Rheumatoid Vasculitis

What is rheumatoid vasculitis?

Rheumatoid vasculitis is a condition that causes blood vessels to be inflamed. It happens in some people who have had rheumatoid arthritis (RA) for a long time.

RA is an autoimmune disease. This type of disease is caused by a problem with the immune system. The immune system’s job is to protect the body from disease. It does this by attacking things in the body, such as viruses, that may cause harm. When you have an autoimmune disease, your immune system attacks your own body.

RA usually affects your joints first. If it also affects your blood vessels, it leads to rheumatoid vasculitis. Blood vessels carry blood throughout the body. They send blood with oxygen from the heart to the body, and blood that needs oxygen back to your heart. Rheumatoid vasculitis can affect both small and medium-sized blood vessels. It doesn’t affect large blood vessels, except in rare cases. Damage to blood vessels may cause them to be blocked. This can cause not enough oxygen to get to some parts of the body. This can lead to tissue problems or death.

Rheumatoid vasculitis is only one type of vasculitis. There are many types. Vasculitis can happen with other autoimmune diseases, such as lupus. Other times, it happens on its own.

RA affects millions of Americans. It happens most often in women in their 40s to 60s. Rheumatoid vasculitis affects a minority of people with RA. Of people with RA, men are more likely to have rheumatoid vasculitis. It may be less common now because of better treatments for RA.

What causes rheumatoid vasculitis?

Experts are still working to understand what causes this disease. The immune system is very complex. A combination of effects likely leads to rheumatoid vasculitis. Genes are likely part of the cause.

Who is at risk for rheumatoid vasculitis?

You may have a higher risk for rheumatoid vasculitis if you've had severe RA for a long time. Smoking may also increase your risk.

What are the symptoms of rheumatoid vasculitis?

Symptoms often don’t start until a few years after you've had RA for about 10 years or more. They often start after your joint disease has become less active.

Rheumatoid vasculitis can affect blood vessels in many parts of your body. For this reason, it can cause many different symptoms. It most often damages blood vessels to the skin, fingers and toes, nerves, eyes, and heart. This reduces blood flow to these areas and damages them.

Many people with this disease have general symptoms. These include tiredness, fever, and weight loss. These symptoms are also common in RA. But people with rheumatoid vasculitis often have them more severely. Other symptoms may include:

• Skin sores (ulcers)
• Purplish bruises
• Pain in fingers and toes
• Tissue death (gangrene) in fingers and toes
• Muscle weakness in parts of the body
• Loss of feeling in parts of the body
• Tingling and pain in parts of the body
• Eye pain
• Eye redness
• Blurry vision
• Chest pain
• Abnormal heart rhythms, some of which may be fatal

How is rheumatoid vasculitis diagnosed?

When you have RA, your healthcare provider will check you for rheumatoid vasculitis and other possible complications. They'll ask about your health history and your symptoms. They'll do a physical exam. You'll also have tests. These are done to make sure that your symptoms aren’t caused by another type of vasculitis or other health condition. These tests may include:

• Blood tests. These check for inflammation.
• Blood cultures. These look for infection.
• Biopsy. A sample (biopsy) is taken of a blood vessel. It's then checked in a lab.
• Angiography. This imaging test looks at a blood vessel.

You may need other tests to check for damage to parts of the body served by the affected vessels. For instance, you may need an electrocardiogram (ECG) to check your heart rhythm.

How is rheumatoid vasculitis treated?

Your treatment may vary. It will depend on how severe the vasculitis is. And it depends on which blood vessels are affected. There's no cure for this disease. But early treatment can help control vessel damage and ease symptoms.

If you have only mild symptoms, such as a fingertip sore, your healthcare provider may want to simply protect the area and prevent infection.

If your vasculitis affects more parts of your body, you'll likely need more treatment such as:

• Steroid medicines given by mouth or through a vein to reduce inflammation
• Immunosuppressant medicines such as rituximab to help control the immune system
• Other immunosuppressant medicines such as cyclophosphamide, if the vasculitis is severe

Your provider will carefully tailor your treatment according to your other health problems and your response to therapy. You may only need to take medicines for a short time during a disease flare-up. But you may need to take medicines for a longer time to control your condition. You may also have a future episode of vasculitis that needs to be treated.

Some of the medicines may have major side effects. These can include bleeding from your bladder or increased risk for infection. Your provider will watch you for any problems. You may also need treatments to help prevent side effects from medicines. For instance, you may need extra calcium and vitamin D to help prevent thinning of the bones (osteoporosis) from steroid use.

What are possible complications of rheumatoid vasculitis?

In rare cases, vasculitis damages blood vessels in other body systems. If this happens, you may have symptoms from damage to the lungs, kidneys, or digestive tract.

In some cases, vasculitis can also lead to:

• Pressure injuries and infection
• Blindness
• Atherosclerosis
• Heart attack
• Inflammation of the sac around the heart (pericarditis)

What can I do to prevent rheumatoid vasculitis?

You may be able to reduce your risk for rheumatoid vasculitis by getting early, active treatment for your RA. Not smoking may also help reduce your risk.

When should I call my healthcare provider?

Call your healthcare provider at the first sign of a vasculitis flare-up. Early treatment can help limit the severity of your symptoms.

Key points about rheumatoid vasculitis

• Rheumatoid vasculitis is a condition that causes inflammation of small or medium-sized blood vessels. It happens in some people who have had RA for a long time.
• It most often affects vessels of the skin, fingers and toes, nerves, eyes, and heart.
• Untreated, it can cause serious complications, including death.
• You may need treatment with a steroid and other medicine during a disease flare-up.
• Quitting smoking may help you reduce your risk.
• Call your healthcare provider right away if you have signs of a vasculitis flare-up.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you.
• Know why your provider prescribed a new medicine or treatment, and how it will help you. Also know what the side effects are and when you should report them.
• Ask if there are other treatment options for your condition.
• Know why your provider radvises a test or procedure and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.