Vasculitis associated with rheumatoid arthritis: a case-control study.
OBJECTIVE
The aim of this study was to determine the clinical correlates and predictors of rheumatoid vasculitis (RV).


METHODS
A retrospective cohort of patients with RV evaluated at a tertiary referral centre between 1 January 2000 and 1 January 2010 was identified. RV cases were compared in a 1:2 ratio to controls (RA without vasculitis) to identify risk factors for developing RV.


RESULTS
Eighty-six RV cases (58% women, 88% white) were identified. Histopathological confirmation was available for 58% of patients. Cutaneous vasculitis was the most common presentation, followed by vasculitic neuropathy. The median age at presentation was 63 years and the median duration of RA was 10.8 years. One third were current smokers. The majority were seropositive and had elevated inflammatory markers. Treatment was with a range of immunomodulating agents. At 6 months, 38% of patients achieved complete remission, 52% had partial improvement and 10% noted no clinical improvement. Thirty-six per cent relapsed by 5 years and 26% died. After adjusting for age and disease duration, current smoking at RA diagnosis [odds ratio (OR) 1.98], coexistent peripheral vascular disease (OR 3.98), cerebrovascular disease (OR 6.48), severe RA (OR 2.02) (characterized by radiographic erosions, nodulosis on clinical examination or requirement of joint surgery) and the use of biologics (OR 2.80) were found to increase the odds for developing RV; the use of HCQ (OR 0.54, CI 0.31, 0.94) and low-dose aspirin (OR 0.42, CI 0.21, 0.85) was associated with decreased odds for developing RV.


CONCLUSIONS
This largest single-centre series of patients with RV suggests that even in recent years, RV remains a serious complication of RA and is associated with significant mortality.
Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA. makol.ashima@mayo.edu.
Ashima
A
Makol
Cynthia S
CS
Crowson
David A
DA
Wetter
Olayemi
O
Sokumbi
Eric L
EL
Matteson
Kenneth J
KJ
Warrington
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000401:mortality; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056653:Rheumatoid Vasculitis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents
biologics; rheumatoid arthritis; rheumatoid vasculitis; systemic vasculitis