Rheumatoid vasculitis is an uncommon but potentially catastrophic complication of RA. There are few extensive experiences recorded in the current literature and there is no consensus regarding the clinical features, laboratory findings, histologic pattern, prognosis, or appropriate management of this syndrome. We therefore surveyed 1,947 North American ARA members for their perceptions of
rheumatoid vasculitis. Four hundred twenty-eight surveys were returned, of which 290 were suitable for analysis. The majority of respondents were within 10 years of fellowships and were evenly distributed among private practice, and part-time and full-time academic positions. The respondents saw 15-50
rheumatoid arthritis (RA) patients weekly and less than five RA
vasculitis patients annually. The majority correctly diagnosed two actual and complex case histories from patients with and without autopsy-proven
vasculitis. Respondents associated the following features most strongly with
rheumatoid vasculitis -
mononeuritis multiplex, digital
gangrene, digital ischemic lesions, nailfold ischemic lesions, non-healing
leg ulcers, palpable
purpura, fingertip nodules, sensory neuropathy, scleromalacia perforans, high titer
rheumatoid factor, positive visceral angiography,
cryoglobulinemia, hypocomplementemia, circulating
immune complexes, and histologic necrotizing
vasculitis or vascular transmural neutrophilia. Digital lesions or sensory neuropathy alone were not viewed as portending an ominous prognosis by most respondents and would have been treated with nonsteroidal anti-inflammatory drugs,
antimalarials,
gold salts, or
D-penicillamine. Other clinical manifestations considered as reflecting
rheumatoid vasculitis (
gangrene,
mononeuritis multiplex,
ulcers) were thought to worsen prognosis and would have been managed more often with
corticosteroids,
D-penicillamine,
cytotoxic agents or
plasmapheresis.
Rheumatoid vasculitis is viewed as a heterogeneous group of syndromes with varying clinical and histopathologic features,which have different prognostic implications, and therefore should be managed differently. While these dta do not substitute for an extensive recorded series of patients, they provide useful information about community perceptions of an uncommon but difficult clinical problem. They identify the need for additional data to examine the validity of these attitudes.