RHEUMATOID VASCULITIS - EXPERIENCE WITH 13 PATIENTS AND REVIEW OF THE LITERATURE
RHEUMATOID VASCULITIS - EXPERIENCE WITH 13 PATIENTS AND REVIEW OF THE LITERATURE
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DOI：
10.1016/0049-0172(85)90047-2
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发表时间：
1985-01-01
影响因子：
5
通讯作者：
PANUSH, RS
中科院分区：
文献类型：
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作者：
SCHNEIDER, HA;YONKER, RA;PANUSH, RS
类风湿性血管炎是类风湿性关节炎的一种罕见但潜在的灾难性并发症。目前关于类风湿血管炎的临床、实验室、组织学特征、管理或预后的广泛经验很少，也没有共识。因此，我们回顾了过去十年中13例患者的观察结果，并将其与报告的患者和北美风湿病学家的调查结果进行了比较。我们的患者为7男6女（年龄33 - 70岁），均患有活动性RA 4 - 36年。他们表现为感觉神经病变、多发性单神经炎、Felty综合征、皮肤病变、腿部溃疡、坏疽、贫血、白细胞增多、嗜酸性粒细胞增多、高滴度RF、低补体血症、CICs或冷球蛋白血症，与其他报道的类风湿血管炎患者几乎相同，但他们表现为体质症状、皮下结节、缺血性改变和蛋白尿，而不像其他系列患者那样一致。这些观察结果并不一定如受访者所期望的那样。与其他系列研究和调查对象建议的一样，我们倾向于选择青霉胺或细胞毒药物（或血浆置换）治疗单神经炎、坏疽或腿部溃疡，非甾体抗炎药、抗疟药、金或青霉胺治疗感觉神经病变或指部病变。4名患者死亡，2名病情恶化，7名病情稳定或好转，这一发现也与其他人的经历相似。类风湿性血管炎是一种罕见的、潜在的灾难性综合征，具有不同的临床病理特征，具有不同的预后意义，应单独治疗。
Rheumatoid vasculitis is an uncommon but potentially catastrophic complication of RA. There are few current extensive experiences and no consensus regarding the clinical, laboratory, histologic features, and management or prognosis of rheumatoid vasculitis. We therefore reviewed selected observations in 13 patients followed over the past decade and compared them with patients reported and with results of a survey of North American Rheumatologists. Our patients were seven men and six women (age, 33 to 70 years) who had had active RA for 4 to 36 years. They exhibited sensory neuropathy, mononeuritis multiplex, Felty syndrome, cutaneous lesions, leg ulcers, gangrene, anemia, leukocytosis, eosinophilia, high titers of RF, hypocomplementemia, and CICs or cryoglobulinemia approximately as frequently as other reported patients with rheumatoid vasculitis, but they displayed constitutional symptoms, subcutaneous nodules, ischemic changes, and proteinuria rather less consistently than in other series. These observations were not necessarily as expected by survey respondents. We, as in other series and suggested by survey respondents, tended to select penicillamine or cytotoxic drugs (or plasmapheresis) for patients with mononeuritis, gangrene, or leg ulcers, and nonsteroidal antiinflammatory drugs, antimalarials, gold, or penicillamine for sensory neuropathy or digital lesions. Four patients died, two deteriorated, and seven were stable or improved, a finding that was also similar to the experiences of others. Rheumatoid vasculitis is an uncommon, potentially catastrophic syndrome with varying clinicopathologic features that have different prognostic implications and should be managed individually.