Rheumatoid Vasculitis

Rheumatoid vasculitis (RV) is a rare complication of rheumatoid arthritis (RA). RA is an inflammatory disease that affects the joints and causes pain and damage. If RA impacts blood vessels, it is called rheumatoid vasculitis.1

What is rheumatoid vasculitis?

RV is a complication of RA that happens when blood vessels become inflamed. This inflammation can cause the blood vessels to weaken or thicken. This can block blood flow, which can harm internal organs. RV tends to impact small or medium blood vessels like those in the skin, nerves, fingers, and toes.1

RV is only 1 type of vasculitis. There are many other types and causes.2

How is rheumatoid vasculitis related to RA?

RA is an autoimmune disease. In people with RA, their immune systems attack their bodies, causing inflammation. RA typically impacts joints, but in some cases, it can impact organs in the body. If RA causes inflammation in blood vessels, it is called rheumatoid vasculitis (RV).3

RV is very rare and only affects about 1 percent of people with RA. It is more common in people who have had RA for more than 10 years. Smoking may also increase the risk of RV.2,4

Signs and symptoms

RV can impact blood vessels anywhere in the body. Symptoms may change depending on which area is affected. Some general symptoms of RV are fever, tiredness, or weight loss. People with RV may also have more specific symptoms such as:1,2

  • Pain, numbness, or tingling in fingers or toes
  • Eye pain, redness, or blurry vision
  • Skin rashes or sores
  • Muscle weakness
  • Tissue death in fingers or toes
  • Chest pain

If RV affects blood flow to organs, it can cause serious complications. If major organs are damaged, there is an increased risk for problems like heart attacks, strokes, or kidney failure. RV can also cause blindness if it impacts the eyes.1,2

Diagnosis

If you have RA and show symptoms that are consistent with vasculitis, your doctor may suspect RV. There is no one test used to diagnose RV. Your doctor will likely use a combination of health history, physical examinations, symptoms, and lab tests to rule out other conditions and diagnose RV.4

There are multiple lab tests doctors might do if they suspect RV. They may use a blood test to look for signs of an infection or inflammation. A test for nerve conduction (EMG) is sometimes used if you have symptoms of tingling or numbness. They also may check for damage to internal organs with imaging tests or an electrocardiogram (ECG).1

To confirm a diagnosis, your doctor may do a biopsy from the affected tissue. If the affected tissue is not easy to access, they may use an angiogram. An angiogram is a special X-ray used to take pictures of your veins using dye.3

Treatment

There is no cure for RV. But if it is caught early, RV can be managed to prevent complications. Targeted treatment for RV depends on which areas of the body are affected and how seriously they are affected. In less serious cases, RV might only cause pain or skin problems in fingers or toes. This is treated with pain medicine, antibiotic cream, and local protection.2

In more serious cases, doctors may use drugs to manage RV complications. These drugs may include steroids, cyclophosphamide (a chemotherapy-type drug), or other immunosuppressants.3

Some research shows that biologic drugs may help treat RV, particularly one called rituximab. Biologic drugs help reduce inflammation by targeting specific parts of the immune system.1 If RV is impacting your organs, your doctor may also recommend medicine to treat complications, such as high blood pressure.1,3

After managing symptoms and complications, doctors will likely treat your RV by focusing on the underlying RA symptoms. They may adjust your medicine to attempt to control your RA, which will limit the risk of complications from RV. Proper management of RA reduces the chance of developing RV overall.3

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Written by: Juliette Daly | Last reviewed: February 2021