[Rheumatoid polyarthritis and extensive necrotizing vasculitis. Apropos of 2 cases]

The author reports two cases of severe rheumatoid arthritis (RA) where the manifestations of necrosis vasculitis consisted of extensive and bullous gangrene of the lower limbs. In one case, the laboratory picture was that of major complement consumption (CH50 unmeasureable, marked fall in various compounds including C3 and C4) with very high levels of circulating immune complexes. An attempt at treatment by plasmapheresis, immunodepressants and corticosteroids led to moderate stabilisation of the vasculitis (regression of purpura) but remained incapable of resolving the local problem of gangrene. The severity of the lesion led to amputation of both legs. In the other case, there as a fall in CH50 with the presence of circulating immune complexes. Similar treatment led to stabilization of the lesions but final amputation could not be avoided to deal with the residue. Interruption of treatment was followed by an inflammatory exacerbation which was satisfactorily dealt with by further sessions of plasmapheresis. The authors discuss the value of such immunodepressant therapy in severe RA in the light of these cases.