OVERVIEW
Rheumatoid vasculitis is a manifestation of rheumatoid arthritis.
Rheumatoid vasculitis is a coexisting manifestation of rheumatoid arthritis, with a wide variety of manifestations, including purpura, ulceration, and necrosis of the extremities. Most patients also have rheumatoid nodules, as well as mostly positive serologic rheumatoid factor and positive anti-cyclic guanidinic acid antibodies.
Whether medical insurance
Yes
Department
Rheumatology and Immunology
Clinical symptoms
Purpura, ulcers, limb necrosis, rheumatoid nodules, etc.
Harm
This disease brings great pain to patients physically and mentally, and can lead to death if many kinds of vascular inflammatory occlusion occur.
Examination
Rheumatoid factor, antikeratin antibody, antinuclear peripheral factor antibody, anti-cycloguanidine antibody, and in combination with other connective tissue diseases, supplementary examination of immunoglobulin, complement examination, antinuclear antibody and ENA antibody spectrum.
Diagnosis
Diagnosis is based on the manifestations of purpura, ulceration, limb necrosis, rheumatoid nodules, etc., combined with rheumatoid factor examination and complement examination.
Treatment principle
Mild cases usually do not need treatment, while severe cases are mostly treated with medication.
Curable
Symptoms can be improved by active treatment.
Dietary advice
Give a diet high in protein and vitamins, avoid alcohol and tobacco.
Causes
Causes
The cause of this disease is not clear, and may be related to genetic, infection and other factors.
Symptoms and Diagnosis
Typical symptoms
1. Occlusive endarteritis with small strips of reddish brown infarcts at the nail folds, small patches of hemorrhage on the nails and fingertips, accompanied by obvious gangrene of the fingers.2. Subacute inflammation of medium and small blood vessels may result in most of the visceral and cutaneous damages with skin infarcts, ulcers on the lower limbs, purpura or urticaria, occasional blisters at the ends of the fingers (toes), often accompanied by subcutaneous nodules, pericarditis, scleritis, or nephritis, etc.3. Violent vasculitis is less common. There are fever, multiple organ and system involvement, myocardial infarction, intestinal perforation and cerebrovascular accident, etc., which often lead to death.4. Necrotizing pustulosisSevere necrotizing vasculitis can lead to necrotizing pustulosis.
Diagnostic basis
1. Clinical manifestations (1) Occlusive endarteritis: small strips of reddish-brown infarcts at the nail folds, small patches of hemorrhage on the nails and fingertips, accompanied by obvious gangrene of the fingers. (2) Subacute inflammation of medium and small blood vessels: it can cause most of the internal organs and skin damage, with skin infarction, ulceration of lower limbs, purpura or urticaria, occasional maculopapular blisters at the ends of fingers (toes), often accompanied by subcutaneous nodules, pericarditis, scleritis or nephritis, and so on. (3) Violent vasculitis: there are fever, multiple organ and system involvement, myocardial infarction, intestinal perforation and cerebrovascular accident, etc., which often leads to death. (4) gangrenous pyoderma: severe necrotizing vasculitis can cause gangrenous pyoderma.2. Laboratory examination: IgG-type rheumatoid factor, circulating immune complexes, decreased complement, especially C4, Cl, C2, and anticomplementary activity can be detected in the blood during the acute stage; all of them return to normal during the remission period. Synovial fluid has decreased C4, C1, C2 and often 7S IgM.
Treatment
Treatment guidelines
Mild cases usually do not require treatment, while severe cases are mostly treated with medication.
Drug treatment
1. If gangrene occurs in mild rheumatoid vasculitis, vasodilator drugs can be given to improve peripheral circulation. Other drugs such as salicylates, chloroquine and penicillamine can also be applied.2. Heavy rheumatoid vasculitis (1) glucocorticoids: the use of glucocorticosteroids in patients who do not use such drugs can be expected to improve. (2) Immunosuppressants: In patients with severe active rheumatoid vasculitis, such as increased circulating immune complexes, hypocomplementemia, and high potency rheumatoid factor, cyclophosphamide is often used alone, which can improve clinical and serologic indicators. (3) Glucocorticoids combined with immunosuppressive drugs: glucocorticoids can be used in combination with cyclophosphamide or azathioprine. (4) Other drugs: salicylates, chloroquine and penicillamine are also effective.
Other treatments
1. Light rheumatoid vasculitis can be relieved by rheumatoid drugs. 2. Heavy rheumatoid vasculitis (1) general therapy: if there is fever, joint swelling and pain and general discomfort, bed rest can be given and supportive therapy can be given as appropriate. (2) A few patients can be treated with plasma exchange therapy.
Prognosis
The overall mortality rate is 30%. Those with neuropathy and rectal biopsy showing necrotizing arteritis changes have a higher mortality rate, while those with skin biopsy showing leukocytoclastic vasculitis and normal rectal biopsy have a better prognosis.
Nursing care
Daily care
1. Eliminate the sense of inferiority and dependence, and continue to work within the permitted physical ability.2. Actively prevent and treat various infections.3. Avoid various triggers, such as cold, dampness, overwork, and mental stimulation.4. Follow the doctor’s prescription of medication, adhere to long-term treatment, and do not stop, change, add or subtract medication without authorization.
Dietary management
Give high protein and high vitamin diet, avoid smoking and alcohol.