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Vasculitis: The Risks of RA Inflammation

Posted on May 06, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Victoria Menard

Rheumatoid vasculitis (RV) is a type of vasculitis, or inflammation of the blood vessels. RV is rare, affecting about 1 percent of people with rheumatoid arthritis (RA). RV is a complication of long-standing RA — generally, it occurs after a person has had RA for 10 or more years.

Rheumatoid vasculitis is one potential systemic (widespread) symptom of RA. It can cause a variety of symptoms, including skin sores, bruising, fatigue, and eye pain.

If you have had rheumatoid arthritis for several years, talk to your doctor about the possibility of rheumatoid vasculitis. They will be able to assess whether you are at risk of developing RV and work with you to find the right treatment plan.

What Is Rheumatoid Vasculitis?

Vasculitis refers to inflammation of the blood vessels — the channels that move blood throughout the body. When the blood vessels become inflamed, their walls thicken, limiting how much blood can pass through them. Restricted blood flow can be serious, potentially causing damage to the body’s organs and tissues.

Read: 6 tips to manage itching in rheumatoid vasculitis

Rheumatoid vasculitis is an uncommon extra-articular (non-joint-related) inflammatory complication of RA. Although RV can affect anyone, it most commonly develops in people who have had rheumatoid arthritis for many years and have developed severe joint damage and deformity.

Symptoms of Rheumatoid Vasculitis

The symptoms of RV tend to start after the joint symptoms of RA have become less active. Because RV can affect blood vessels in many different parts of the body, its symptoms can vary. However, in most cases, RV damages the blood vessels in the skin, fingers, toes, eyes, nerves, and heart. Damage to the blood vessels can reduce blood flow and damage these areas of the body.

It is common for people with RV to experience general symptoms, including tiredness, weight loss, and fever. Although these symptoms frequently occur in RA itself, they are typically more severe in people with rheumatoid vasculitis than in those without it. RV may also cause symptoms specific to certain areas of the body, including:

  • Blurred vision
  • Chest pain
  • Abnormal heart rhythms (arrhythmias), some of which could be life-threatening
  • Muscle weakness, numbness, or tingling

Other serious symptoms include:

  • Digital ischemia
  • Scleritis
  • Cutaneous ulcers
  • Foot or wrist drop

Digital Ischemia

Digital ischemia occurs as the result of a blood flow deficiency in the arteries of the fingers or toes. Digital ischemia may be painful and cause the fingers or toes to turn red or dark purple (almost black) in color. As one myRAteam member wrote, “About three to five fingers break down and bleed. My immunologist says it’s from vasculitis.”

Scleritis

Scleritis, or inflammation of the white part of the eye (sclera), is common in people with RV. This complication may lead to eye redness and pain or light sensitivity. Scleritis requires prompt treatment with immunosuppressants (medications that suppress immune activity).

Cutaneous Ulcers

Cutaneous ulcers are open skin sores that develop when the small blood vessels or the medium blood vessels become obstructed (blocked). These lesions can develop on different parts of the body, commonly affecting the legs (especially near the ankles).

Foot or Wrist Drop

Nerve damage caused by RV can result in mononeuritis multiplex — commonly referred to as foot drop or wrist drop. This condition usually begins with unusual sensations in the affected area, such as pain, burning, numbness, or tingling. It can eventually lead to muscle weakness, paralysis, and decreased muscle mass.

What Causes Vasculitis in Rheumatoid Arthritis?

Researchers are not sure exactly what causes rheumatoid vasculitis. Like RA itself, most cases of RV can be considered autoimmune diseases. An autoimmune disorder occurs when the body’s immune system mistakenly attacks healthy tissues.

Several factors are thought to play a role in whether a person with RA will go on to develop RV, including whether you have:

  • Severe, long-standing RA for 10 or more years
  • Seropositive RA (a high concentration of rheumatoid factor antibodies and certain proteins in the blood)
  • A history of smoking cigarettes, which can damage the blood vessels’ lining
  • Felty’s syndrome, a complication of rheumatoid arthritis that results in low white blood cell levels and an enlarged spleen
  • Rheumatoid nodules, firm lumps under the skin that form around the joints

Managing Rheumatoid Vasculitis

Improvements in RA treatments may be decreasing the risk of severe complications like vasculitis. If a person develops RV, the type of treatment used depends on the areas of the body that are affected. Generally, treatment focuses on reducing inflammation caused by RA and managing any complications that arise.

Treating Rheumatoid Arthritis

In some cases, RA medications may improve both joint symptoms and vasculitis. Because of this benefit, it is important to make sure a person with RV has current rheumatoid arthritis treatments that work well for them. Severe or widespread RV may be treated with a combination of corticosteroids and immunosuppressant medications, such as Imuran (azathioprine) or methotrexate. More severe cases may require biologics (a certain type of disease-modifying antirheumatic drug, abbreviated as DMARD).

One myRAteam member hoped biologic treatment would improve another’s RV: “Praying that the Rituxan infusions send the rheumatoid vasculitis packing — it must be hard to deal with,” they said.

Treating Mild RV Symptoms

Mild symptoms of RV, including sores on the fingertips, will likely involve keeping the affected area clean and protected to prevent infection. Corticosteroids, such as prednisone, may also be helpful.

Treating RV With Organ Involvement

RV with a serious degree of organ involvement may need to be treated with higher doses of steroid medications. These cases may also call for the use of biologics such as Orencia (abatacept) or Rituxan (rituximab). Some people may need to take the DMARD Cytoxan (cyclophosphamide).

Smoking Cessation

Smoking cigarettes puts a person at a higher risk of developing rheumatoid vasculitis. If you are a smoker, quitting now may reduce your risk of developing the disease. You can ask your rheumatologist or another health care provider for recommendations if you would like support throughout the quitting process.

Meet Your Team

Managing the symptoms of rheumatoid arthritis can be a challenge. The good news is that you don’t have to do it alone.

On myRAteam, you’ll meet people with rheumatoid arthritis and their loved ones. Here, more than 150,000 members from around the world come together to connect with others who understand life with RA.

Do you have rheumatoid vasculitis? What have you found that works to manage it? Share your experience in the comments below or by posting on myRAteam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Victoria Menard is a writer at MyHealthTeam. Learn more about her here.

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