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Rheumatoid variable vessel vasculitis concurrently affecting small, medium and large vessels
Andrew Bernard Xu1, Ian Liang1,2, Matthew Parker3,2,4
1Rheumatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
BMJ Case Reports
|July 4, 2025
Summary
Rheumatoid vasculitis (RV) can manifest before rheumatoid arthritis (RA) diagnosis. This case shows RV affecting multiple vessel sizes preceding RA, challenging early diagnosis.
Area of Science:
- Rheumatology
- Immunology
- Vascular Medicine
Background:
- Rheumatoid vasculitis (RV) is a severe complication of rheumatoid arthritis (RA).
- RV typically affects patients with established, erosive RA and involves small to medium-sized vessels.
- Large vessel involvement in RV is less common but possible.
Purpose of the Study:
- To report a case of de novo rheumatoid vasculitis (RV).
- To highlight the diagnostic challenges of RV presenting before rheumatoid arthritis (RA) diagnosis.
- To illustrate RV affecting small, medium, and large vessels in this unique presentation.
Main Methods:
- Case report.
- Clinical presentation and diagnostic workup of a patient with multisystem vasculitis.
- Serological testing for rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies.
Main Results:
- The patient presented with multisystem vasculitis affecting small, medium, and large vessels.
- Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies were markedly elevated.
- The diagnosis of rheumatoid vasculitis (RV) was confirmed prior to the diagnosis of rheumatoid arthritis (RA).
Conclusions:
- Rheumatoid vasculitis (RV) can present as de novo multisystem vasculitis.
- RV may precede the clinical diagnosis of rheumatoid arthritis (RA).
- Elevated RF and anti-CCP antibodies are crucial for diagnosing RV, even before RA is established.
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