Early Stages of a Rheumatoid Vasculitis Rash

Rheumatoid vasculitis (RV) is a rare but serious symptom of rheumatoid arthritis (RA) that is uncontrolled or poorly managed. RV occurs when blood vessels become inflamed and affect the skin, nerves, fingers, and toes. It can also affect your internal organs. It is difficult to miss RV as it may manifest as a scary-looking rash.

The following are the common signs and symptoms of RV:

• Small pits on the fingertips
• Painful, red rash (usually on the legs)
• Purple bruises
• Redness or sores around the nails
• Blotchy red lesions on the extremities
• Fever
• Fatigue
• Loss of appetite
• Weight loss
• Necrosis (tissue death) of the fingers or toes
• Numbness
• Tingling
• Muscle weakness
• Joint pain
• Loss of sensation
• Chest pain
• Abdominal pain
• Heart attack, stroke, or kidney failure (in rare cases)

Skin rashes that lead to ulcers define the severity of RV. If your nerves are affected, you may experience a pins and needles sensation. Because RV can affect many different parts of the body, the symptoms vary depending on which part is affected. Pain, redness, and vision problems are also possible.

When RA progresses to RV, you may experience fatigue, fever, and weight loss.

Rheumatoid vasculitis (RV) is an immune reaction caused by the heightened autoimmune state associated with rheumatoid arthritis (RA). Apart from that, experts are still unsure what causes it.

RV most likely results from a combination of factors, such as:

• Uncontrolled RA
  • Higher levels of certain antibodies and proteins that are often found in the blood of people with RA (anti-inflammatory proteins, rheumatoid factor antibodies)
• Genetic predisposition
• Drug reactions
• Infection
• Types of cancer that affect the blood, such as leukemia and lymphoma

Risk factors for RV

• Smoking: Has been linked to RV. Some researchers suggest that smoking damages the lining of the blood vessels, which predisposes the person to develop RV.
• RA: RV is reported to be more common in people with RA.
  • People with rheumatoid factor antibodies, rheumatoid nodules, and long-standing RA are most likely to develop RV.
• Felty’s syndrome: A combination of rheumatoid arthritis, a large spleen, and low neutrophil count in the blood. People with this syndrome are also more likely to develop RV.

There is no particular test to identify RV. Blood tests may reveal signs of inflammation and elevated levels of some antibodies, but they do not specifically identify RV. To rule out other types of vasculitis, a biopsy of affected tissue or organ (such as the skin, muscle, nerve, and kidney) may confirm vasculitis but may not be specific to RV. Electrical examinations of the nerves and muscles (neurophysiology tests) occasionally serve as a guide for biopsies and can reveal signs of inflammation. The blood vessels can be imaged using X-ray or other imaging techniques that may reveal vague signs of vasculitis.

Your treatment may differ depending on the severity of your vasculitis and which blood vessels are affected. Rheumatoid vasculitis (RV) has no known cure. However, prompt treatment can help control vessel damage and alleviate symptoms.

Medications

• In some cases, rheumatoid arthritis (RA) medications can help alleviate both joint pain and vasculitis. Because of this advantage, it is critical for a person with RV to have RA treatments that work well for them.
• Corticosteroids and immunosuppressive medications may be used to treat severe or widespread RV. Biologics may be required in more severe cases.

Treating mild RV symptoms

• Mild RV symptoms, such as sores on the fingertips, will most likely require keeping the affected area clean and protected to avoid infection.
• Prednisone and other corticosteroids may also be beneficial.

Treating RV with organ involvement

• RV with a severe degree of organ involvement may require higher doses of steroid medications. These circumstances may necessitate the use of biologics and disease-modifying antirheumatic drugs.

Smoking cessation

• Cigarette smoking increases one's risk of RV. If you smoke, quitting now may lower your risk of the disease.
• If you need assistance with quitting, you can seek advice from your rheumatologist.

Others options

In addition to strictly adhering to the prescribed treatment, the following steps can aid in the management of vasculitis:

• A healthy diet
• Routine vaccinations
• Regular exercise
• A strong support system

Some of the medications may cause serious side effects. These can include blood in the urine (hematuria) or an increased risk of infection. Your healthcare provider will keep an eye out for any issues.

You may also require treatments to help prevent medication side effects. You may require additional calcium and vitamin D to help prevent bone thinning (osteoporosis) caused by steroid use. Talk to your doctor about getting a flu shot, pneumonia vaccination, and/or shingles vaccination, which can reduce your risk of infection.

Rheumatoid vasculitis (RV) relapses can occur despite effective treatment. If your symptoms return or you develop new ones, contact your doctor immediately. Regular doctor visits and ongoing lab and imaging test monitoring are critical in detecting relapses early.

If RV is left untreated it may lead to the following complications:

• Heart attack
• Stroke
• Kidney failure
• Restriction of blood supply to the bowel
• Atherosclerosis
• Damage to the lungs, kidneys, or digestive tract (can be caused in rare cases, when RV damages blood vessels in other body systems)
• Pressure injuries and infection
• Blindness
• Pericarditis (inflammation of the sac around the heart)

RV is one of the most serious complications of long-term rheumatoid arthritis (RA), and the prognosis is determined by the severity of the disease and the organs involved. Some people experience milder symptoms, whereas others can develop serious complications such as heart failure, kidney failure, and stroke.

In general, people with RA and RV have poor prognoses than those with only RA. The prognosis, however, will differ depending on the severity of the symptoms and whether the RV is localized or systemic. Localized RV, which affects only one part of the body, such as the fingertips, may be easier to manage than systemic RV, in which the entire body is affected.

Systemic RV is becoming less common. This is most likely because RA and RV treatments are more effective now than they were previously. Early detection and treatment are critical for disease control and the protection of blood vessels, vital tissues, and organs. Quitting smoking may reduce the risk of RV. However, if RV becomes systemic, it is extremely dangerous and can be fatal.

Vasculitis can be acute or chronic. Doctors often help prevent permanent damage to vital organs and nerves (such as the lungs, kidneys, and brain). However, various other issues such as extreme fatigue, pain, arthritis, nose, and sinus problems frequently bother patients. The side effects of medications, particularly those of glucocorticoids, can also be troubling. Infections are more likely in people who are immunocompromised. When the latest RV treatments are used, the outcome for people with vasculitis is often favorable.