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Rheumatoid vasculitis

an update

Makol, Ashimaa; Matteson, Eric L.a,b; Warrington, Kenneth J.a

Current Opinion in Rheumatology: January 2015 - Volume 27 - Issue 1 - p 63–70
doi: 10.1097/BOR.0000000000000126
VASCULITIS SYNDROMES: Edited by Hasan Yazici
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Purpose of review Rheumatoid vasculitis is the most serious extra-articular complication of rheumatoid arthritis, with high morbidity and mortality noted in multiple prior reports. Recent studies have expanded our understanding of this entity in the era of modern immunosuppressive therapy. New clinical predictors and possible protective factors have also been identified.

Recent findings This review provides an update on the epidemiology, clinical correlates, predictors, therapy and outcomes of rheumatoid vasculitis over the past decade. During this time, there has been increasing use of the treat-to-target management practices and incorporation of biologic response modifiers that have revolutionized rheumatoid arthritis treatment with better disease control and overall improved outcomes. The incidence of rheumatoid vasculitis has declined significantly in the past several decades, but morbidity and mortality continue to remain high, despite aggressive treatment with cyclophosphamide or biologic agents. Hydroxychloroquine and low-dose aspirin may have a protective role. There is ongoing debate about the role of newer biological therapies in prevention, treatment or even as a trigger for rheumatoid vasculitis.

Summary Rheumatoid vasculitis remains a rare yet challenging extra-articular manifestation of rheumatoid arthritis with high morbidity and mortality, despite aggressive use of disease-modifying therapy.

aDivision of Rheumatology

bDepartment of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

Correspondence to Ashima Makol, MD, Assistant Professor of Medicine, Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA. Tel: +1 507 284 1625; fax: +1 507 284 0564; e-mail: makol.ashima@mayo.edu

© 2015 Lippincott Williams & Wilkins, Inc.