Rheumatoid vasculitis explained

Rheumatoid vasculitis is a skin condition that is a typical feature of rheumatoid arthritis, presenting as peripheral vascular lesions that are localized purpura, cutaneous ulceration, and gangrene of the distal parts of the extremities.^{[1] [2]}

Signs and symptoms

Rheumatoid vasculitis may affect almost any organ in the body. The skin and peripheral nerves are the most frequently affected areas. Although major organ system involvement of the kidney, bowel, or heart is much less common, it can result in serious morbidity and mortality, such as renal failure, bowel ischemia, and myocardial infarction.^[3] While the involvement of the central nervous system is uncommon, numerous case reports document its occurrence.^{[4] [5]}

Rheumatoid vasculitis can cause palpable purpura, ulcers, nodules, and digital necrosis on the skin.^[6] Even though it is nonspecific and present in many different disorders, livedo reticularis is frequently observed.^[3]

Peripheral nervous system involvement is the second most common organ involved. Peripheral nervous system manifestations include distal symmetric sensory polyneuropathy, distal motor or combined neuropathy, and mononeuritis multiplex.^[3]

Causes

Patients who have nodular rheumatoid arthritis that is seropositive are nearly exclusively affected by rheumatoid vasculitis.^[7]

Diagnosis

The patient's medical history and symptoms, physical examination, relevant laboratory tests, specialized testing (such nerve conduction studies), and tissue biopsy of the affected skin, muscle, nerves, or other organ are typically used to make the diagnosis.^[8]

Treatment

Treatment options for mild cases of rheumatoid vasculitis affecting the skin or peripheral nerves include methotrexate or azathioprine combined with prednisone. More severe organ system involvement might need to be treated with biologic agents, cyclophosphamide, and higher doses of steroids.^[3]

See also

• Rheumatoid nodulosis
• List of cutaneous conditions

Further reading

• Genta . Marcia S. . Genta . Robert M. . Gabay . Cem . Systemic Rheumatoid Vasculitis: A Review . Seminars in Arthritis and Rheumatism . Elsevier BV . 36 . 2 . 2006 . 0049-0172 . 10.1016/j.semarthrit.2006.04.006 . 88–98 . 17023257 . none.
• Gorman . Jennifer D. . David-Vaudey . Eve . Pai . Madhukar . Lum . Raymond F. . Criswell . Lindsey A. . Particular HLA–DRB1 shared epitope genotypes are strongly associated with rheumatoid vasculitis . Arthritis & Rheumatism . Wiley . 50 . 11 . 2004 . 0004-3591 . 10.1002/art.20588 . 3476–3484 . 15529352 . none.

External links

• Cedars-Sinai
• Cleveland Clinic

Notes and References

1. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 180. .
2. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
3. Bartels . Christie M. . Bridges . Alan J. . Rheumatoid Vasculitis: Vanishing Menace or Target for New Treatments? . Current Rheumatology Reports . Springer Science and Business Media LLC . 12 . 6 . September 15, 2010 . 1523-3774 . 10.1007/s11926-010-0130-1 . 414–419. 20842467 . 2950222 .
4. Caballol Pons . Núria . Montalà . Núria . Valverde . José . Brell . Marta . Ferrer . Isidre . Martínez-Yélamos . Sergio . Isolated cerebral vasculitis associated with rheumatoid arthritis . Joint Bone Spine . Elsevier BV . 77 . 4 . 2010 . 1297-319X . 10.1016/j.jbspin.2010.02.030 . 361–363. 20471884 .
5. Zolcinski . M. . Bazan-Socha . S. . Zwolinska . G. . Musial . J. . Central nervous system involvement as a major manifestation of rheumatoid arthritis . Rheumatology International . Springer Science and Business Media LLC . 28 . 3 . August 10, 2007 . 0172-8172 . 10.1007/s00296-007-0428-0 . 281–283. 17690887 . 32816100 .
6. Chen . K-R. . Toyohara . A. . Suzuki . A. . Miyakawa . S. . Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis . British Journal of Dermatology . Oxford University Press (OUP) . 147 . 5 . 2002 . 0007-0963 . 10.1046/j.1365-2133.2002.04933.x . 905–913. 12410699 .
7. Voskuyl . A E . Zwinderman . A H . Westedt . M L . Vandenbroucke . J P . Breedveld . F C . Hazes . J M . Factors associated with the development of vasculitis in rheumatoid arthritis: results of a case-control study. . Annals of the Rheumatic Diseases . BMJ . 55 . 3 . March 1, 1996 . 0003-4967 . 10.1136/ard.55.3.190 . 190–192. 8712883 . 1010127 .
8. Cojocaru . M. . Cojocaru . Inimioara Mihaela . Chicoş . B. . New insight into the rheumatoid vasculitis . Romanian Journal of Internal Medicine . Walter de Gruyter GmbH . 53 . 2 . June 1, 2015 . 1220-4749 . 10.1515/rjim-2015-0017 . 128–132. 26402981 . free .