1. 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

2. Systemic JRA (Still’s d.) 15 month female presented with rash and chronic recurring fever for 3 weeks.

3. 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.

4. ●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)

5. 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.

6. Comparison between psoriatic arthritis and rheumatoid arthritis in both hands and feet.

7. ■ 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

8. ■ 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.