlike pattern; most common type (45%). The hands, wrists, ankles, and feet may be involved. ○ It is differentiated from rheumatoid arthritis (RA) by
- distal interphalangeal (DIP) joint involvement, - the absence of subcutaneous nodules, - negative test result for rheumatoid factor (RF).
This condition generally is milder than RA, with less deformity.
■ Spondylitis (with or without sacroiliitis) ○ about 8-10% of patients with psoriatic arthritis○ male predominance○ vertebrae are affected asymmetrically (involvement differs from that observed in ankylosing spondylitis.)
PSORIATIC ARTHRITIS
■ Juvenile psoriatic arthritis - accounts for 10-20% of childhood arthritis and is monoarticular at onset. - mean age of onset is 9-10 years, with a female predominance. - The disease is usually mild, although occasionally it may be severe and destructive, progressing into adulthood. - In 50% of children, the arthritis is monoarticular; DIP joint involvement occurs at a similar rate.