Objectives The aim of this study was to compare the incidence and severity of systemic vasculitis (SV) in various organs of rheumatoid arthritis (RA) and progressive systemic sclerosis (SSc) patients.
Methods Twelve organs (heart, lung, liver, spleen, kidneys, pancreas, gastrointestinal tract, adrenal glands, skeletal muscle, peripheral nerve, skin and brain) of 36 RA and 11 SSc patients with SV were studied. RA and SSc were confirmed clinically according to the criteria of the ACR. SV and the average value of vasculitis (incidence and severity) in various organs were determined histologically. The “incidence” of vasculitis in various organs was determined based on the presens of vasculitis in blood vessels of different sizes. The “severity” of vasculitis in various organs was evaluated by semi-quantitative, visual estimation on a 0 to 3 plus scale (based on the number of involved vessels/light microscopic field x40).
Results: SV was observed in all of 36 RA and 11 SSc patients with variable incidence and severity. The average value of incidence and severity/organ in SSc was appreciably higher than that of RA. In RA patients, not all investigated organs were involved with SV and the prevalence of blood vessels with vasculitis in each organ was different. In SSc patients SV was present in each of the investigated organs, but with different incidence and severity.
Conclusions The incidence and severity of vasculitis in various organs of RA and SSc patients were different. Incidence and severity of vasculitis are different aspects of the same pathological process usually running parallel in both autoimmune diseases. In RA the heart, skeletal muscle, pancreas, lung, kidneys and gastrointestinal tract were most markedly involved, while in SSc the kidneys, spleen, lung, pancreas, heart and gastrointestinal tract were. The mortality of RA and SSc basically depended on the location of vasculitis. In RA the SV was lethal in sequence of severity, by involvement of the heart, lung and kidneys, whereas in SSc it was by involvement of the kidneys, lung and heart, respectively. In RA patients mortality was not influenced by the relatively high prevalence of SV in skeletal muscle, pancreas and G-I tract or in SSc patients by SV in the spleen, pancreas, and G-I tract. In RA easily available sites of biopsy for the histological diagnosis of SV are the sural nerve with surrounding skeletal muscle (1) and in SSc it is the frequently involved G-I tract.
References: Apáthy Á, Bély M Diagnosis of Systemic Vasculitis in Rheumatoid Arthritis: Biopsy of Skeletal Muscle in Combination with Sural Nerve is Optimal - A Retrospective Clinicopathologic Study of 161 Autopsy Patients. Ann Rheum Dis 2010;69:222 http://www.abstracts2view.com/eular/
Disclosure of Interest: None Declared