Rheumatoid vasculitis
Overview
Vasculitis is a condition in which blood vessels become inflamed. When blood vessels become inflamed, they may become weakened, become thickened and increase in size, or become narrowed, sometimes to the point of stopping blood flow. The blood vessels most often involved are arteries which bring blood to the skin, nerves and internal organs. Small veins can also be involved. If inflammation is severe, tissues that are nourished by the blood vessel can be damaged when blood flow decreases. Because large blood vessels nourish larger quantities of tissue, the larger the involved vessel, the more likely serious tissue damage may occur. For this reason, the size of the blood vessel involved influences the amount of damage from rheumatoid vasculitis.
Symptoms
Blood vessel inflammation Red spots on skin Inflammation of white part of eyes Pericarditis Abnormal heart rate
Causes
An abnormally active immune system (the body’s defense system) appears to be the cause of the blood vessel inflammation. Indirect evidence linking the immune system to vasculitis includes high levels of rheumatoid factor, the presence of other proteins in the blood called immune complexes, and lower levels of proteins in the blood called complement which are used up when inflammation occurs. Direct evidence comes from looking at the inflamed blood vessels under the microscope using special chemicals which show these proteins in the wall of the vessel.
Diagnosis
Your doctor will suspect the diagnosis based on symptoms of rash, numbness or tingling of the hands or feet, skin ulcers, cough and shortness of breath, chest pain, abdominal pain or stroke symptoms. An electrical test of nerve function (EMG) is sometimes done to study the numbness and tingling sensations in the arms and legs. Biopsy of the skin or other symptomatic organs is sometimes necessary.
Treatment
Treatment depends upon the size of the vessel and the organs affected. Vasculitis involving the finger tips and skin around the fingernails, or that only causes a rash, is treated with pain control, antibiotic cream and local protection. Many rheumatoid arthritis patients who experience this kind of vasculitis are not being effectively treated for their joint disease. Drugs which treat joint disease such as methotrexate (MTX) or sulfasalazine (SSZ) can be started and often improve both the joint symptoms and the vasculitis. Because more serious rheumatoid vasculitis is rare, studies comparing an active drug to an inactive material (placebo) have not been published. Treatment recommendations for vasculitis that causes nerve damage, skin ulcers, and damage to internal organs rely on descriptions of series of patients with vasculitis, and your doctor’s previous experience. When this kind of vasculitis occurs, despite adequate treatment of joint disease, stronger treatments to control the immune system are used. These may include higher doses of cortisone drugs like prednisone given by mouth or directly into the vein. Other medicines which can be used include azathioprine (AZA), cyclophosphamide and gamma globulin given directly into the vein. Newer medicines known as biologic agents such as infliximab, etanercept, or adalimumab might also be chosen. When any of these treatments are used, very careful monitoring is necessary.