Vasculitis in rheumatoid arthritis.
OBJECTIVE
To examine the occurrence and pathophysiology of vasculitis in rheumatoid arthritis (RA), describe the epidemiology and clinical features, and provide a therapeutic perspective.


RESULTS
With improved control of RA over the past two decades, the risk of severe outcomes such as vasculitis may be decreasing. Rheumatoid vasculitis continues to be associated with longstanding, erosive, seropositive disease, and it has recently been shown to be more frequent among patients with antibodies to cyclic citrullinated peptides. Apart from circulating immune complexes, expansion of cytotoxic CD28null T cells and circulating proinflammatory cytokines also play a role in the pathogenesis. The role of agents directed against the tumor necrosis factor (TNF) in the occurrence and management of rheumatoid vasculitis remains unclear, as rheumatoid vasculitis may be both associated with and treated with anti-TNF agents, once it has appeared.


CONCLUSIONS
Vasculitis in RA is generally associated with longstanding disease, has an important impact on a patient's well being, and markedly influences patient life expectancy. Advances in therapies for RA will likely continue to reduce the incidence of vasculitis, and improved management of cardiovascular comorbidity in patients with RA will be of particular benefit to those who suffer from vasculitis and other extraarticular manifestations.
Turesson
Carl
C
Department of Rheumatology, Malmo University Hospital, Malmo, Sweden. turesson.carl@mayo.edu
Matteson
Eric L
EL
D001158:Arteries / Q000187:drug effects / Q000276:immunology / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications*; D001323:Autoantibodies / Q000276:immunology; D018106:CD28 Antigens / Q000276:immunology; D002908:Chronic Disease / Q000188:drug therapy; D006801:Humans; D007111:Immunity, Cellular / Q000187:drug effects / Q000276:immunology; D007155:Immunologic Factors / Q000494:pharmacology / Q000627:therapeutic use; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D014657:Vasculitis / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology
D001323:Autoantibodies; D018106:CD28 Antigens; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha