Page 323 - The Vasculitides, Volume 1: General Considerations and Systemic Vasculitis

In: The Vasculitides, Volume 1 ISBN: 978-1-63463-110-5
Editors: David S. Younger © 2015 Nova Science Publishers, Inc.

Chapter 16

Rheumatoid Arthritis Vasculitis

Elana J. Bernstein, M.D., M.Sc. and Robert F. Spiera, M.D.?

Scleroderma, Vasculitis & Myositis Center, Department of Medicine, Division of
Rheumatology, The Hospital for Special Surgery, New York, NY, US

Abstract

Rheumatoid arthritis is a systemic autoimmune disease characterized by
inflammatory synovitis. Rheumatoid vasculitis is suggested by the presence fever, weight
loss, digital infarcts, deep cutaneous ulcers, mononeuritis multiplex, peripheral gangrene,
and other extra-articular complications. It is confirmed by the presence of necrotizing
arteritis in a biopsy of involved skin, nerve and muscle tissue. Accurately recognized and
properly treated with immunosuppressant and biological therapies, rheumatoid vasculitis
has an overall favorable prognosis. Thus, it is important to consider the diagnosis in all
those so suspected. This chapter considers the epidemiology, clinical and laboratory
manifestations, histopathology, and management of rheumatoid vasculitis.

Introduction

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by
inflammatory synovitis. An estimated 1,293,000 adults ? 18 years of age in the United States
have RA representing about 0.6% of the adult population. Rheumatoid arthritis vasculitis or
rheumatoid vasculitis (RV) is suggested by the presence fever, weight loss, digital infarcts,
deep cutaneous ulcers; mononeuritis multiplex (MNM), peripheral gangrene, and other extra-
articular complications extra-articular (ExRA) complications, including necrotizing vasculitis,
the initial histopathologic manifestations of which are generally found in a biopsy of skin,
nerve and muscle tissue in the majority of affected patients. While not strikingly different

? Correspondence: Robert F. Spiera M.D., Professor of Clinical Medicine, Director, Scleroderma, Vasculitis &
Myositis Center, Department of Medicine/Division of Rheumatology, The Hospital for Special Surgery, 535
East 70th Street, New York NY 10021. Email: [email protected],

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