ABSTRACT
A 65-year-old man with a 20-year history of rheumatoid arthritis was transferred to our hospital due to a second episode of intestinal obstruction, a fever, and joint pain within the previous 6 months. He had an extremely high rheumatoid factor level and decreased complement levels. Abdominal computed tomography, a small bowel series, and small intestinal endoscopy revealed severe ileal stenosis. Resection of the stenotic lesion was performed, and a histopathological examination revealed vasculitis. Rheumatoid vasculitis was diagnosed, and the patient began treatment with prednisolone and methotrexate, which improved his condition. Rheumatoid vasculitis is a rare, but possible cause of recurrent bowel obstruction.
Subject(s)
Arthritis, Rheumatoid/complications , Constriction, Pathologic/etiology , Ileum/pathology , Intestinal Obstruction/etiology , Rheumatoid Vasculitis/physiopathology , Aged , Constriction, Pathologic/surgery , Endoscopy, Gastrointestinal , Humans , Ileum/surgery , Intestinal Obstruction/surgery , Male , Methotrexate/therapeutic use , Prednisolone/therapeutic use , Rheumatoid Factor/blood , Rheumatoid Vasculitis/drug therapySubject(s)
Rheumatoid Vasculitis/epidemiology , Rheumatoid Vasculitis/physiopathology , Aged , Antirheumatic Agents/therapeutic use , Female , Forecasting , Humans , Incidence , Male , Middle Aged , Prognosis , Rheumatoid Vasculitis/drug therapy , Rheumatology/standards , Rheumatology/trends , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
We report a case of rheumatoid vasculitis (RV) that responded well to abatacept, a cytotoxic T lymphocyte-associated antigen 4 (CTLA4)-immunoglobulin fusion protein. A 38-year-old woman developed RV despite treatment with methotrexate and tumor necrosis factor (TNF) inhibitors. The effects of steroid therapy, immunoabsorption plasmapheresis, and interleukin-6 inhibitor were insufficient, however, administration of abatacept rapidly improved her clinical symptoms with almost normalization of the immunological findings. This is the first published case report of the successful treatment of RV with abatacept.