Ab0627 Clinical Characteristics and Associations of Rheumatoid Vasculitis: A Monocentric Retrospective Study

Background: With the advances in the treatment of Rheumatoid arthritis, the incidence of Rheumatoid vasculitis (RV) has decreased, especially in the Caucasian population. (1) There is a paucity of studies on Rheumatoid vasculitis from Indian subcontinent and hence the exact prevalence and associations of Rheumatoid vasculitis in this population is not clear. Objectives: We aimed to study the prevalence, clinical characteristics, and associations of Rheumatoid vasculitis. Methods: We conducted a retrospective records review of all adult patients who fulfilled the 2010 ACR EULAR classification criteria of Rheumatoid arthritis and attended the Rheumatology clinic/ admitted in the wards of a tertiary care hospital in South India between October 2020 and December 2023. Among these patients, the various Rheumatoid vasculitis manifestations screened were scleritis, episcleritis, vasculitic neuropathy, non healing vasculitic ulcers, palpable purpura, nail fold infarcts, digital ischemia, pyoderma gangrenosum, peripheral ulcerative keratitis, and Rheumatoid nodules. The comorbidities studied were diabetes mellitus, systemic hypertension, coronary artery disease, chronic obstructive pulmonary disease, hypothyroidism, and stroke. Age, gender, disease duration, comorbidities, seropositivity, ESR, smoking, DAS28 ESR and methotrexate use were compared between patients with RV and those without RV. Means were compared with unpaired t test, whereas medians were compared using Mann Whitney U test. Categorical variables were compared using Chi-squared test. Binomial logistic regression was used to identify factors associated with Rheumatoid vasculitis. Results: Out of the 430 RA patients included, 369 were female (85.8%) and the median age was 52 years (45-60). The median disease duration was 36 months (12-108). Rheumatoid factor (RF) was positive in 85.3% of patients. 41.6% patients had at least 1 comorbidity. 7.2% of patients were current or former smokers. 49.5% of patients were methotrexate naïve. Median DAS 28 ESR was 4.67 (3.81-5.62). Rheumatoid vasculitis was seen in 28 patients (6.5%). Among patients with RV, 78.5% were female. The median age of patients with RV was 53.5 years (48-62) and the median disease duration was 108 (72-186) months. 96.4% of Rheumatoid vasculitis patients were seropositive and 7.14% were smokers. 35.72% of patients with RV were methotrexate naive and 57.14 % had atleast 1 comorbidity. The most common manifestations of Rheumatoid vasculitis were anterior scleritis (n=8, 28.5 %), vasculitic neuropathy (n=7, 25%), Rheumatoid nodules (n=7, 25%), non healing vasculitic ulcer (n=5, 17.8 %), pyoderma gangrenosum (n=2, 7.1%) and peripheral ulcerative keratitis (n=2, 7.1 %). On binomial logistic regression, longer disease duration and lower DAS28 ESR were significant factors associated with Rheumatoid vasculitis (Table 1). Conclusion: Despite decreasing prevalence in Caucasian populations, we found that Rheumatoid vasculitis is still a major concern in South Indian patients with RA. As has been previously reported, we found positive association of RV with long disease duartion and negative association with joint disease activity. Contrary to Caucasian cohorts, Rheumatoid vasculitis was seen irrespective of the age, seropositivity status, smoking or methotrexate use in our population. REFERENCES: [1] Ntatsaki E, Mooney J, Scott DG, et al. Systemic rheumatoid vasculitis in the era of modern immunosuppressive therapy. Rheumatology (Oxford). 2014;53(1):145–52. doi:10.1093/rheumatology/ket326. Acknowledgements: Department of Internal Medicine Government Medical College Kottayam. Disclosure of Interests: None declared.