Ghadiali Jay, Talwar Aditya, Ligon Colin
Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA.
SAGE Open Med Case Rep. 2021 May 20;9:2050313X211015895. doi: 10.1177/2050313X211015895. eCollection 2021.
Rheumatoid vasculitis is a rare extra-articular complication of rheumatoid arthritis. The most common manifestation is cutaneous; however, it can manifest in various organ systems and is associated with a high degree of morbidity and mortality. Diagnosis is challenging, and there are no validated diagnostic or classification criteria. Most cases should be confirmed with tissue biopsy when possible given the severity of disease and the extent of immunosuppression required to treat this condition. We report the case of a 54-year-old white woman with long-standing, uncontrolled, and seropositive rheumatoid arthritis with a history of elevated anticardiolipin IgG and IgM antibodies who presented with acute stenosis of her left femoral artery which ultimately required a left above-the-knee amputation. Histopathology revealed findings consistent with vasculitis and thrombosis, and subsequent imaging revealed multifocal arterial and venous thromboses. She was diagnosed with rheumatoid vasculitis and antiphospholipid antibody syndrome, and was treated with high-dose glucocorticoids, cyclophosphamide, and warfarin. Rheumatoid vasculitis is a rare but devastating complication of rheumatoid arthritis, and vigilance for this condition must be maintained, especially in patients with long-standing, seropositive disease.
类风湿性血管炎是类风湿关节炎一种罕见的关节外并发症。最常见的表现是皮肤症状；然而，它可在多个器官系统中表现出来，且与高发病率和死亡率相关。诊断具有挑战性，并且没有经过验证的诊断或分类标准。鉴于疾病的严重性以及治疗该疾病所需的免疫抑制程度，大多数病例在可能的情况下应通过组织活检来确诊。我们报告了一例54岁白人女性病例，该患者患有长期未得到控制的血清阳性类风湿关节炎，有抗心磷脂IgG和IgM抗体升高病史，出现左股动脉急性狭窄，最终需要进行左膝上截肢。组织病理学检查结果符合血管炎和血栓形成，随后的影像学检查显示多灶性动静脉血栓形成。她被诊断为类风湿性血管炎和抗磷脂抗体综合征，并接受了大剂量糖皮质激素、环磷酰胺和华法林治疗。类风湿性血管炎是类风湿关节炎一种罕见但具有破坏性的并发症，必须对此保持警惕，尤其是在患有长期血清阳性疾病的患者中。
