Malignant rheumatoid arthritis

: Malignant rheumatoid arthritis (MRA) is designated as rheumatoid arthritis with vasculitis, but MRA is commonly called rheumatoid vasculitis in western countries. Patients with MRA show a variety of symptoms and signs based on vasculitis. The clinical features include subcutaneous nodule, skin ulcer, pericarditis, myocarditis, pleuritis, pneumonitis, intestinal infarction, mononeuritis multiplex and other involvements. The cause of the various vascular lesions in MRA has not been clearly defined, but a number of observations suggest that they result from injury induced by immune complexes, especially, those containing rheumatoid factor (RF). The theory of self-associated IgG RF has been proposed. MRA is usually treated with steroid, and steroid pulse therapy and immunosuppressants are highly useful for severe MRA.