MADISON, Wisconsin—Rheumatoid vasculitis cases took a nosedive between the years 2000 and 2001, probably because treatment of rheumatoid arthritis (RA) with biologicals such as TNFα inhibitors and because standard care shifted to early, aggressive combination therapy, according to the University of Wisconsin's Christie Bartels, MD.

In a retrospective cross-sectional study reported in Arthritis & Rheumatism, Dr. Bartels and colleagues examined trends in rheumatoid vasculitis prevalence among more than 37,000 RA patients receiving care in the national Veterans Health Administration (VA) system.¹

They found “a clear decline in the prevalence of rheumatoid vasculitis, and this decline remained evident even after accounting for a decrease number of hospitalizations among RA patients.”

Between 2000 and 2001 rheumatoid vasculitis prevalence dropped by

• 53% among inpatients, and
• 31% among outpatients.

“Rheumatoid vasculitis appears to be a vanishing entity,” Dr. Bartels told Musculoskeletal Report.

The researchers suspect that the key factor in this decline may have been clinicians' shift to use of biologicals and to earlier, more aggressive combination DMARD therapy. Dr. Bartels told MSKreport.com that plans to explore this possibility are on the drawing board.

“We are currently trying to overcome the technical problem that within the VA data on drug treatment are in a different database from those on diagnosis. We intend to go back and examine what was actually done in drug treatment during the period in question,” Dr. Bartels said.

Smoking rates might also be a factor. During roughly the same period the VA initiated stronger programs to curtail smoking. Since smoking is a risk factor for RA severity, reducing tobacco consumption could have contributed to the decline in extra-articular RA pathology.

“We would like to study this, too, but unfortunately we are limited by the accuracy of our data sources. So far we have not identified sources that would let us study smoking status longitudinally in RA patients,” Dr. Bartels said.

Translating research into practice: RA treatment is not just good for the joints

From the clinical viewpoint, Dr. Bartels said that her data add further support for early, aggressive therapy in RA.

“This is important not only for articular disease but also for extra-articular manifestations such as rheumatoid vasculitis,” she said.

Reference

1. Bartels C, Bell C, Rosenthal A, et al. Decline of rheumatoid vasculitis prevalence among US veterans. A retrospective cross-sectional study. Arthritis Rheum. 2009;60:2553-2557.