TY - JOUR
T1 - Vasculitis associated with rheumatoid arthritis
T2 - A case-control study
AU - Makol, Ashima
AU - Crowson, Cynthia S.
AU - Wetter, David A.
AU - Sokumbi, Olayemi
AU - Matteson, Eric L.
AU - Warrington, Kenneth J.
N1 - Funding Information:
Funding: This work was funded by the Mayo Clinic Margaret Harvey Schering Clinician Career Development Award Fund for Arthritis Research and supported by grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS). The sponsors of these grants did not have any involvement with the study design, data collection, analysis and interpretation of data, writing of the manuscript or the decision to submit the manuscript for publication.
PY - 2014/5
Y1 - 2014/5
N2 - 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. Conclusion: 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.
AB - 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. Conclusion: 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.
KW - Biologics
KW - Rheumatoid arthritis
KW - Rheumatoid vasculitis
KW - Systemic vasculitis
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U2 - 10.1093/rheumatology/ket475
DO - 10.1093/rheumatology/ket475
M3 - Article
C2 - 24441152
AN - SCOPUS:84898816013
SN - 1462-0324
VL - 53
SP - 890
EP - 899
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 5
M1 - ket475
ER -