Atlas of Rheumatology by Eric L. Matteson (auth.), Gene G. Hunder MD (eds.)

By Eric L. Matteson (auth.), Gene G. Hunder MD (eds.)

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33 Clinical Features-Joints FIGURE 1·121. Micrognathia in juvenile rheumatoid arthritis (JRA). This child has impressive micrognathia as a sequelae of JRA, evident on this lateral photograph. (Courtesy of Suzanne L. ) FIGURE 1·120. Juvenile rheumatoid arthritis (JRA)-polyarticular disease. This child has florid polyarticular JRA. There are large effusions in the knees, ankles, hands, and wrists. The limited extension of the neck is indicative of cervical spine involvement. Prominent muscular atrophy of the extremities is secondary to persistent arthritis disease.

Ocular complications of drug treatment for rheumatoid arthritis include cataracts and glaucoma from glucocorticoid treatment (common), and antimalarial associated retinopathy (rare). FI GURE 1·81. Scleritis. Scleritis is a serious complication ofrheumatoid arthritis which can lead to permanent loss of vision if left untreated. Symptoms include pain and loss of visual acuity. Scleritis often occurs in patients with long standing rheumatoid arthritis, and as in this case may be nodular. Many patients with scleritis have had vasculitis and other systemic disease manifestations.

A biopsy of a minor salivary gland of the lower lip can detect lymphoid aggregates consistent with Sjogren's syndrome. Autoantibodies are frequently found in patients with Sjogren's syndrome, but antibodies to SSA (Ro) or SSB (La) are more specific for Sjogren's syndrome. SSA-Sjogren's antigen A; SSB-Sjogren's antigen B. Primary Sjogren's Secondary Sjogren's Rheumatoid arthritis Systemic lupus erythematosus Scleroderma Inflammatory myopathies Other connective tissue diseases Lymphoproliferative disorders FIGURE 1·148.

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