Rheumatoid arthritis associated vasculitis: a rare entity; case and review.

Area of Science:

• Rheumatology
• Gastroenterology
• Vascular Surgery

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints but can manifest systemically.
• Systemic RA can lead to vasculitis, inflammation of blood vessels, which can affect various organs, including the gastrointestinal tract.
• Cerebral vasculitis is a known complication of RA, but mesenteric vasculitis is less common and often underdiagnosed.

Observation:

• A 60-year-old male with known rheumatoid arthritis and cerebral vasculitis presented with acute abdominal and back pain.
• The patient developed peritonitis, necessitating an exploratory laparotomy.
• Surgical findings included jejunal ischemia, necrosis, and perforation, requiring extensive bowel resection.

Findings:

• Pathology confirmed intramural inflammation of mesenteric vessels, consistent with vasculitis.
• The patient experienced an anastomotic leak postoperatively, leading to hospice care.
• This case highlights the gastrointestinal manifestations of RA-associated vasculitis.

Implications:

• A high index of suspicion for mesenteric vasculitis is warranted in RA patients with unexplained abdominal pain.
• Gastrointestinal involvement in RA-associated vasculitis carries a high mortality rate.
• Prompt diagnosis and management, potentially including corticosteroids, immunosuppressants, or surgery, are critical for improving outcomes.