13290 Rheumatoid Vasculitis

Overview

Rheumatoid vasculitis is a rare but serious condition that can affect people who have rheumatoid arthritis. It happens when the same immune system that attacks the joints also attacks and inflames small and medium-sized blood vessels. This can reduce blood flow to the skin, nerves, and organs.

No. Rheumatoid vasculitis is very rare. It is now even less common because rheumatoid arthritis is treated more effectively than in the past.

It most often affects people who have had rheumatoid arthritis for at least 10 years, especially those with severe joint disease, a history of smoking, or who are male. About 1 in 100 people with RA may develop it.

Symptoms

Common symptoms

• Skin symptoms such as small red-purple spots, skin ulcers, especially around the lower legs or fingers
• Numbness, tingling, or burning pain in parts of the body, such as hands and feet (from nerve damage)
• Painful, pale, or blue fingertips and toes, sometimes with tiny dark spots or sores
• Fatigue, fever, weight loss, or a general feeling of being unwell
• Eye redness, pain, or vision problems (if eye blood vessels are involved)

Symptoms in children

• This condition almost never appears in children. Children with juvenile arthritis can have rashes or fevers for other reasons.
• If a child with arthritis develops new rashes, numbness, or pain, seek medical advice promptly.

Symptoms in older adults

• Older adults may have more fatigue and confusion if vasculitis affects the brain or organs.
• They are also more likely to have leg ulcers, poor circulation, and infections because of age-related frailty.

Causes

Main causes

• The exact cause is not known. It is an autoimmune reaction where the body's defense system attacks its own blood vessels.
• In people with rheumatoid arthritis, ongoing inflammation may lead the immune system to make abnormal autoantibodies that stick to blood vessel walls and cause inflammation.

Risk factors

• Long-term, active rheumatoid arthritis
• Smoking
• High levels of rheumatoid factor or anti-CCP antibodies in the blood
• Presence of rheumatoid nodules under the skin
• Being male

When to see a doctor

See a doctor urgently if:

• If you develop any of the emergency signs above, call your local emergency number immediately.
• If you have spreading skin ulcers, worsening pain, or new numbness, get same-day medical assessment.

Book a routine appointment if:

• If you have rheumatoid arthritis and notice skin changes, unexplained fatigue, or new numbness, book an appointment with your GP or rheumatology team.
• If you are already on RA treatment and have new symptoms, tell your specialist team.

Diagnosis

A doctor will review your medical history, examine your skin and nervous system, and may order blood and imaging tests. You will likely be referred to a rheumatologist, a specialist in immune and joint conditions.

Tests that may be done

• Blood tests for inflammation markers, rheumatoid factor, anti-CCP antibodies, and ANCA (antibodies linked to some vasculitides)
• Urine tests to check kidney involvement
• Skin biopsy — removing a tiny piece of affected skin to examine under a microscope
• Nerve conduction studies to check nerve damage
• Imaging tests such as chest X-ray, MRI, or CT scan to look at blood vessel changes

What to expect at your appointment

A skin biopsy can feel a little sore but is usually quick. Blood tests may take a few days. If vasculitis is suspected, treatment is often started quickly to protect organs.

Treatment

The goal of treatment is to reduce inflammation, calm the immune system, and protect blood flow to important organs. This often involves a combination of strong anti-inflammatory medicines and treatments that suppress the immune system. Starting treatment early gives the best chance of preventing permanent damage.

Self-care at home

• Stop smoking — this is one of the most important steps to protect your blood vessels.
• Keep your skin clean and moisturised, and use soft dressings on ulcers as advised.
• Keep warm and wear gloves/socks to improve circulation in hands and feet.
• Take your rheumatoid arthritis medicines exactly as prescribed, and attend regular check-ups.
• Tell your doctor straight away if you notice new symptoms in your skin, nerves, or vision.

Medical treatments

Typical treatment includes medicines that calm the immune system, such as steroid tablets or infusions, and stronger immunosuppressive therapies. These medicines may be given as tablets, injections, or through a drip in hospital. Your specialist will choose a plan based on how severe the vasculitis is and which organs are affected. Treatment is usually continued for months to years, then reduced carefully.

When is surgery considered?

Surgery is rarely needed. It may be used in severe cases to remove dead tissue from digital ulcers (gangrene) or to repair damaged bowel caused by blocked blood vessels.

Living with this condition

Living with rheumatoid vasculitis means keeping a close eye on your symptoms and working closely with your rheumatology team. Keep a symptom diary if it helps, and tell your team about any new rash, numbness, ulcers, or chest or belly pain. Manage your energy and prioritise rest when your body needs it.

Lifestyle tips

• Quit smoking and avoid secondhand smoke.
• Protect your skin from cold and trauma using gloves, socks, and padded cushions.
• Keep up with gentle movement to reduce stiffness and maintain circulation.
• Look after your mouth and eyes — dry eyes and mouth can be a part of the condition.

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, wholegrains, and healthy fats, as this supports your heart and blood vessels. Regular low-impact exercise, such as walking or swimming, can improve fitness and wellbeing — but talk to your physiotherapist before starting new exercise if you have tissue damage.

Mental health and emotional wellbeing

Living with a rare complication like vasculitis can feel frightening and overwhelming. It can bring up anxiety, low mood, or stress. You may feel isolated. It is important to acknowledge these feelings and talk to your doctor or a mental health professional. You are allowed to ask for help.

Prevention

You cannot always prevent rheumatoid vasculitis, but controlling rheumatoid arthritis well and stopping smoking can reduce your chance of it developing. Taking your RA medicines as prescribed and attending regular reviews are the best ways to lower risk.

Vaccines

Because vasculitis medications weaken the immune system, it is important to keep your vaccinations up to date — but always ask your doctor before having any live vaccine. Your rheumatology team can give you a personal vaccination plan.

Screening programmes

There is no routine screening test for vasculitis. Regular rheumatology follow-up for RA is the best way to catch early warning signs.

Complications

If left untreated

• Nerve damage causing persistent numbness, weakness, or pain
• Skin ulcers that become infected or do not heal, sometimes leading to tissue death (gangrene)
• Damage to internal organs such as lungs, heart, kidneys, or gut
• Stroke or heart attack if blood vessels to the brain or heart are involved
• Bowel perforation (a tear in the bowel) caused by blockage of blood vessels

Long-term outlook

The outlook has improved greatly with modern treatment. Many people with rheumatoid vasculitis recover, especially when it is caught early and treated aggressively. Some people may need long-term immune-suppressing therapy, but the aim is to control the disease and protect your organs. You can live well with this condition by keeping close to your medical team and looking after your health.

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