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Systemic rheumatoid vasculitis: a review.

Marcia S Genta1, Robert M Genta, Cem Gabay

  • 1Division of Rheumatology, Geneva University Hospitals, Geneva, Switzerland. marcia.genta@hotmail.com

Seminars in Arthritis and Rheumatism
|October 7, 2006
PubMed
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Rheumatoid vasculitis (RV), a rare complication of rheumatoid arthritis (RA), affects 1-5% of patients. Prompt recognition and treatment are crucial, though management remains empirical.

Area of Science:

  • Rheumatology
  • Immunology
  • Vascular Medicine

Background:

  • Rheumatoid vasculitis (RV) is a serious extra-articular manifestation of rheumatoid arthritis (RA).
  • It affects approximately 1-5% of patients with established RA, involving small- and medium-sized vessels.
  • Clinical presentations vary, commonly including skin lesions (gangrene, ulcers) and peripheral neuropathy (mononeuritis multiplex).

Purpose of the Study:

  • To review current information on rheumatoid vasculitis (RV).
  • To cover incidence, clinical course, pathology, pathogenesis, diagnosis, and treatment.
  • To include emerging data on biologic therapies for RV.

Main Methods:

  • Literature search of PubMed and MEDLINE databases (1950-2006).
  • Keywords: "vasculitis," "rheumatoid arthritis," "extra-articular manifestations."

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  • Follow-up searches included "anti-TNF," "rituximab," "IL-1 receptor antagonists," and "CTLA-4 Ig" in conjunction with "vasculitis."

    • Main Results:

    • RV diagnosis requires excluding other causes and ideally histopathological confirmation of necrotizing vasculitis.
    • Despite advances in RA treatment, no clinical trials specifically assess RV therapies.
    • Management of RV remains largely empirical.

    Conclusions:

    • Rheumatoid vasculitis (RV) incidence may be decreasing due to improved rheumatoid arthritis (RA) management.
    • RV remains a significant RA complication requiring prompt recognition.
    • Effective and evidence-based treatment strategies for RV are still needed.