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Vasculitis associated with rheumatoid arthritis: a case-control study.

Ashima Makol1, Cynthia S Crowson, David A Wetter

  • 1Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. makol.ashima@mayo.edu.

Rheumatology (Oxford, England)
|January 21, 2014
PubMed
Summary

Rheumatoid vasculitis (RV) is a severe rheumatoid arthritis complication. Smoking, vascular disease, and severe RA increase RV risk, while HCQ and aspirin may reduce it.

Keywords:
biologicsrheumatoid arthritisrheumatoid vasculitissystemic vasculitis

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Area of Science:

  • Rheumatology
  • Immunology
  • Clinical Medicine

Background:

  • Rheumatoid vasculitis (RV) is a serious, though infrequent, complication of rheumatoid arthritis (RA).
  • Understanding the clinical correlates and predictors of RV is crucial for early diagnosis and management.
  • Previous studies have been limited in scope and sample size.

Purpose of the Study:

  • To determine the clinical features and identify predictors of rheumatoid vasculitis (RV) in a large cohort of RA patients.
  • To compare RV cases with RA patients without vasculitis to identify risk factors.

Main Methods:

  • Retrospective cohort study of 86 RV cases and 172 controls (RA without vasculitis) from a tertiary referral center (2000-2010).
  • Comparison of demographic, clinical, and treatment data to identify risk factors for RV.
  • Statistical analysis, including odds ratios (OR) adjusted for age and disease duration.

Main Results:

  • RV commonly presented as cutaneous vasculitis or vasculitic neuropathy, with a median age of 63 years and 10.8 years of RA duration.
  • Current smoking at RA diagnosis (OR 1.98), peripheral/cerebrovascular disease (OR 3.98-6.48), severe RA (OR 2.02), and biologic use (OR 2.80) were associated with increased RV risk.
  • Hydroxychloroquine (HCQ) (OR 0.54) and low-dose aspirin (OR 0.42) use were associated with decreased RV risk.

Conclusions:

  • Rheumatoid vasculitis (RV) remains a significant and serious complication of rheumatoid arthritis (RA), associated with substantial mortality.
  • Identifying patients at high risk for RV is essential for proactive management and potentially altering disease course.
  • Further research into the protective mechanisms of HCQ and aspirin in RV is warranted.