Clinical heterogeneity and prognostic determinants in rheumatoid vasculitis: a systematic analysis of organ-specific manifestations, therapeutic outcomes, and biomarker correlations.
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Abstract
Background: Rheumatoid vasculitis (RV), a severe extra-articular complication of rheumatoid arthritis (RA), with current evidence limited to fragmented case reports and a lack of consensus on diagnostic/therapeutic protocols. This study systematically evaluated the clinical heterogeneity, prognostic determinants, and management challenges of RV through the comprehensive analysis of case reports.
Methods: We conducted a systematic review of 112 RV cases from PubMed, Scopus, and Embase in the past 10 years. After dual-reviewer screening and exclusion of confounded cases (concurrent autoimmune diseases, drug-induced vasculitis, infection-associated cases), data spanning demographics, organ involvement patterns, treatments, and outcomes were extracted. Subsequent statistical analyses and data visualization were conducted using R software.
Results: The mortality group exhibited significantly higher rates of concurrent infections (P = 0.03) and elevated anti-cyclic citrullinated peptide (anti-CCP) antibody titers (P = 0.04) compared to the survival group. Only less than half of the medical records had histopathological confirmation of the diagnosis, which was particularly notable in cardiac (14.3%, 1/7), pulmonary (33.3%, 2/6),and cerebral (25.0%, 9/36) involvement. During the induction of disease remission, glucocorticoids remained the primary therapy. Both conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (P < 0.05) and biologic DMARDs (P < 0.001) demonstrated favorable prognostic associations.
Conclusions: This study highlighted RV's heterogeneous organ involvement and underscored the prognostic value of anti-CCP and infection screening. The limited histopathological confirmation rates emphasized the need for multimodal diagnostics. Our findings also provided robust evidence supporting the therapeutic efficacy of biologic DMARDs in RV management.
期刊介绍：
Frontiers in Immunology is a leading journal in its field, publishing rigorously peer-reviewed research across basic, translational and clinical immunology. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Immunology is the official Journal of the International Union of Immunological Societies (IUIS). Encompassing the entire field of Immunology, this journal welcomes papers that investigate basic mechanisms of immune system development and function, with a particular emphasis given to the description of the clinical and immunological phenotype of human immune disorders, and on the definition of their molecular basis.
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