Background Systemic Rheumatoid Vasculitis (SRV) is an uncommon but potentially serious systemic disease manifestation of rheumatoid arthritis (RA). It presents in a wide spectrum of organs and has a high mortality. The treatment paradigm for RA has dramatically evolved with an emphasis in tighter and better control of disease activity especially in the last decade. The incidence of SRV appears to be decreasing1 possibly reflecting the progress in RA therapeutics.
Objectives The aim of this study was to review the clinical manifestations of SRV in a stable well defined population in the new millennium (2001-2010) and to compare with our previous cohort of patients (1988-2000) and also a cohort from the 1970s (1975-1981) (Bath cohort)2.
Methods Using NORVAS, a prospective register of patients with systemic vasculitis since 1988, all patients with a diagnosis of SRV from 1st January 2001 until 31 December 2010 were identified. SRV was defined according to the Scott and Bacon criteria (1984). The diagnosis was established by retrospective review of medical notes and confirmed by an independent physician (RAW). Clinical features were recorded and cohorts compared using a chi-square test.
Results 18 patients with SRV were identified (10 male), median age at SRV diagnosis was 72 years and average disease duration 15.6 years. Prior to SRV diagnosis patients had used a median of 2 DMARDs (64% on Methotrexate) and 2 patients had been on biologic drugs (12.5%). The average annual incidence was 3.9/million (95%CI 2.3-6.2) which is lower compared to the previous Norwich cohort (9.1/million (95% CI 6.8-12.0))1. Broadly, the clinical manifestations were similar apart from systemic and cutaneous features (infarcts and LCCV) that were more common in the older cohorts. Five year mortality was approximately 50% for the Norwich cohorts.
Conclusions The incidence of SRV has declined in the last 40 years; however, the clinical manifestations remain similar. Systemic symptoms are less often and cutaneous manifestations such as infarcts and nodules are less common in the recent cohorts. Despite modern immunosuppressive therapy there are no significant changes in the clinical features of SRV.
Watts RA, Mooney J, Lane SE, Scott DG. Rheumatoid vasculitis: becoming extinct? Rheumatology (Oxford)2004 Jul;43(7):920-928
Scott DG, Bacon PA, Tribe CR. Systemic rheumatoid vasculitis: a clinical and laboratory study of 50 cases. Medicine (Baltimore)1981 Jul;60(4):288-97.
Disclosure of Interest None Declared