A 48-year-old woman with RA develops worsening peripheral neuropathy, purpuric skin lesions on the lower extremities, and mononeuritis multiplex. ANCA is negative. Which complication of RA is MOST likely?
- A Secondary amyloidosis
- B Felty syndrome
- C Rheumatoid vasculitis ✓
- D Atlanto-axial subluxation
Correct answer: C. Rheumatoid vasculitis
Explanation
Rheumatoid vasculitis is a rare but serious extra-articular manifestation typically occurring in long-standing, seropositive RA. It presents with mononeuritis multiplex, digital infarcts, purpura, and skin ulcers due to involvement of small-medium vessels. Felty syndrome consists of RA + splenomegaly + leucopenia without prominent vasculitis. Secondary amyloidosis causes nephropathy (proteinuria, renal failure), not neuropathy. Atlanto-axial subluxation causes cervical myelopathy, not peripheral neuropathy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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