Arteritis in rheumatoid arthritis

Abstract The clinical and pathologic features of seventeen patients with rheumatoid arthritis and histologically proved arteritis were examined and compared with the findings in fourteen other patients with arthritis who had a negative biopsy. Of the seventeen patients with arteritis, eleven had a necrotizing lesion. The reports of an additional eighty-one patients with arteritis, described in the literature, were surveyed for comparison with those of the present study. Several findings were more commonly associated with the patient with necrotizing arteritis. These included a higher incidence of episcleritis, peripheral neuritis and the serum L.E. factor. The presence of these findings is suggestive evidence of necrotizing arteritis. Subcutaneous nodules and clinically diagnosed pericarditis were noted equally in patients with either type of arteritis but infrequently in the patients with a negative biopsy. No precipitating factors for arteritis were found. Evidence for the suggestion that the use of corticosteroids is related to this complication is not convincing, although more cases of necrotizing arteritis have been reported in the era after cortisone; the data lend some support to the suggestion that in some patients corticosteroid may promote transformation of nonnecrotizing to necrotizing arteritis. The data do not finally answer the question whether arteritis, especially of the necrotizing type, is a fundamental event in the pathogenesis of arthritis or, alternatively, that arteritis and arthritis are diverse manifestations of rheumatoid disease.