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[Malignant rheumatoid arthritis]
1Department of Clinical Immunology, Kyushu University.
Abstract:
Malignant rheumatoid arthritis (MRA) is a name for rheumatoid arthritis (RA) complicated with systemic vasculitis or other severe extra-articular manifestations, which can cause a fatal outcome. MRA is found in 4-5% of inpatients with RA. The male to female ratio is 1:1.45. Histologically, 3 main types are recognised in rheumatoid vasculitis; RA type (vasculitis with rheumatoid nodule-like appearance), PN type (fibrinoid vasculitis similar to PN), and EA type (endoarteritis obliterans). High titers of rheumatoid factor, immune complexes, hypocomplementemia, hypoproteinemia, decreased choline esterase activity, elevated alkaline phosphatase activity and leukocytosis are characteristic laboratory features of MRA. Recently, it appears that MRA is becoming less and the prognosis is getting better, perhaps due to the advancement in treatment.
Insights
Malignant rheumatoid arthritis (MRA), a severe form of rheumatoid arthritis (RA) with systemic vasculitis, affects 4-5% of RA patients. Advancements in treatment are improving prognosis for this condition.
Area of Science:
- Rheumatology
- Immunology
- Pathology
Context:
- Malignant rheumatoid arthritis (MRA) is a severe complication of rheumatoid arthritis (RA).
- It involves systemic vasculitis or severe extra-articular manifestations, potentially leading to fatal outcomes.
- MRA affects 4-5% of hospitalized RA patients, with a male to female ratio of 1:1.45.
Purpose:
- To define and describe the characteristics of Malignant Rheumatoid Arthritis (MRA).
- To outline the histological types, laboratory features, and epidemiological data of MRA.
- To discuss the recent trends and prognosis of MRA.
Summary:
- Histologically, rheumatoid vasculitis in MRA presents in three main types: RA type, PN type, and EA type.
- Characteristic laboratory findings include high rheumatoid factor titers, immune complexes, hypocomplementemia, hypoproteinemia, decreased choline esterase, elevated alkaline phosphatase, and leukocytosis.
- Recent observations suggest a decline in MRA incidence and improved prognosis, likely due to therapeutic advancements.
Impact:
- Understanding MRA's distinct features aids in early diagnosis and management.
- Improved prognosis highlights the effectiveness of contemporary RA treatments.
- Further research into MRA pathogenesis can lead to targeted therapies.