Rheumatoid vasculitis
Vasculitis complication of rheumatoid arthritis affecting skin and nerves.
Rheumatoid vasculitis is a skin condition commonly linked to rheumatoid arthritis. It shows up as peripheral vascular issues, such as localized purpura, skin ulcers, and gangrene in the fingers or toes. While it can affect nearly any organ, the skin and peripheral nerves are hit most often. Less common but more serious involvement of the kidneys, bowel, or heart can lead to severe outcomes like kidney failure, bowel ischemia, or heart attacks. Central nervous system involvement is rare but has been reported.
On the skin, it may cause palpable purpura, ulcers, nodules, and digital necrosis. Livedo reticularis is also frequently seen, though it’s not specific to this condition. Peripheral nerve problems are the second most common symptom, including distal symmetric sensory polyneuropathy, distal motor or combined neuropathy, and mononeuritis multiplex.
This condition almost exclusively affects patients with seropositive nodular rheumatoid arthritis.
Diagnosis relies on the patient’s medical history, symptoms, physical exam, lab tests, specialized tests like nerve conduction studies, and tissue biopsy of the affected skin, muscle, nerves, or other organs.
For mild cases affecting the skin or peripheral nerves, treatment options include methotrexate or azathioprine combined with prednisone. More severe organ involvement may require biologic agents, cyclophosphamide, and higher steroid doses.
- Field
- Rheumatology, Dermatology
- Known for
- Vasculitis complication of rheumatoid arthritis
- Typical feature
- Peripheral vascular lesions including purpura, ulceration, and gangrene
- Most affected areas
- Skin and peripheral nerves
- Serious complications
- Renal failure, bowel ischemia, myocardial infarction
Lore & Background
Rheumatoid vasculitis is a condition that occurs nearly exclusively in patients who have nodular rheumatoid arthritis that is seropositive. The skin and peripheral nerves are the most frequently affected areas, though major organ system involvement of the kidney, bowel, or heart can result in serious morbidity and mortality such as renal failure, bowel ischemia, and myocardial infarction. While involvement of the central nervous system is uncommon, numerous case reports document its occurrence.
Reader's Guide
Rheumatoid vasculitis is significant as a serious extra-articular manifestation of rheumatoid arthritis, capable of causing substantial morbidity and mortality. Its diagnosis relies on patient history, physical examination, laboratory tests, specialized testing such as nerve conduction studies, and tissue biopsy of affected skin, muscle, nerves, or other organs. Treatment varies by severity: mild cases affecting skin or peripheral nerves may be managed with methotrexate or azathioprine combined with prednisone, while more severe organ system involvement might require biologic agents, cyclophosphamide, and higher doses of steroids. The condition underscores the systemic nature of rheumatoid arthritis and the need for vigilant monitoring for vascular complications.
Did You Know?
- Rheumatoid vasculitis may affect almost any organ in the body.
- Peripheral nervous system involvement is the second most common organ affected.
- Treatment for severe organ involvement may include biologic agents, cyclophosphamide, and higher doses of steroids.
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