Acute abdomen in rheumatoid arthritis due to necrotizing arteritis.

Lindsay, Michael; Tavadia, H B; Whyte, A S; Lee, P; Webb, John

doi:10.1136/bmj.2.5866.592

Cited by 24 publications

(6 citation statements)

References 8 publications

(7 reference statements)

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“…Cutaneous vasculitis in RA may coexist with 1,35 or be subsequently followed by an acute abdomen due to arteritis 10 . This was found in two of our patients, in whom acute abdominal pain developed within 2 weeks after onset of the vasculitic skin lesions; one of these died of multiple intestinal tract bleeding.…”

Section: Discussionmentioning

confidence: 51%

“…Cutaneous manifestations are the most frequent extra‐articular features 1,3 , 5–9 and were reported among 80–89% of patients with RV in a large series 1,5–8 . They often present as the initial manifestation, 3,8 , 9 and may be followed by a fatal acute abdomen due to necrotizing arteritis 10 . The clinical and pathological features in rheumatoid patients with cutaneous vasculitis tend to be associated with the involved vessels, which range from subcutaneous muscular medium‐size arteries to dermal postcapillary venules 11–13 .…”

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confidence: 99%

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Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis

Kr¹,

A²,

Suzuki

et al. 2002

Br J Dermatol

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Features of cutaneous rheumatoid vasculitis overlapping both the characteristics of cutaneous necrotizing venulitis and cutaneous polyarteritis nodosa together with coexistence of these different type of vasculitis in the same or different lesional skin account for the associated diverse cutaneous vasculitic manifestations. Although dermal venulitis (leucocytoclastic vasculitis) was the most common presentation, the presence of leucocytoclastic vasculitis in rheumatoid patients did not necessarily indicate a favourable prognosis. Associations with mononeuritis multiplex and bowel involvement had a fatal prognosis, while patients with superficial dermal venulitis without other extra-articular involvement may follow a favourable prognosis.

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Section: Discussionmentioning

confidence: 51%

mentioning

confidence: 99%

Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis

Kr¹,

A²,

Suzuki

et al. 2002

Br J Dermatol

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“…Necrotizing arteritis may occur in the setting of severe rheumatoid arthritis. Such arteritis is indistinguishable histologically from polyarteritis nodosa and may similarly cause a wide variety of clinical manifestations having a grave prognosis (9).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: A possible manifestation of methotrexate hypersensitivity

et al. 1997

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Large haemorrhagic and necrotic cutaneous lesions developed after two low dose (5 mg) methotrexate injections in a patient suffering from long standing rheumatoid arthritis. Differential clinical diagnosis included factitia dermatitis, infectious processes, pyoderma gangrenosum, rheumatoid neutrophilic dermatitis, necrotizing arteritis and vasculitis. Histological and direct immunofluorescent examinations of skin biopsies supported the diagnosis of leucocytoclastic vasculitis. We discuss the respective roles of methotrexate and rheumatoid arthritis in the outbreak of leucocytoclastic vasculitis. Hypersensitivity is strongly suspected.

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“…Rheumatoid arteriolitis in the gut may cause multiple ischemic ulcers and perforation, while vasculitis of larger vessels results in segmental or extensive bowel infarction sometimes complicated by intraperitoneal hemorrhage [11][12][13]. The bleeding from a ruptured aneurysm may cause abdominal pain and syncope [14].…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal and Hepatic Manifestations of Rheumatoid Arthritis

Ebert

Hagspiel

2011

Dig Dis Sci

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Rheumatoid arthritis (RA), characterized by inflammation of the synovium and surrounding structures, has a prevalence of 0.5-1%. Rheumatoid vasculitis (RV) is an inflammatory condition of the small- and medium-sized vessels that affects up to 5% of patients with RA with intestinal involvement in 10-38% of these cases. Clinically apparent RV of the gastrointestinal (GI) tract, while rare, is often catastrophic, resulting in ischemic ulcers and bowel infarction. Vasculitis of the colon may present as pancolitis clinically similar to ulcerative colitis. Rectal biopsies that include submucosal vessels are positive for vasculitis in up to 40% of cases. Abnormal esophageal motility in RA may result in heartburn and dysphagia. Chronic atrophic gastritis may be associated with hypergastrinemia and hypo- or achlorhydria, promoting small bowel bacterial overgrowth. RA is the most common cause of secondary amyloidosis with GI symptoms in 22% of affected patients. Although amyloid is usually found in the liver, it is rarely evident clinically. Felty's syndrome occurs in less than 1% of patients with RA and is characterized by neutropenia and splenomegaly. The liver may be involved with portal fibrosis or nodular regenerative hyperplasia. Liver histology is abnormal in 92% of RA patients at autopsy, although the changes are usually mild without associated hepatomegaly. Drug-induced liver disease may occur with aspirin, sulfasalazine, and methotrexate. Significant liver damage is rare if the drug is discontinued or the patient is properly monitored. RA can affect both the GI tract and the liver; changes are usually mild except with RV.

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Acute abdomen in rheumatoid arthritis due to necrotizing arteritis.

Cited by 24 publications

References 8 publications

Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis

Clinical and histopathological spectrum of cutaneous vasculitis in rheumatoid arthritis

Cutaneous necrotizing vasculitis after low dose methotrexate therapy for rheumatoid arthritis: A possible manifestation of methotrexate hypersensitivity

Gastrointestinal and Hepatic Manifestations of Rheumatoid Arthritis

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