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Rheumatoid Vasculitis — RACP Adult Medicine MCQ

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HardRheumatologyRheumatoid VasculitisRACP Adult Medicine

A 60-year-old man presents with progressive symmetric polyarthritis affecting small joints of hands and feet, with rheumatoid nodules and positive RF (1:640) and anti-CCP (>300 U/mL). He also has a sensory peripheral neuropathy, palpable purpura, and cryoglobulins are positive (type III). C4 is low. What is the extra-articular RA manifestation?

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Correct answer: D — Rheumatoid vasculitis

Long-standing seropositive RA (high-titre RF, anti-CCP) with peripheral neuropathy, palpable purpura, and cryoglobulinaemia (type III) is rheumatoid vasculitis. It affects small-medium vessels and is a serious extra-articular manifestation occurring in severe seropositive RA. Other features: digital gangrene, skin ulcers, scleritis, mesenteric vasculitis. Treatment: aggressive immunosuppression (cyclophosphamide or rituximab + corticosteroids). It is becoming rarer with modern DMARD/biologic therapy.

Reference: eTG Rheumatology – 2024 – Extra-articular RA; BSR 2024