Rheumatoid vasculitis

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.