- High levels of rheumatoid factor
- The presence of other proteins in the blood (called immune complexes)
- Lower levels of proteins in the blood (called complement), which are used up when inflammation occurs.
- The appearance of inflamed blood vessels under the microscope, which shows immune cells within the wall of the vessel.
How is a diagnosis of rheumatoid vasculitis made?
The 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.
How is rheumatoid vasculitis treated?
Treatment depends upon the size of the vessel, the organs affected, and the overall severity of the vasculitis. Vasculitis involving the fingertips 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 that treat rheumatoid arthritis, 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. When any of these treatments are used, very careful monitoring by a doctor is necessary.
What is the long-term outcome from rheumatoid vasculitis?
Skin involvement alone is usually not very serious. Vasculitis that involves the nerves and internal organs is more difficult to treat and usually occurs in people with very severe rheumatoid arthritis. For all of these reasons, it can potentially impact outcome and requires close medical follow-up.
References
Vasculitis Foundation.
www.vasculitisfoundation.org/. Accessed 6/1/2011.
Vasculitis. Nursing Consult.
www.nursingconsult.com. Accessed 6/1/2011.
Khasnis A, Langford CA, Update on Vasculitis. J Allergy Clin Immunol. 2009;123:1226-36.