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AB0260 Cutaneous rheumatoid vasculitis: still a challenge
  1. T. Pamplona1,
  2. K. Bonfiglioli1,
  3. L. Quedes1,
  4. D. Domiciniano1,
  5. A. C. Medeiros1,
  6. C. R. Gonçalves1,
  7. I. M. M. Laurindo1
  1. 1Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Abstract

Background A decrease in rheumatoid vasculitis (RV) has been recently reported, particularly cutaneous vasculitis. However, we have observed otherwise: new cases, relapses and cases refractory to treatment, despite the use of new biologic medications.

Objectives Objective: to study frequency, relapses, medication and response to treatment of rheumatoid cutaneous vasculitis in patients from a unique center and in long term follow-up.

Methods Methods – all cases of cutaneous vasculitis observed in a cohort of RA(ACR1987) patients 12-70 years old, in regular follow up (7600 patients/years of observation) in our center were included. Demographic data, smoking status, co-morbidities, disease activity, medication in use at the vasculitis onset and remission were recorded. All cases of nailfold vasculitis (small vases) and deep cutaneous ulcers and ischemia (medium vases) were included. Malleolar and/or perimalleolar ulcers were excluded

Results Results – 30 episodes were observed in 22 patients; most females (91%), mean age 57(11.6)yrs, mean disese duration 23(11.6)yrs. Regarding auto-antibodies, 96%were RF positive and 61% presented ANA positive but without any specific pattern or specific antibody. In 41% small vase vasculitis was detected (nailfold lesions and purpura) and in 59% medium vase vasculites (deep cutaneous ulcers and ischemia); no patient presented involvement of both small and of medium vases. No difference was observed regarding demographic data, disease duration, co morbidities or disease activity between patients with nailfold vasculitis or cutaneous ulcers. Medications in use at the beginning of the vasculitis were also similar, most patients being on DMARDS although one patient developed nailfold vasculitis while in use of infliximab and etanercept and one presented cutaneous ulcers using infliximab. The response to treatment was also variable, with similar number of patients using biologic agents due o non response to traditional therapy. Duration of each vasculitis episode was widely variable, since prompt response and relapse to long duration refractory to theraphy. Interesting that most cases developed during disease activity (76%), contrarily to the classical descriptions. Also, of note, the distribution of cases during follow up, with an increased number in recent years (2000-2005= 10 cases, 2006-2012=16cases)

Conclusions Conclusion –A reduction in rheumatoid vasculitis cases was not observed in our population as well as a consistent response to new biologic agents. It seens an area with unmet needs.

Disclosure of Interest None Declared

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