Rheumatoid vasculitis: diagnostic and therapeutic decisions

R. S. Panush, P. Katz, S. Longley, R. Carter, J. Love, H. Stanley

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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. Fourhundred twenty-eight surveys were returned, of which 290 were suitable for analysis. The majority of respondents were within 10 years of fellowships and were even distributed among private practice, and parttime 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 data 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.

Original languageEnglish
Pages (from-to)321-330
Number of pages10
JournalClinical Rheumatology
Volume2
Issue number4
DOIs
StatePublished - Dec 1 1983
Externally publishedYes

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Rheumatoid Vasculitis
Mononeuropathies
Rheumatoid Arthritis
Penicillamine
Gangrene
Vasculitis
Therapeutics
Cryoglobulinemia
Leg Ulcer
Purpura
Plasmapheresis
Rheumatoid Factor
Private Practice
Cytotoxins
Antimalarials
Antigen-Antibody Complex
Gold
Ulcer
Blood Vessels
Autopsy

Keywords

  • Rheumatoid Arthritis
  • Rheumatoid Vasculitis
  • Vasculitis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

Cite this

Panush, R. S., Katz, P., Longley, S., Carter, R., Love, J., & Stanley, H. (1983). Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clinical Rheumatology, 2(4), 321-330. https://doi.org/10.1007/BF02041550

Rheumatoid vasculitis : diagnostic and therapeutic decisions. / Panush, R. S.; Katz, P.; Longley, S.; Carter, R.; Love, J.; Stanley, H.

In: Clinical Rheumatology, Vol. 2, No. 4, 01.12.1983, p. 321-330.

Research output: Contribution to journalArticle

Panush, RS, Katz, P, Longley, S, Carter, R, Love, J & Stanley, H 1983, 'Rheumatoid vasculitis: diagnostic and therapeutic decisions', Clinical Rheumatology, vol. 2, no. 4, pp. 321-330. https://doi.org/10.1007/BF02041550
Panush RS, Katz P, Longley S, Carter R, Love J, Stanley H. Rheumatoid vasculitis: diagnostic and therapeutic decisions. Clinical Rheumatology. 1983 Dec 1;2(4):321-330. https://doi.org/10.1007/BF02041550
Panush, R. S. ; Katz, P. ; Longley, S. ; Carter, R. ; Love, J. ; Stanley, H. / Rheumatoid vasculitis : diagnostic and therapeutic decisions. In: Clinical Rheumatology. 1983 ; Vol. 2, No. 4. pp. 321-330.
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