Cromie David A J, Stewart Sarah K, Wright Gary D, Healy Estelle G
Department of Intensive Care Medicine, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK.
Department of Rheumatology, Craigavon Area Hospital, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK.
Rheumatol Int. 2025 Jul 14;45(8):168. doi: 10.1007/s00296-025-05926-z.
Rheumatoid vasculitis (RV) is an extra-articular manifestation (EAM) of rheumatoid arthritis (RA), which is typically observed in long-standing, severe disease. The skin and peripheral nerves are most commonly affected, although the clinical presentation can be highly variable. We report an unusual case of a 58-year-old male who presented with peripheral neuropathy, constitutional symptoms, and Raynaud's phenomenon and was subsequently diagnosed with RV despite having no history of RA. Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies were strongly positive, and a sural nerve biopsy demonstrated vasculitis. The patient also developed nodular lesions over his forearms consistent with rheumatoid nodules that regressed following treatment. Currently, the patient has not developed any clinical synovitis. In addition, a search of Pubmed/Medline, Embase, Web of Science, ScienceDirect, the Directory of Open Access Journals (DOAJ), and Google Scholar identified 18 full-text case reports describing patients who developed RV in the absence of a diagnosis of RA at the time of onset. Further analysis of these cases revealed a wide range of clinical manifestations. RV preceded RA onset in 5 of these patients, with durations ranging from 6 months to 6 years. In addition to our patient, 3 patients with RV who did not develop evidence of articular involvement were identified. The development of subcutaneous nodules in our patient appeared to be a unique finding among the identified patients. We highlight that RV can precede RA and suggest that this presentation be considered in any future diagnostic criteria for RV.
类风湿性血管炎（RV）是类风湿关节炎（RA）的关节外表现（EAM），通常在病程长且病情严重的患者中出现。皮肤和周围神经最常受累，尽管临床表现可能差异很大。我们报告了一例罕见病例，一名58岁男性，表现为周围神经病变、全身症状和雷诺现象，尽管既往无RA病史，但随后被诊断为RV。类风湿因子（RF）和抗环瓜氨酸肽（抗CCP）抗体均呈强阳性，腓肠神经活检显示血管炎。患者前臂还出现了与类风湿结节一致的结节性病变，治疗后消退。目前，患者未出现任何临床滑膜炎。此外，检索PubMed/Medline、Embase、Web of Science、ScienceDirect、开放获取期刊目录（DOAJ）和谷歌学术，共找到18篇全文病例报告，描述了发病时未诊断为RA却发生RV的患者。对这些病例的进一步分析显示了广泛的临床表现。其中5例患者RV先于RA发病，持续时间从6个月至6年不等。除了我们的患者外，还发现了3例无关节受累证据的RV患者。我们的患者出现皮下结节似乎是已识别患者中的独特发现。我们强调RV可能先于RA出现，并建议在未来任何RV的诊断标准中考虑这种表现。
