What is rheumatoid vasculitis?
Vasculitis is a serious complication of rheumatoid arthritis. While
rheumatoid arthritis affects the body's joints, 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 that bring blood to the skin, nerves, and internal organs.
Veins can also be involved. The size of the blood vessel involved
influences the amount of damage from rheumatoid vasculitis.
For example, because large blood vessels nourish larger
quantities of tissue, the larger the involved vessel, the more
likely serious tissue damage may occur. Involvement of larger
arteries can cause nerve damage resulting in numbness, and
sometimes loss of function of arms or legs. Inflammation of these
larger arteries can also damage fingers and toes and harm internal
organs such as the bowel, kidneys, heart, lungs, and brain.
Similarly, if inflammation to small and medium sized arteries is
severe, tissues that are nourished by these blood vessels can be
damaged when blood flow decreases.
What are the symptoms of rheumatoid vasculitis?
When vasculitis involves the small arteries and veins that nourish
the skin of the fingertips and skin around the nails, small pits in
the fingertips or small sores causing pain and redness around the
nails can occur. This condition is rarely serious. Involvement of
somewhat larger arteries and veins of the skin can cause a painful
red rash that often involves the legs. If the skin is very
inflamed, ulcers can occur and infection becomes a complicating
risk.
Vasculitis that injures the nerves can cause loss of sensation,
numbness and tingling, possibly followed by weakness or loss of
function of the hands and/or feet. The rare vasculitis of larger
arteries can cause complete absence of blood flow to tissue sites
supplied by the affected vessel (termed occlusion, resulting in
infarction), which can cause gangrene of fingers or toes, stomach
pain, cough, chest pain, heart attack, and/or a stroke if the brain
is involved. This form of systemic vasculitis can also cause
general symptoms such as fever, loss of appetite, weight loss, and
loss of energy.
Which patients with rheumatoid arthritis get vasculitis?
Rheumatoid vasculitis most often occurs in people with at least 10
years of severe disease. In general, people who get vasculitis have
many joints with pain and swelling, rheumatoid nodules, high
concentrations of rheumatoid factor in their blood, and sometimes
smoke cigarettes. They may also have an enlarged spleen and chronic
low white cell count, a condition known as Felty's Syndrome.