BACKGROUND Diseases of musculoskeletal system are among the most common human afflictions. Rheumatoid Arthritis (RA) is a systemic autoimmune disease of unknown aetiology characterised by symmetric erosive arthritis and in some cases extra-articular involvement. Characteristic feature of RA is persistent inflammatory synovitis usually involving peripheral joints in a symmetric distribution. The aim of the study is to study the extra-articular manifestations of Rheumatoid Arthritis (RA). MATERIALS AND METHODS 50 cases who satisfied the criteria for diagnosis of RA laid down by the American Rheumatism Association Criteria were selected. They were studied for evidence of extra-articular manifestations by clinical, biochemical, radiological, echocardiographic and pulmonary function tests. Data was collected and analysis was made using various statistical parameters. RESULTS Among the 50 cases of RA studied, the disease was common in females and maximum incidence was seen between 30-39 years of age (30%). Morning stiffness, pain and swelling in the joints were the commonest presenting symptoms. The joints of the hand (70%) were the most commonly involved followed by wrist, knee, ankle and foot joints. In the present study, 28 (56%) had extra-articular manifestations with more incidence in males than females. The commonest one was anaemia (20%) followed by cardiac involvement (12%). Next, in the order of involvement were pulmonary, lymphadenopathy, vasculitis and rheumatoid nodule. Pericardial effusion was the most common cardiac finding followed by mitral regurgitation and aortic regurgitation. RA factor was positive in 33 (66%) cases. All the patients who had extra-articular manifestation had RA factor positive. CONCLUSION Although, the rheumatoid arthritis was common among females, the extra-articular manifestations were common among males. Longer duration of disease and positive RA factor were associated with higher incidence of extra-articular manifestations. Currently, there are no reliable predictors for these features in early RA, although they are associated with men, more severe joint disease and worse function. Early recognition and appropriate treatment might limit the morbidity and lead to better outcomes.

BACKGROUND Thyroid abnormalities are seen in most of the patients suffering from liver cirrhosis. Cirrhosis of the liver is the major cause of morbidity and mortality worldwide. Cirrhosis plays a vital role in the thyroid hormone metabolism and thyroid hormone circulation by producing thyroid binding globulin. Hence, it is seen that the thyroid dysfunction is associated with the severity of liver disease. We wanted to study the changes in the levels of thyroid hormones in patients suffering from alcoholic liver cirrhosis. METHODS In this cross-sectional study, 50 patients who were admitted to the IP department and ICU of General Medicine Department of Akash Hospital, Devanahalli, for symptoms of cirrhosis of liver were evaluated for their thyroid profile along with other relevant investigations. RESULTS Among the 50 patients studied, 43 were male and 7 were female. 17 patients had an increase in their thyroid stimulating hormone (TSH). These patients also had a significant association with various LFT parameters such as indirect bilirubin, AST, ALT, APS, and GGT. These 17 patients who had increase in TSH also had associated hepatic complications such as - jaundice (41 %), hepatic encephalopathy (35.29 %), bleeding varices (29.4 %), and portal hypertension (82.35 %). CONCLUSIONS Thyroid abnormalities are not uncommon in patients with cirrhosis. Hypothyroidism is the most common abnormality that was detected. Rate of complications is also high in patients with elevated levels of TSH. A fair amount of suspicion is required for detecting thyroid abnormalities in patients suffering from cirrhosis. KEYWORDS Cirrhosis, Thyroid Hormone, Hypothyroidism, Hyperthyroidism, Thyroiditis