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.