Summary
Rheumatoid arthritis (RA) as a systemic disease can attack many other organs in addition to the joints. A variety of pathological lesions of the blood vessels are responsible for the extra-articular features (EAF). In the present study, we investigated firstly whether the presence of blood vessel changes in one organ—namely the skin—may indicate blood vessel pathology and, consequently, EAF in other organs. Secondly, we investigated the number of EAF in individual patients with RA, and observed whether this changed during the course of the disease. Fifty-one RA-patients (40 female, 11 male; ages had a mean of 49.5, minimum 19, maximum 73 years; mean duration of RA was 7.3, minimum 0.25, maximum 41 years) were included in the study. Punch biopsies from the posterior calf were examined immunohistologically for vessel wall immune deposits. Further, EAF were determined by means of instrumental clinical methods such as pulmonary function test, echocardiography, electromyography, and nerve conduction velocity measurement. At the first investigation 21/51 patients had skin vessel wall immune deposits (SVWID). Five patients—all showed SVWID at first investigation—died during the three-year investigation period, 10 patients could not be followed-up for unknown reasons; the skin biopsy of one patient could not be assessed. At the final investigation, we found SVWID in 11/35 patients. SVWID-positive patients had more EAF compared to SVWID-negative patients; this was true both, at the first investigation (1.85 EAF/patient vs 1.05 EAF/patient) and at the final investigation (1.91 EAF/patient vs 0.67 EAF/patient). However, if patients with and without SVWID at first investigation were followed-up independent of their belonging to SVWID-positive or SVWID-negative group at final investigation number of EAF did not change significantly in both patient groups. It can be concluded from these data that in RA-patients SVWID are poor indicators of prognosis regarding survival. Further, SVWID indicate a greater risk for presence of EAF. However, SVWID were not associated with an increase in the absolute number of EAF occuring during the period of observation in surviving patients.
Similar content being viewed by others
References
Bannatyne, G.A. Rheumatoid Arthritis. Bristol: John Wright, 1898.
Gordon, D.A., Stein, J.L., Broder, I. The extraarticular features of rheumatoid arthritis. A systemic analysis of 127 cases. Am J Med 1973, 54, 445–452.
Hurd, E.R. Extra-articular manifestations of rheumatoid arthritis. Semin Arthritis Rheum 1979, 8, 151–176.
Cruickshank, B. The arteritis of rheumatoid arthritis. Ann Rheum Dis 1954, 13, 136–146.
Bywaters, E.G.L. Peripheral vascular obstruction in rheumatoid arthritis and its relationship to other vascular lesions. Ann Rheum Dis 1957, 16, 84–103.
Conn, D.L., Schroeter, A.L., McDuffie, F.C. Cutaneous vessel immune deposits in rheumatoid arthritis. Arthritis Rheum 1976, 19, 15–20.
Bywaters, E.G.L. Vasculitis in rheumatoid arthritis. In: Non articular forms of rheumatoid arthritis, Proceedings of the IV ISRA Symposium, The Hague 1976, Editor: Feltkamp, T.E.W., Leyden, Staffens Scientific Pub Co., 1977, 82–84.
Ball, J. Rheumatoid arthritis and polyarteriitis nodosa. Ann Rheum Dis 1954, 13, 277–290.
Baydur, A., Mongan, E.S., Slager, U.T. Acute respiratory failure and pulmonary arteritis without parenchymal involvement. Chest 1979, 75, 518–520.
Machacek, E., Tausch, G. Arteriitis und Amyloidose bei chronischer Polyarthritis. Gleichzeitiger Nachweis durch Rectumbiopsie. Z Rheumatol 1974, 33, 267–272.
Meriwether, J.H., Weinberger, H.J., Cleason, I.O. The renal vascular lesion in rheumatoid disease. Arthritis Rheum 1967, 10, 298.
Ramos, M., Mandybur, T.I. Cerebral vasculitis in rheumatoid arthritis. Arch Neurol 1975, 32, 271–275.
Schmid, F.R., Cooper, N.S., Ziff, M., et al. Arteritis in rheumatoid arthritis. Am J Med 1961, 30, 56–83.
Sokoloff, L., McCluskey, R.T., Bunim, J.J. Vascularity of the early subcutaneous nodule of rheumatoid arthritis. AMA Archs pathol 1953, 55, 475–495.
Sokoloff, L., Bunim, J.J. Vascular lesions in rheumatoid arthritis. J Chron Dis 1957, 5, 668–687.
Ullman, S., Høier-Madsen, M., Halberg, P., et al. Deposits of immunoglobulins and complement in skin of patients with rheumatoid arthritis. Scand J Rheumatol 1979, 8, 119–123.
Westedt, M.L., Meijer, C.J.L.M., Vermeer, B.J., et al. Rheumatoid arthritis—The clinical significance of histo- and immunopathological abnormalities in normal skin. J Rheumatol 1984, 11, 448–453.
McGill, P.E., Brougham, P.A., Tulloch, J. Immune deposits in the skin of patients with rheumatoid arthritis. J Rheumatol 1984, 11, 454–456.
Rapoport, R.J., Kozin, F., Mackel, S.E., et al. Cutaneous Vascular Immunofluorescence in Rheumatoid Arthritis. Correlation with Circulating Immune Complexes and Vasculitis. Am J Med 1980, 68, 325–331.
Steinbrocker, O., Traeger, C.H., Battermann, R.C. Therapeutic criteria in rheumatoid arthritis. JAMA 1949, 140, 659–662.
Calkins, E. Committee report to ARA membership. June 1962, unpublished.
Wick, G., Baudner, S., Herzog, F. Immunfluoreszenz. Marburg/Lahn, Medizinische Verlagsgesellschaft, 1976.
Anthonisen, N.R., Danson, J., Robertson, P.C., et al. Airway closure as a function of age. Respir Physiol 1969, 8, 58–65.
Buist, S.A., Ross, B.B. Quantitative analysis of the alveolar plateau in the diagnosis of early airway obstruction. Am Rev Respir Dis 1973, 108, 1078–1087.
Horowitz, M.S., Schultz, C.S., Stinson, E.B., et al. Sensitivity and specificity of echocardiographic diagnosis of pericardial effusions. Circulation 1974, 50, 239–247.
Daniel, W., Sterzel, B., Rathsack, P., et al. Häufigkeit, klinische Korrelation und Verlauf echokardiographisch gesicherter Perikardergüsse bei chronischer Niereninsuffizienz. In: 3. Donau-Symposion für Nephrologie, Linz, 22.–24.09.78, Editor: Watschinger, B., Friedberg/Lahn, Carl Bindernagel, 1979, 216–221.
Zubler, R.H., Lange, G., Lambert, P.H., et al. Detection of immune complexes in unheated sera by a modified 125 I C1q binding test. Effect of heating in the binding of C1q by immune complexes and application of the test to systemic lupus erythematosus. J Immunol 1976, 116, 232–235.
Krapf, F., Renger, D., Schedel, I., et al. A PEG-precipation laser nephelometer technique for detection and characterization of circulating immune complexes in human sera. J Immunol Methods 1982, 54, 107–117.
Bültmann, B., Geitner, R., Seibold, H., et al. Interaction of circulating immune complexes with granulocyte function in rheumatoid arthritis. Klin Wochenschr 1980, 58, 727–732.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mielke, H., Daniel, W., Deicher, H. et al. A three-year prospective study of systemic manifestation in rheumatoid arthritis. Clin Rheumatol 6 (Suppl 2), 26–34 (1987). https://doi.org/10.1007/BF02203382
Issue Date:
DOI: https://doi.org/10.1007/BF02203382