Rheumatoid arthritis-associated aortitis: a case report and literature review

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disorder that primarily affects the synovial joints. Rheumatoid vasculitis (RV) is an extra-articular manifestation of RA, and its association with aortitis is rare and not widely recognised. Here, we report the case of a 69-year-old woman with RA-associated aortitis and review the literature on rheumatoid aortitis. The mean oral steroid dose administered to RA-associated aortitis patients was 46.3 mg/day prednisolone (PSL). In our patient, the aortitis was also thought to be due to RV because she had findings of RV, such as cutaneous ulceration and a high rheumatoid factor titre, and because a moderate PSL dose dramatically improved the clinical findings. RA-associated aortitis, if left untreated, can be fatal; therefore, early detection and treatment initiation is very important.

Case Report: Aortitis associated with rheumatoid arthritis: A challenging rheumatoid vasculitis presentation

“…Our patient was 54 years old. The mean age of patients at diagnosis of aortitis in a literature review was 56±15.2 years old 6 . RV commonly affects small and medium sized vessels.…”

“…The association of aortitis with RV is not widely recognized. However, many authors reported an association of RA with aortitis 6 . Our patient had a lesion typical of vasculitis of the aorta on his chest CT scan.…”

Vasculitic neuropathy associated with Rheumatoid Arthritis, a case report

“…Less common manifestations are scleritis (0.3-6.3% incidence), pericarditis (<10% incidence), aortitis, pulmonary vasculitis and necrotizing glomerulonephritis (8%). A case report and literature review by Kanoko S et al reviewed 45 cases of active noninfectious aortitis seen among 513 consecutive ascending aortic resections, of which approximately 4% were RA patients [5][6][7][8]. Although common extra-articular manifestations are skin lesions, a clinician should also look for cardiac and pulmonary manifestation expecially if there is presence of concerning symptoms which are not otherwise explained.…”

New insight into the rheumatoid vasculitis

“…Rheumatoid vasculitis may suspect on symptoms of rash, skin ulcers, numbness or tingling of the hands or feet, weakness in a hand or foot, cough and shortness of breath, chest pain, abdominal pain, or stroke symptoms [12].…”

“…A blood test for specific antibodies that are directed against the inner layer of blood vessels (endothelial cells) are present in approximately 75% of patients with RV compared to only 15 to 20% of those with RA alone. Therefore, this blood test may be checked regularly in patients with any of these new or worsened symptoms [12].…”