Rheumatoid arthritis (RA) is an inflammatory condition that affects the joints, but it can move to other parts of the body. When RA affects the blood vessels, health experts call it rheumatoid arthritis vasculitis (RV).
Vasculitis refers to inflammation of blood vessels. RV is a rare but potentially serious complication of RA.
In this article, we look at what RV is, including its causes, symptoms, diagnosis, and treatment. We also discuss the complications of RV and the outlook for people with the condition.
RA is an autoimmune condition in which the immune system mistakenly attacks the lining of the joints. This causes:
RA commonly develops in the hands and feet, but it can also affect the eyes, skin, or lungs.
RV occurs when the immune system begins to attack blood vessels, in addition to joints. This results in inflammation of the small and medium blood vessels. The medical name for this is vasculitis.
RV narrows the blood vessels, which reduces the amount of blood that can flow through them, making RV a potentially serious condition.
According to the Vasculitis Foundation (VF), RV is rare, affecting just 1% of people with RA. Moreover, males appear to be more likely to develop RV as a complication of RA than females.
It is unclear why some people with RA develop RV while others do not.
According to VF, the following factors may cause a person with RA to develop RV:
- a history of severe RA for 10 years or more
- high blood concentrations of rheumatoid factor (RF), which is the antibody experts associate with RA
- Felty’s syndrome, a complication of RA that causes a low white blood cell count and an enlarged spleen
- the presence of rheumatoid nodules, which are hard lumps under the skin around the joints
- smoking, which can damage blood vessels and raise the risk of RV
A combination of other factors, such as genetics, drug reactions, and viruses, may also increase the likelihood of RV.
RV can affect blood vessels in many parts of the body, and therefore, the symptoms will vary. Individuals with RV may experience similar symptoms to those with RA, such as:
However, in individuals with RV, these symptoms may be more severe.
RV can also affect the skin, nerves, fingers, and toes. People may develop:
- painful rashes, particularly on the legs
- pits, sores, or ulcers around the fingertips
- tingling, numbness, or weakness in parts of the body
- eye pain or redness
- blurred vision
- chest pain
- abdominal pain
- irregular heartbeat
- tissue death in the fingers and toes, also known as gangrene or necrosis
There is no specific test for detecting RV. Instead, a doctor will ask a person about their symptoms and medical history and carry out a physical examination.
They may also conduct a number of tests, such as:
- blood tests for antibodies and signs of inflammation, such as RF or C-reactive protein
- medical imaging tests, to see blood vessels around the body and look for signs of damage
- an electrocardiogram, to test the heart rhythm
- an electromyography test, to check how well muscles respond to nerve signals
- a biopsy, to test the health of tissues
- an endoscopy, which allows doctors to see inside the esophagus — or food pipe — stomach, and intestines
As with RA, there is no cure for RV. Treatment will focus on controlling damage to the blood vessels and alleviating symptoms.
To make a treatment plan, a doctor will take into account the severity of a person’s symptoms. If symptoms are mild and isolated to one area, the doctor may protect the area to prevent infection and may prescribe corticosteroids, such as prednisone.
If RV is affecting more than one area of the body or if the symptoms are more severe, the doctor may recommend a combination of treatments to reduce inflammation and suppress the immune system. This may involve:
- higher dose steroids
- low doses of chemotherapy drugs, such as cyclophosphamide, or methotrexate
- antibody medication, such as rituximab
Some individuals may only need to take medications for a short time during a flare-up, while others may need to take them for longer to manage the condition.
Some medications that doctors prescribe for RV can cause serious side effects, such as bleeding from the bladder or bone density loss. A doctor will monitor a person closely while they take these drugs.
The doctor may also recommend measures to offset side effects, such as taking extra calcium and vitamin D to protect the bones.
For those taking immunosuppressants, it is important to take precautions against developing an infection. People should get the flu shot every year and stay up to date with other immunizations.
If a person with RV does not receive treatment or if the condition begins to affect the major organs, it can result in life threatening complications, including:
- heart failure
- kidney failure
- restricted blood supply to the bowels
- atherosclerosis, or thickening or hardening of the arteries
- pericarditis, or inflammation of the fibrous sac around the heart
Seeking treatment from a doctor as early as possible is essential for preventing these complications.
Anyone who is concerned their RA may have led to RV should seek guidance from a rheumatologist.
According to the National Rheumatoid Arthritis Society (NRAS), in general, the prognosis for people with RA and RV is worse than for those who have only RA.
However, the outlook will vary depending on the severity of symptoms and whether RV is localized or systemic.
Localized RV affects only one area of the body, such as the fingertips, and may be much easier to manage. By contrast, in systemic RV, the whole body has become affected.
The NRAS states that the incidence of systemic RV is declining. This is likely because the treatments for managing RA and RV are more effective than they used to be.
If RV does become systemic, it is very serious and can be life threatening.
RV is a rare chronic condition, affecting around 1% of individuals with RA. A number of factors influence a person’s risk, including having a history of severe RA, smoking, being male, and having rheumatoid nodules.
Symptoms of RV vary depending on the area of the body the condition affects. Treatment focuses on managing the condition and reducing damage to the blood vessels. A person may take a combination of medications for this.
Frequent monitoring for people with RV is essential, as this allows doctors to detect changes in the condition early and to check for medication side effects.
A person should consult a doctor as soon as possible if they have concerns about RV.