Its Plummer -Vinson syndrome Associated with mutilans rheumatoud arthritis In arthritis mutilans,a patient's fingers become shortened by arthritis,and d shortening becomes severe enough that d hands looks paw-like,with d firts deformity occuring at interphalangeal n metacarpophalangeal joints. The excess skin from d shortening of d phalanx become folded transversely and retracted into one another. As d condition worsens ,luxation,phalabgeal,metacarpal bone absorption abd skeletal architecture loss in d fingers occur. Arthritis mutilans occurs mainly in d patients with psoriasis n rarely advanced rheumatoid arthritis but can occur independently. The hall mark feature of Rheumatoid arthritis is persisyent symmetric pokyarthritis(synovitis) that affcts d hands n feets. Although any joint lined by synovial membrane can b involved. The severity of RA fluctuate overtime , but chronic RA most commonly results in progressive development of various degrees of joint destruction,deformity and a significant decline in functional status of d patient. *Extra articular involvment of d organs such as skin,heart,lungs and eyes are also significant* The most important etiological factor is iron -deficiency. Other possible factors include Malnutrition , genetic predisposition or autoimmune process Plummer-Vinson Syndrome can b treated with iron supplementation. Since plummer-vinson syndrome is associated with increased risk of squamous cell carcinoma of pharynx n oesophagus ,d patient should b followed closely.

May be useful for General practitioners and Medical Students. Common Nail Findings associated with diseases. 1. BEAU'S Lines- These are transverse grooves or depressions parallel to the lunula. Caused by the conditions that cause the nail to grow slowly or even cease to grow for short intervals. The point of arrested growth is seen as a transverse groove. Often associated with - infections (Typhus, Acute Rheumatic Fever, AIDS) -Protein deficiency -Pellagra -Raynauds disease -Diabetes -Hypothyroidism -Hypocalcemia -Chronic Pancreatitis 2. MEES' Bands- White transverse line or band parallel to lunula resulting from poisoning or systemic illness.seen in -Chronic arsenic poisoning -Hodgkins disease -CHF -Leprosy 3. LINDSAY'S Nails- also called half & half nails. Proximal portion of Nail bed is whitish whereas distal part is red or pink. commonly associated with -Chronic Renal Failure -Azotemia 4. TERRY'S Nails - are white nail beds to within 1 to 2 mm of distal border of nail associated with -Hepatic Failure -Cirrhosis -Hypoalbuminemia -Chronic CHF -Hyoerthyroidism 5. SPLINTER HAEMORRHAGE. These are formed by extravasation of blood from longitudinal nail bed blood vessels to adjacent troughs. These are most often related to local, light trauma. Classically associated with -Subacute Bacterial Endocarditis. May be seen in -Leukemia -Vasculitis -Rheumatoid Arthritis -SLE 6. KOILONYCHIA - Spoon Nail is a dystrophic state in which the nail plate thins and a cup like depression. develops. Commonly associated with - Iron deficiency Anemia. 7. CLUBBING - Angle between the normal nail bed and finger is approx 160 degrees and nail bed is firm. This angle is referred to as LOVIBOND'S angle. When clubbing develops, this angle straightens out to be greater than 180 degrees & nail bed becomes spongy and has a bullous shape with exaggerated horizontal and longitudinal curvature. Most commonly associated with -Congenital Cyanotic Heart Disease -Cystic Fibrosis -Mesothelioma of Pleura -Pulmonary Neoplasms -Bronchogenic Carcinoma. 8. PITTING of Nails is seen in Psoriasis. SOURCE. TEXTBOOK OF PHYSICAL DIAGNOSIS. MARK. H. SWARTZ.

Friends today I am discussing about Nail Abnormalities. What are nail abnormalities? Healthy nails appear smooth and have consistent coloring. As you age, you may develop vertical ridges, or your nails may be a bit more brittle. This is harmless. Spots due to injury should grow out with the nail. Abnormalities — such as spots, discoloration, and nail separation — can result from injuries to the fingers and hands, viral warts (periungual warts), infections (onychomycosis), and some medications, such as those used for chemotherapy. Certain medical conditions can also change the appearance of your fingernails. However, these changes can be difficult to interpret. Your fingernails’ appearance alone isn’t enough to diagnose a specific illness. A doctor will use this information, along with your other symptoms and a physical exam, to make a diagnosis. Abnormalities of the fingernail Some changes in your nails are due to medical conditions that need attention. See your doctor if you have any of these symptoms: discoloration (dark streaks, white streaks, or changes in nail color) changes in nail shape (curling or clubbing) changes in nail thickness (thickening or thinning) nails that become brittle nails that are pitted bleeding around nails swelling or redness around nails pain around nails a nail separating from the skin These nail changes can be caused by a variety of different conditions, including ones we describe below. Beau’s lines Depressions that run across your fingernail are called Beau’s lines. These can be a sign of malnourishment. Other conditions that cause Beau’s lines are: diseases that cause a high fever such as measles, mumps, and scarlet fever peripheral vascular disease pneumonia uncontrolled diabetes zinc deficiency Clubbing Clubbing is when your nails thicken and curve around your fingertips, a process that generally takes years. This can be the result of low oxygen in the blood and is associated with: cardiovascular diseases inflammatory bowel disease liver diseases pulmonary diseases AIDS Koilonychia (spooning) Koilonychia is when your fingernails have raised ridges and scoop outward, like spoons. It’s also called “spooning.” Sometimes the nail is curved enough to hold a drop of liquid. Spooning can be a sign that you have: iron deficiency anemia heart disease hemochromatosis, a liver disorder that causes too much iron to be absorbed from food lupus erythematosus, an autoimmune disorder that causes inflammation hypothyroidism Raynaud’s disease, a condition that limits your blood circulation Leukonychia (white spots) Nonuniform white spots or lines on the nail are called leukonychia. They’re usually the result of a minor trauma and are harmless in healthy individuals. Sometimes leukonychia is associated with poor health or nutritional deficiencies. Factors can include infectious, metabolic, or systemic diseases as well as certain drugs. Mees’ lines Mees’ lines are transverse white lines. This can be a sign of arsenic poisoning. If you have this symptom, your doctor will take hair or tissue samples to check for arsenic in your body. Onycholysis When the nail plate separates from the nail bed, it causes a white discoloration. This is called onycholysis. This can be due to infection, trauma, or products used on the nails. Other causes for onycholysis include: psoriasis thyroid disease Pitting Pitting refers to small depressions, or little pits, in the nail. It’s common in people who have psoriasis, a skin condition that causes the skin to be dry, red, and irritated. Some systemic diseases can also cause pitting. Terry’s nails When the tip of each nail has a dark band, it’s called Terry’s nails. This is often due to aging, but it can also be caused by: congestive heart failure diabetes liver disease Yellow nail syndrome Yellow nail syndrome is when the nails get thicker and don’t grow as fast as normal. Sometimes the nail lacks a cuticle and may even pull away from the nail bed. This can be the result of: internal malignancies lymphedema, swelling of the hands pleural effusions, fluid buildup between the lungs and chest cavity respiratory illnesses such as chronic bronchitis or sinusitis rheumatoid arthritis These are just some of the signs of abnormal fingernails. Having any of these signs isn’t proof of any medical condition. You’ll need to visit your doctor to determine if your condition is serious. In many cases, proper care of your nails is enough to correct their appearance. How to care for your nails You can prevent many nail abnormalities by taking good care of your nails. Follow these general guidelines to keep your nails healthy: Tips Don’t bite or tear at your nails, or pull on hangnails. Always use nails clippers and trim them after you bathe, when nails are still soft. Keep your nails dry and clean. Using sharp manicure scissors, trim your nails straight across, rounding the tips gently. If you have a problem with brittle or weak nails, keep them short to avoid breakage. Use lotion on your nails and cuticles to keep the nail and nail beds moisturized. Homoeopathic medicines for nail abnormalities Medicines according to Cause1 Cause Medicines From a hurt Ledum pal. Prick with a needle under the nail Allium cepa, Bovista, Sulphur; Hard work Rhus tox, Sepia; Prick near the nail Iodum; Splinters Baryta carb., Hepar sulph., Iodum, Lachesis, Nitricum acidum, Petroleum, Silicea, Sulphur; Splits of the skin adhering to the nails Allium cepa, Natrum mur. TABLE 2 Medicines according to the Sensation Sensations Medicines Irritable feeling under finger nails, relieved by biting them Ammonium brom. Itching-about roof of Upas tiente Pains-Burning under Sarsarparilla Pains, gnawing, beneath finger nails Alumina; Sarsaparilla.; Sepia Pains, neuralgic, beneath finger nails Berberis vulgaris Pains, neuralgic Alumina; Allium cepa; Colchicum Pains, smarting at roots Sulphur Pains, splinter-like, beneath toe nails Fluoric acidum Pains, ulcerative, beneath toe nails Antimonium crudum; Graphites; Teucrium Medicines according to Location1 Fig. Medicines according to location pastedGraphic.png TABLE 3 Medicines according to Pathology Pathology Medicines Atrophy Silicea Blueness Digitalis; Oxalicum Acidum Deformed-brittle, thickened (onchogryposis) Alumina; Anatherium; Antimonium crudum; Arsenicum album; Causticum; Dioscorea; Fluoricum acidum; Graphites; Merc. Sol.; Natrum muriaticum; Sabadilla; Secal cor..; Senecio aureus; Sepia; Silicea; Thuja.; X-ray. Falling off Brassica napus; Butyric acid; Helleborus faetidus; Helleborus Hangnails Lycopodium; Natrum muriaticum; Sulphur; Upas tiente Hypertrophy (onychauxis) Graphites Inflammation of pulp (onychia) Arnica; Calendula; Fluoricum acidum.; Graphites; Phosphorus; Psorinum; Sarsaparilla; Silicea; Upas tiente Inflammation, under toe nails Sabadilla Ingrowing toe nails Causticum; Magnetis polus austral.; Nitricum acidum; Silicea; Staphysagria; Teucrium; Tetrodymite Softening Plumbum met; Thuja Spots, white on Alumina; Nitricum acidum Trophic changes Radium brom Ulceration Alumina; Garphites; Merc. Sol.; Phosphorus; Sanguinaria; Sarsaparilla; Silicea; Teucrium; Tetrodymite Yellow color Conium maculatum

50 year old female brought to hospital with complaints of altered sensorium for the past 1 day and loss of consciousness for past 6 hours She is a k/c/o Rheumatoid arthritis and on regular medication for the past 20years Previously patient was admitted in another private hospital with the above complaints and was found recurrent hypoglycemic and treated with IVF DNS , 5 percent Dextrose and 25 percent dextrose each one pint O/E Patient was unconscious. Not responding to painful stimuli Pr- 90 Bp-110/70 Spo2- 96 percent Temp- 98.4F Grbs - 222mg/dl Cvs - s1s2 + RS- BAE+ PA - soft CNS - Reflexes - normal Pupils - b/l 3mm ,reactive to light Patient also developed balckish discoloration over the dorsal aspect of both hands for the past 2 months . Her blood investigations showed she was anaemic . Dx Mx

A 28 yrs lady c/o - severe pain of ankle ,wrist , & small joint of fingers & toe since 1 months . Relief only occur after painkillers taken as soon as painkillers stop pain start. Pain start along with the lesion on hands. Kindly suggest dx & Rx.