Rheumatoid arthritis with systemic necrotizing arteritis

An autopsy case of rheumatoid arthritis with active polyarthritis, systemic necrotizing arteritis, pleuritis, pericarditis, rheumatoid nodules in a few organs and a healing gastric ulcer was reported. Histologically, systemic necrotizing arteritis was characterized by vascular changes of the following three types: Granulomatous arteritis with a characteristic arrangement of mesenchymal cells forming a palisade around coagulation necrosis of media and some of them formed a rheumatoid nodule-like lesion in the wall (RA type); Fibrinoid arteritis very similar to the Kussmaul-Maier type periarteritis nodosa (PN type); and chronic arteritis with endarterial proliferation (Ep type). Although it is hard to distinguish arteritis of PN type from the Kussmaul-Maier type periarteritis nodosa, arteritis of RA type with rheumatoid nodule-like lesion in the wall may be interpreted as an extremely developed form of vasculitis in rheumatoid arthritis.