Porth's Essentials of Pathophysiology, 4e

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Disorders of the Skeletal System: Metabolic and Rheumatic Disorders

C h a p t e r 4 4

Neck discomfort

Eye lesions: Episcleritis

Scleromalacia

Symmetric polyarthritis

Nonspecific systemic symptoms: Low-grade fever Fatigue Weakness Loss of appetite

Lymphadenopathy

Hematologic manifestations: Elevated ESR Anemia

Other organ involvement:

Pleural effusion Pericarditis Nephropathy

Splenomegaly

Rheumatoid subcutaneous nodules

Vasculitis:

Ulnar deviation

Ischemic areas in the nail fold

Pannus

Loss of cartilage

Inflamed synovium

Pannus-filled erosion

A

B

Hallux valgus and hammer toe FIGURE 44-6. Clinical manifestations of rheumatoid arthritis featuring (A) hand and finger manifestations and (B) destructive joint changes. ESR, erythrocyte sedimentation rate.

found to correlate with the amount of disease activity. A moderate hypochromic anemia is common. Extra-articular involvement occurring in long-stand- ing disease include the development of rheumatic nod- ules (Fig. 44-6A). These granulomatous lesions have a central core of fibrinoid necrosis that is made up of a mixture of fibrin and other proteins such as degraded collagen. 4 The nodules may be tender or nontender, movable or immovable, and small or large. Typically,

they are found over pressure points such as the extensor surfaces of the ulna. The nodules may resolve spontane- ously or be surgically removed. Vasculitis, or inflammation of small and medium- sized arteries, is an uncommon manifestation that pro- duces ischemic areas in the nail fold and digital pulp that appear as brown spots. Ulcerations may occur in the lower extremities, particularly around the malleo- lar areas. In some cases, neuropathy may be the only