Steroid therapy and vascular lesions in rheumatoid arthritis

Abstract

The clinical mangestations and pathol-Es describite le manifestationes clinic ogy of diffuse vascular lesions, occur-e le pathologia de diffuse lesiones vasring in three patients with rheumatoid cular, occurrente in tres patientes con arthritis, are described. The possible arthritis rheumatoide. Es discutite in significance of such lesions including detalio le signification possibile de tal their apparent relationship to cortico-lesiones, incluse lor apparente relation steroid therapy is discussed in detail. con therapia corticosteroide. HE OCCURRENCE of lesions of the small arteries and arterioles re-T sembling and sometimes indistinguishable from polyarteritis nodosa in patients with rheumatoid arthritis treated with adrenocortical steroids is being reported with increased frequency. In the past five years, 33 fatal cases (table 1) have shown at autopsy extensive arterial lesions which frequently were considered responsible for the fatal outcome. It is established that arteritis, sometimes of severe degree, occurs in association with rheumatoid arthritis in patients who have not received adrenocortical steroids. However, there appears to be an increase in the incidence of severe disseminated vascular lesions in this disease since the use of corticotropin and the corticosteroids in its treatment has become widespread. It is the purpose of this report to present three cases of malignant rheumatoid arthritis who received adrenocortical steroids and developed febrile polyneuropathy and gangrene of the extremities prior to death. In each of these cases extensive severe arteritis was found at autopsy. In addition, clinical observations of 14 patients with rheumatoid arthritis who developed peripheral neuropathy during or after administration of adrenocortical steroids are discussed. The literature concerning vascular lesions in rheumatoid arthritis is reviewed giving special attention to their relationships to adrenal corticosteroid and corticotropic hormone therapy. CASE HISTORIES AND SUMMARIES Three Cases with Autopsy FindingsDuring the period 1955-1957 manifestations of diffuse arteritis, proved at autopsy, were observed in three patients with progressive deforming rheiimatoid arthritis receiving adrenocortical. hormone therapy. These three pa-

Rheumatoid arthritis: A review of the cutaneous manifestations

“…141 Steroid therapy was also implicated at one time. 169,170 Bywaters, however, doubted this theory and explained that therapy with steroids is self-selective and used in the seriously ill, who are more prone to vascular damage. 143 Wilkinson and Torrance 142 and Vollertsen et al 129 agreed and stated that corticosteroids, if anything, may solely trigger the occult tendency for RV in certain patients.…”

Recovery from Rheumatoid Cerebral Vasculitis by Low-Dose Methotrexate.

“…Moreover, the published observations of cases of rheumatoid cerebral vasculitis, in whomRAhad been treated with steroids, revealed a poor prognosis (2)(3)(4)(5)(6)(7)(8)(9). Steroid therapy over a long period of time might have affected cerebral vasculitis in the present case.…”

“…MRIscan qualitatively disclosed the injured area. Other causes of cerebral vasuclitis has been suggested to be related to steroid therapy (3,5).…”

“…These manifestations result from various causes associated with the diversity of the disease process of RA (1). Cursory review of the literature revealed very rare cases of cerebral vasculitis in RA, usually with a fatal outcome (2)(3)(4)(5)(6)(7)(8)(9). Here, we describe a patient with RAwho developed cerebral infarction due to vasculitis of vertebrobasilar arteries, and showed striking clinical and angiographic recovery by low-dose methotrexate (MTX)therapy.…”

Drug-Induced Diseases

“…Neuropathy is not a rare drug complication (154); it is a well-recognized effect of isoniazid and has also been reported after steroid therapy (81). Demyelination of the spinal cord by tri-o-cresyl phosphate has been shown in the rat to arise from a neurotoxic metabolite (SO, 61).…”