Rheumatoid Vasculitis: Vanishing Menace or Target for New Treatments?

Abstract

Rheumatoid vasculitis is a rare but serious complication of rheumatoid arthritis. Herein we examine the pathophysiology, epidemiology, clinical diagnosis, and treatment of rheumatoid vasculitis. Seropositivity, specific HLA variations, and tobacco use are among the genetic and environmental predictors of rheumatoid vasculitis. Fortunately, recent reports have noted declines in the prevalence of rheumatoid vasculitis. Nevertheless, proper recognition of systemic manifestations may assist in pathologically confirming the diagnosis, determining the extent of disease, and guiding treatment. Contemporary treatment reports are discussed in the context of the ongoing debate regarding whether new agents may trigger, treat, or even prevent rheumatoid vasculitis. Evolving genetic, histopathologic, and immunologic studies partnered with ongoing clinical experience with biologics offer promise to inform future prevention and treatment of rheumatoid vasculitis.

Rheumatoid arthritis with ANCA associated vasculitis

“…4 The involvement of kidney is less common in rheumatic vasculitis. 5 ANCA associated vasculitis constitutes: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) or Wegener's granulomatosis and eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome, and occurs from the antineutrophil cytoplasmic antibody, directed towards myeloperoxidase (MPO) or proteinase 3 (PR3).6 Clinically, MPA mostly involves MPO-ANCA and GPA involves PR3-ANCA. 6 The disease effects organs such as kidney, stomach, intestine, and lungs, and include clinical features such as fever, anemia, malaise, weight loss, synovitis and rash.…”

Leprosy in a rheumatology setting: a challenging mimic to expose

“…Though RA can be complicated by peripheral neuropathy, and uncommonly, a claw hand seen as a manifestation of ulnar nerve affection, leprosy must be meticulously excluded in our setting. Rheumatoid vasculitis may involve virtually any organ of the body including the skin and nervous system [18]. …”

Vascular Involvement in Rheumatoid Arthritis

“…RV is characterized by inflammation of small-and medium-sized arteries and capillaries. The risk factors associated with RV are represented by RA with prolonged evolution (> 10 years), rheumatoid nodules, males, smoking, seropositivity of rheumatoid factor, HLA-DRB1*0401/*0401, *0401/*0404, and *0101/*0401, HLA-C3 [55,56].…”