Ohta Ryuichi, Sano Chiaki
Communiy Care, Unnan City Hospital, Unnan, JPN.
Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.
Cureus. 2023 Nov 17;15(11):e48962. doi: 10.7759/cureus.48962. eCollection 2023 Nov.
Rheumatoid arthritis (RA) is a chronic inflammatory disorder with a wide clinical heterogeneity. Among its complications, rheumatoid vasculitis (RV) is notable for its severity and potential to involve multiple organ systems. A particularly serious manifestation of RV is ischemia, which is indicative of advanced vasculitic involvement and a significant risk of tissue damage. This case report describes an 83-year-old male with RA who presented with polyarticular joint pain and hand ischemia. Despite the initial diagnosis of RA exacerbation, worsening systemic symptoms without identifiable infectious causes and hypocomplementemia led to the diagnosis of RV exacerbation. Initial management with steroids showed temporary improvement. However, relapse after dose reduction prompted the administration of rituximab, an anti-cluster-of-differentiate-20 (anti-CD20) monoclonal antibody, which yielded favorable outcomes. This case underscores the importance of clinical vigilance in older patients with RA for signs, such as ischemic hands, emphasizing the pivotal role of early detection and intervention in RV management, particularly in community hospital settings.
类风湿关节炎（RA）是一种具有广泛临床异质性的慢性炎症性疾病。在其并发症中，类风湿血管炎（RV）因其严重性和累及多个器官系统的可能性而引人注目。RV的一种特别严重的表现是缺血，这表明血管炎已进展到晚期且存在组织损伤的重大风险。本病例报告描述了一名83岁的RA男性患者，他出现多关节疼痛和手部缺血。尽管最初诊断为RA病情加重，但在无明确感染原因的情况下全身症状恶化以及补体血症低下导致诊断为RV病情加重。最初使用类固醇治疗显示出暂时的改善效果。然而，剂量减少后病情复发促使使用利妥昔单抗，一种抗分化簇20（抗CD20）单克隆抗体，最终取得了良好的治疗效果。本病例强调了老年RA患者临床警惕诸如手部缺血等体征的重要性，突出了早期发现和干预在RV管理中的关键作用，尤其是在社区医院环境中。
