Skip to main content
PMC home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 1987 Oct;46(10):727–733. doi: 10.1136/ard.46.10.727

Clinical and serological features of severe vasculitis in rheumatoid arthritis: prognostic implications.

A J Geirsson 1, G Sturfelt 1, L Truedsson 1
PMCID: PMC1003378  PMID: 3689000

Abstract

Sixteen patients with classic rheumatoid arthritis (RA) complicated by severe vasculitis were studied and compared with a matched control group of 16 RA patients without vasculitis. Seven of the patients with vasculitis died within 4 to 120 months (median 32 months) after developing vasculitic symptoms. Gangrene of digits and extremities, bowel ulcers or bowel perforation, or both, and cardiac involvement were more common among the patients who died than among those with a more favourable course. The present data suggest that large vessel vasculitis in RA is associated with high frequency of arteriosclerotic vascular disease. The serum concentrations of complement components C3 and C4 were lower, and concentrations of IgM rheumatoid factor, complement activating rheumatoid factor, and C1q binding immune complexes (C1q solid and C1q fluid phase assay) were significantly higher among vasculitic patients than in the control group. Laboratory data provided little prognostic information with regard to rheumatoid vasculitis, with the exception that IgM and IgG rheumatoid factors were significantly higher among patients with fatal course of disease than in those who achieved remission.

Full text

PDF
730

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abel T., Andrews B. S., Cunningham P. H., Brunner C. M., Davis J. S., 4th, Horwitz D. A. Rheumatoid vasculitis: effect of cyclophosphamide on the clinical course and levels of circulating immune complexes. Ann Intern Med. 1980 Sep;93(3):407–413. doi: 10.7326/0003-4819-93-3-407. [DOI] [PubMed] [Google Scholar]
  2. Anderson S. G., Bentzon M. W., Houba V., Krag P. International reference preparation of rheumatoid arthritis serum. Bull World Health Organ. 1970;42(2):311–318. [PMC free article] [PubMed] [Google Scholar]
  3. BALL J. Serum factor in rheumatoid arthritis agglutinating sensitized sheep red cells. Lancet. 1950 Nov 11;2(6637):520–524. doi: 10.1016/s0140-6736(50)91500-5. [DOI] [PubMed] [Google Scholar]
  4. BLUMBERG B. S., BUNIM J. J., CALKINS E., PIRANI C. L., ZVAIFLER N. J. ARA NOMENCLATURE AND CLASSIFICATION OF ARTHRITIS AND RHEUMATISM (TENTATIVE). Arthritis Rheum. 1964 Feb;7:93–97. doi: 10.1002/art.1780070113. [DOI] [PubMed] [Google Scholar]
  5. BYWATERS E. G., SCOTT J. T. THE NATURAL HISTORY OF VASCULAR LESIONS IN RHEUMATOID ARTHRITIS. J Chronic Dis. 1963 Aug;16:905–914. doi: 10.1016/0021-9681(63)90139-5. [DOI] [PubMed] [Google Scholar]
  6. Brandslund I., Siersted H. C., Svehag S. E., Teisner B. Double-decker rocket immunoelectrophoresis for direct quantitation of complement C3 split products with C3d specificities in plasma. J Immunol Methods. 1981;44(1):63–71. doi: 10.1016/0022-1759(81)90107-1. [DOI] [PubMed] [Google Scholar]
  7. Frohnert P. P., Sheps S. G. Long-term follow-up study of periarteritis nodosa. Am J Med. 1967 Jul;43(1):8–14. doi: 10.1016/0002-9343(67)90144-1. [DOI] [PubMed] [Google Scholar]
  8. KEMPER J. W., BAGGENSTOSS A. H., SLOCUMB C. H. The relationship of therapy with cortisone to the incidence of vascular lesions in rheumatoid arthritis. Ann Intern Med. 1957 May;46(5):831–851. doi: 10.7326/0003-4819-46-5-831. [DOI] [PubMed] [Google Scholar]
  9. Kannel W. B., Castelli W. P., Gordon T., McNamara P. M. Serum cholesterol, lipoproteins, and the risk of coronary heart disease. The Framingham study. Ann Intern Med. 1971 Jan;74(1):1–12. doi: 10.7326/0003-4819-74-1-1. [DOI] [PubMed] [Google Scholar]
  10. Laurell C. B. Electroimmuno assay. Scand J Clin Lab Invest Suppl. 1972;124:21–37. doi: 10.3109/00365517209102748. [DOI] [PubMed] [Google Scholar]
  11. Panush R. S., Katz P., Longley S., CarterR, Love J., Stanley H. Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clin Rheumatol. 1983 Dec;2(4):321–330. doi: 10.1007/BF02041550. [DOI] [PubMed] [Google Scholar]
  12. ROPES M. W., BENNETT G. A., COBB S., JACOX R., JESSAR R. A. 1958 Revision of diagnostic criteria for rheumatoid arthritis. Bull Rheum Dis. 1958 Dec;9(4):175–176. [PubMed] [Google Scholar]
  13. Rus H. G., Niculescu F., Constantinescu E., Cristea A., Vlaicu R. Immunoelectron-microscopic localization of the terminal C5b-9 complement complex in human atherosclerotic fibrous plaque. Atherosclerosis. 1986 Jul;61(1):35–42. doi: 10.1016/0021-9150(86)90111-5. [DOI] [PubMed] [Google Scholar]
  14. SCHMID F. R., COOPER N. S., ZIFF M., McEWEN C. Arteritis in rheumatoid arthritis. Am J Med. 1961 Jan;30:56–83. doi: 10.1016/0002-9343(61)90064-x. [DOI] [PubMed] [Google Scholar]
  15. Scott D. G., Bacon P. A., Allen C., Elson C. J., Wallington T. IgG rheumatoid factor, complement and immune complexes in rheumatoid synovitis and vasculitis: comparative and serial studies during cytotoxic therapy. Clin Exp Immunol. 1981 Jan;43(1):54–63. [PMC free article] [PubMed] [Google Scholar]
  16. Scott D. G., Bacon P. A. Intravenous cyclophosphamide plus methylprednisolone in treatment of systemic rheumatoid vasculitis. Am J Med. 1984 Mar;76(3):377–384. doi: 10.1016/0002-9343(84)90654-5. [DOI] [PubMed] [Google Scholar]
  17. Scott D. G., Bacon P. A., Tribe C. R. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine (Baltimore) 1981 Jul;60(4):288–297. [PubMed] [Google Scholar]
  18. Scullion M., Balint G., Whaley K. Evaluation of the C1q solid-phase binding assay for immune complexes. A clinical and laboratory study. J Clin Lab Immunol. 1979 Apr;2(1):15–22. [PubMed] [Google Scholar]
  19. Sjöholm A. G., Berglund K., Johnson U., Laurell A. B., Sturfelt G. C1 activation, with C1q in excess of functional C1 in synovial fluid from patients with rheumatoid arthritis. Int Arch Allergy Appl Immunol. 1986;79(2):113–119. doi: 10.1159/000233956. [DOI] [PubMed] [Google Scholar]
  20. Sjöholm A. G. Complement components in normal serum and plasma quantitated by electroimmunoassay. Scand J Immunol. 1975;4(1):25–30. doi: 10.1111/j.1365-3083.1975.tb02596.x. [DOI] [PubMed] [Google Scholar]
  21. Sturfelt G., Sjöholm A. G. Complement components, complement activation, and acute phase response in systemic lupus erythematosus. Int Arch Allergy Appl Immunol. 1984;75(1):75–83. doi: 10.1159/000233593. [DOI] [PubMed] [Google Scholar]
  22. Truedsson L., Sjöholm A. G., Sturfelt G. Complement activating rheumatoid factors in rheumatoid arthritis studied by haemolysis in gel: relation to antibody class and response to treatment with podophyllotoxin derivatives. Clin Exp Rheumatol. 1985 Jan-Mar;3(1):29–37. [PubMed] [Google Scholar]
  23. Wilkinson M., Torrance W. N. Clinical background of rheumatoid vascular disease. Ann Rheum Dis. 1967 Nov;26(6):475–480. doi: 10.1136/ard.26.6.475. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Winkelstein A., Starz T. W., Agarwal A. Efficacy of combined therapy with plasmapheresis and immunosuppressants in rheumatoid vasculitis. J Rheumatol. 1984 Apr;11(2):162–166. [PubMed] [Google Scholar]
  25. Zubler R. H., Lange G., Lambert P. H., Miescher P. A. Detection of immune complexes in unheated sera by modified 125I-Clq binding test. Effect of heating on the binding of Clq by immune complexes and application of the test to systemic lupus erythematosus. J Immunol. 1976 Jan;116(1):232–235. [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES