UWSMPH LogoExperts from the University of Wisconsin School of Medicine and Public Health revealed a downhill trend in the number of rheumatoid arthritis (RA) patients who went on to develop rheumatoid vasculitis (RV).

RA is known to be an autoimmune disease which causes painful inflammation of the joints. Rheumatoid Vasculitis is known to be a complication of severe RA. It is estimated that nearly 2% -5% of RA patients develop RV. RV is believed to be an extra-articular symptom of rheumatoid arthritis which affects small and medium-size arteries inside the body. Supposedly, RV involves many body organs including the skin, eyes, heart, lungs, nerves to the hands and feet, as well as blood vessels in the fingers and toes.

In this cross-sectional study, Christie Bartels, M.D., from the University Of Wisconsin School Of Medicine along with her colleagues analyzed data of RA patients who were admitted to Veterans Health Administration (VHA) hospitals over a 22-year period i.e. from the year 1985 to 2006 or noticed in outpatient settings over a 10-year period from the year 1997 to 2006. Their reports were examined in order to determine the prevalence of rheumatoid vasculitis (RV) amongst them.

Evidently, more than 37,000 patient records where a diagnosis of RA were qualified for the study. In addition, 92% of them were men with a mean age of 64.9 years. In order to determine a RV diagnosis, experts included patients who had one of the following indications namely arthritis, mononeuritis multiplex, peripheral neuropathy. Mononeuritis multiplex appears to be an injury to multiple individual nerve fibers. Peripheral neuropathy seems to occur due to connective tissue disease called as gangrene or chronic ulcers.

The findings revealed a considerable drop of approximately 53% among inpatients and 31% among outpatients between 2000 and 2001.

According to a past study of data from California hospitals hospitalizations for RV seem to have declined between 1980 and 2001. However, analysis of only inpatient data could perhaps lift questions of whether RV cases escaped detection due to altering outpatient management of the disease.

Dr. Bartels state that, “Our study is the first to examine a national U.S. population for RV prevalence among both inpatients and outpatients. We found the frequency of RV fell from 41 to 28 cases per 1,000 RA outpatients and from 32 to only 15 cases per 1000 RA inpatients.”

Experts were of the opinion that the decline in RV reported in the current study may be attributed to a decrease in the number of RV incidences, a disease cure in some patients, patients discontinuing VHA services or dying, or error.

It was estimated that treatment for rheumatoid arthritis improved during the 1990s. Also, experts speculated that the use of biologic agents and more aggressive combinations of anti-rheumatic drugs targeting severe RA may perhaps have reduced extra-articular disease including RV.

Furthermore, this study included a greater number of men who were older than average RA patients. Also, their intake of tobacco was probably higher in contrast to most RA groups Supposedly, these demographics may limit the ability to apply the results to the general RA population.

“Future studies should examine trends in smoking and pharmacotherapy in relation to RV, and ongoing monitoring is merited,” concluded the authors.

Dr. Bartels concluded by saying that, “Previous reports have described increased rates of extraarticular manifestations among men, smokers, and persons who were older at the time of RA onset, so perhaps the characteristics of our study sample facilitated detection of changes among the most at-risk population.”

“As RA treatment evolves, it will be important to continue following trends in rheumatoid vasculitis prevalence using samples with a sex ratio that more closely reflects the general population,” she added.

They observed that the VHA made system-wide efforts in order to reduce tobacco use among patients. Apparently, this may have impacted the rates of rheumatoid vasculitis prevalence.

The findings of the study will be published in the journal, Arthritis and Rheumatism.