SYSTEMIC VASCULITIS IN RHEUMATOID-ARTHRITIS - A CLINICOPATHOLOGICAL STUDY

The frequency and patho-histological characteristics of systemic vasculitis were studied on the autopsy material of 137 patients who had been suffering from rheumatoid arthritis (RA). Systemic vasculitis was observed in 17 cases (12.4 %). The frequency and severity of vasculitis varies with the organs. The most frequently involved organs are the heart, lungs, periphereal nerves, skeletal muscles, pancreas and adrenal gland. The kidney, liver, gastrointestinal tract (GI tract) were less often affected. Vasculitis of the skin was observed in only two of 17 cases. Systemic vasculitis may exist without skin manifestation. 3 types of vasculitides could be observed simultaneously in different vessels or combined in the same vessel. Different stages of inflammation can be found simultaneously in the same vessel and can be seen simultaneously side by side in the same patient. Vasculitis of small arteries and arterioles can lead to local ischaemia and (regressive changes. Microinfarctions of the myocard due to vasculitis were the direct cause of death in 9 cases. A disseminated (focal) lobular-sublobular pneumonia, caused by vasculitis of the pulmonary and bronchial arterioles, and of small arteries (vasculogenic rheumatoid pneumonia), were the cause of death in 3 cases. Systemic vasculitis led to death in 12 of 17 cases 70.6%). There was no significant difference in the age, sex, disease duration, Waaler-Rose, latex, BSR, red blood cells, haemoglobin, white blood cells, carbamide, serum bilirubin, blood sugar, RR, urine specific density, urine sediment RBC, WBC content and proteinuria of vasculitic and non-vasculitic patients. It means that systemic vasculitis may complicate RA in all stages of the disease and does not necessarily mean a severe RA. Most important is the organ involvement and the localisation of the vasculitis.