title: Localized striated muscle vasculitis in rheumatoid arthritis.
abstract: Rheumatoid arthritis (RA) is one of the most prevalent connective tissue diseases and can be complicated by vasculitis with systemic manifestations. Rheumatoid vasculitis can range in severity from a widespread, life-threatening disease refractory to treatment to a more benign, localized disease responsive to treatment. We describe here a patient with RA who presented with bilateral calf muscle pain secondary to rheumatoid vasculitis. The patient had intractable calf muscle pain which did not respond to nonsteroidal anti-inflammatory drugs and muscle relaxants. He did not have any other manifestations of rheumatoid vasculitis such as skin ulcers, peripheral neuropathy, or gastrointestinal involvement. A thorough diagnostic work-up concluding with a muscle biopsy revealed a non-necrotizing small vessel vasculitis. The patient's symptoms responded very well to a course of steroids and he required no additional cytotoxic agents. This case illustrates that rheumatoid vasculitis can present as an isolated striated muscle vasculitis characterized by a relatively benign course and prompt resolution with the initiation of steroids. Clinicians need to be aware that such a phenomenon can exist to facilitate early recognition and appropriate treatment.
authors.affiliation: Division of Rheumatology, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, USA. zarmeena_a@yahoo.com
authors.forename: Zarmeena
authors.initials: Z
authors.lastname: Ali
authors.forename: Prabha
authors.initials: P
authors.lastname: Ranganathan
authors.forename: Arie
authors.initials: A
authors.lastname: Perry
authors.forename: Michael
authors.initials: M
authors.lastname: Gelbart
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications*; D006801:Humans; D007866:Leg; D008297:Male; D018482:Muscle, Skeletal / Q000098:blood supply*; D014657:Vasculitis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy