Rheumatoid Vasculitis: Symptoms, Causes, and Management

Oct 7

8 min read

Updated: 3 days ago

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What is rheumatoid vasculitis?

Rheumatoid vasculitis is blood vessel inflammation triggered by rheumatoid arthritis, in which the immune system attacks blood vessels so they swell and carry less blood [1]. It usually affects people with severe RA for 10 years or more, causing skin sores, rashes and numbness in the hands and feet [1]. It is rare and needs rheumatologist care to protect organs [1].

Illustration showing skin ulcers and rashes, numbness and tingling in the hands and feet, and inflamed blood vessel walls with restricted blood flow in rheumatoid vasculitis. – rinnit.com — Rheumatoid vasculitis can affect the skin, the nerves, and the blood vessels of the hands and feet.

What the research says

Cases have fallen sharply since biologic RA treatments arrived. A scoping review of 60 articles found that the mean incidence of rheumatoid vasculitis dropped from 9.1 per million (95% CI 6.8 to 12.0) between 1988 and 2000 to 3.9 per million (95% CI 2.3 to 6.2) between 2001 and 2010, probably because RA became less severe and fewer people smoked (Mertz et al., Autoimmun Rev, 2023) [2].
The skin and nerves are involved most often. The same review reported skin involvement in 65 to 88% of cases, nerve involvement in 35 to 63%, heart involvement in 33%, and whole-body symptoms such as fever and weight loss in 70%. Smoking at RA diagnosis, longer disease duration, severe RA, positive RA antibodies, and male gender were linked to higher risk (Mertz et al., Autoimmun Rev, 2023) [2].
Rituximab can bring the vasculitis into remission. In a French registry of 1,994 people with RA, 17 were treated with rituximab for active rheumatoid vasculitis. At 6 months, 71% (12 patients) were in complete remission, and at 12 months 82% (14 patients) were in sustained complete remission. Severe infections occurred at a rate of 6.4 per 100 patient-years, and 3 of the 9 patients who did not receive maintenance rituximab relapsed (Puéchal et al., Arthritis Care Res, 2012) [3].

What Is Rheumatoid Vasculitis?

Rheumatoid vasculitis is an autoimmune complication in which the immune system, already damaging the joints in rheumatoid arthritis, begins to attack the blood vessels [1]. The vessel walls swell and thicken [1], which makes it harder for blood to reach the skin, nerves, and sometimes internal organs.

It is rare. Fewer than 50 out of every million people in the U.S. have it, and it affects fewer than 300 per million people older than 50 [1]. It was more common in the past, and the number of cases has declined as RA treatments have improved (Cleveland Clinic, 2024) [1]. Researchers credit early methotrexate use in the 1990s and, later, biologic therapy for much of this decline (Watts & Scott, Best Pract Res Clin Rheumatol, 2016) [2] [4].

Recognizing the Symptoms

Symptoms most often appear on the skin and in the nerves and muscles of the hands and feet [1] [2]. Severe cases can cause symptoms throughout the body [1].

Symptom Category	Common Signs
Skin	Sores (ulcers) on or near the fingertips, rashes or bumps, and discoloration or bruising [1].
Nerves and muscles	Pain in the hands, fingers, feet, or toes; numbness or tingling; and muscle weakness [1].
Whole body (severe cases)	Fever, fatigue, loss of appetite, weight loss, cough, chest pain, and abdominal pain [1].

Causes and Risk Factors

Rheumatoid vasculitis develops when RA is severe and long-lasting, usually more than 10 years [1]. The inflammation spreads from the joints to the blood vessels, especially in the hands and feet [1]. Anyone with RA can develop it, but the risk is higher for people who have:

Severe RA or RA in many joints (polyarthritis) [1].
Long-standing RA: Ten years or more [1].
Rheumatoid nodules: Bumps under the skin near joints affected by RA [1].
Felty syndrome: An RA complication that causes an enlarged spleen and a low white blood cell count [1].
A history of smoking: Cigarettes and other tobacco products raise risk and can worsen the condition [1].

Diagnosis and Clinical Testing

A doctor diagnoses rheumatoid vasculitis with a physical exam and tests [1]. Tell your provider how long you have had RA and how it is being managed. You will probably need to see a rheumatologist [1], who may order the following.

Physical exam and history [1]: Skin sores, nerve problems, and signs of organ involvement.
Blood tests [1]: Markers of inflammation and other antibodies, which also help rule out other types of vasculitis.
Imaging: X-rays, CT scans, MRI, and angiograms [1] to look at organs and blood flow.
Electromyography (EMG) [1]: Checks for nerve damage.
Biopsy [1]: A sample of affected tissue is examined for inflammation of the blood vessel walls.

Three-column infographic covering clinical evaluation, diagnostic testing with blood tests, biopsy, and EMG, and management with RA treatment, corticosteroids, and smoking cessation. – rinnit.com — Diagnosis starts with a clinical evaluation, then testing, and leads to a management plan.

Management and Treatment

The goal is to reduce inflammation in the blood vessels and prevent damage to organs [1]. Managing RA well can often treat rheumatoid vasculitis too, so the first step is usually to review and strengthen your current RA treatment [1].

RA treatment: Your rheumatologist may adjust the medicines that control your arthritis [1].
Corticosteroids [1]: These reduce inflammation quickly and are usually tapered gradually.
Immunosuppressants and biologics [1]: Treatment has conventionally used glucocorticoids with cyclophosphamide, and rituximab is playing a growing role (Watts & Scott, Best Pract Res Clin Rheumatol, 2016) [4]. Most treatment data are retrospective, and no formal guidelines exist (Mertz et al., Autoimmun Rev, 2023) [2].
ACE inhibitors: These blood pressure medicines may also be prescribed [1].
Quitting smoking: This can reduce the severity of rheumatoid vasculitis and may help prevent it [1].

Research suggests that hydroxychloroquine and low-dose aspirin may have a protective role, but this is still debated, so do not start or stop any medicine without your rheumatologist’s advice (Makol et al., Curr Opin Rheumatol, 2015) [5].

Outlook and Complications

Expect to manage rheumatoid vasculitis for a long time, possibly for life [1]. Even without severe symptoms, you will need regular follow-up with a rheumatologist, because relapses can occur. Morbidity and mortality remain high despite aggressive treatment, which is why early diagnosis matters (Makol et al., Curr Opin Rheumatol, 2015) [5].

Without treatment, rheumatoid vasculitis can cause:

Necrosis: Tissue death in the skin around the affected blood vessels [1].
Heart attack [1]: If vessels supplying the heart are inflamed.
Stroke [1]: If vessels supplying the brain are affected.

How to Lower Your Risk

You cannot prevent rheumatoid vasculitis outright, because you cannot prevent the RA that usually triggers it [1]. You can reduce your risk by keeping RA well controlled, attending regular check-ups, reporting new symptoms such as skin sores or numbness early, and quitting smoking if you smoke [1].

Infographic with three focus areas for reducing risk, manage RA, stop smoking, and regular monitoring, plus a warning about tissue death and organ damage from untreated rheumatoid vasculitis. – rinnit.com — Controlling RA, stopping smoking, and regular monitoring lower the risk of vasculitis complications.

Conclusion

Rheumatoid vasculitis is a reminder that rheumatoid arthritis can affect the whole body, not just the joints. It can be frightening, but it is much rarer than it once was, and treatment can bring it under control. Keeping RA well managed, quitting smoking, and reporting new symptoms early give you the best chance of avoiding serious complications.

Next Steps

If you have had RA for many years and notice new skin sores or numbness in your hands or feet, contact your rheumatologist promptly. Review your RA treatment plan with them to make sure it is working as well as it can. If you smoke, ask your doctor about support to quit. Seek emergency care right away for chest pain or stroke symptoms.

Trusted resources: Vasculitis Foundation, Arthritis Foundation, American College of Rheumatology.

Frequently Asked Questions

Is rheumatoid vasculitis the same as rheumatoid arthritis?

No. Rheumatoid arthritis mainly affects the joints. Rheumatoid vasculitis is a complication in which the same autoimmune process inflames the blood vessels.

Can you have vasculitis without rheumatoid arthritis?

Yes. There are many types of vasculitis that are not related to RA. Rheumatoid vasculitis specifically means vasculitis triggered by rheumatoid arthritis.

Who is most at risk for rheumatoid vasculitis?

People with severe RA, RA in many joints, RA for 10 years or more, Felty syndrome, rheumatoid nodules, or a history of smoking. A recent review also found that positive RA antibodies and male gender were linked to higher risk.

How does smoking affect rheumatoid vasculitis?

Smoking at the time of RA diagnosis is a recognized risk factor. Quitting smoking can reduce the severity of rheumatoid vasculitis and might help prevent it.

Are the skin sores painful?

Sores on or near the fingertips are one of the most common signs, and they often come with pain in the hands, fingers, feet, or toes. Any new sore in someone with long-standing RA should be checked by a rheumatologist.

Does rheumatoid vasculitis affect the heart?

Rheumatoid vasculitis can. A recent review found heart involvement in about one in three cases, and severe cases can cause chest pain or a heart attack. Seek emergency care for chest pain.

Is rheumatoid vasculitis curable?

Rheumatoid vasculitis is usually managed over the long term, possibly for life. Treatment can control it, but relapses can occur, so regular follow-up with a rheumatologist is important.

What kind of doctor treats rheumatoid vasculitis?

A rheumatologist, who treats inflammatory diseases. Depending on your symptoms, you may also see a dermatologist or neurologist.

Can rheumatoid vasculitis cause a stroke?

Yes. If inflammation affects the blood vessels that supply the brain, it can lead to a stroke. Sudden weakness, trouble speaking, or facial drooping needs emergency care.

What are rheumatoid nodules?

Rheumatoid nodules are firm bumps under the skin, usually near joints affected by RA. Having them is linked to a higher risk of rheumatoid vasculitis.

Does everyone with RA get vasculitis?

No. It is rare and has become less common. One review estimated its incidence at 3.9 per million between 2001 and 2010.

How is a biopsy used in diagnosis?

A doctor takes a small sample of affected skin, nerve, muscle, or other tissue and examines the blood vessels under a microscope for inflammation and damage.

What do corticosteroids do in treatment?

Corticosteroids quickly reduce inflammation in the blood vessels. They are usually combined with other immune-suppressing medicines, and the dose is tapered gradually under a doctor’s supervision.

Is exercise safe with rheumatoid vasculitis?

Ask your rheumatologist. Gentle movement is generally good for RA, but active vasculitis may call for rest while the inflammation is controlled.

References

Cleveland Clinic. Rheumatoid Vasculitis. Cleveland Clinic. May 20, 2024. https://my.clevelandclinic.org/health/diseases/13290-rheumatoid-vasculitis
Mertz P, Wollenschlaeger C, Chasset F, et al. Rheumatoid vasculitis in 2023: changes and challenges since the biologics era. Autoimmun Rev. 2023;22(9):103391. PMID 37468085. https://doi.org/10.1016/j.autrev.2023.103391
Puéchal X, Gottenberg JE, Berthelot JM, et al. Rituximab therapy for systemic vasculitis associated with rheumatoid arthritis: results from the AutoImmunity and Rituximab Registry. Arthritis Care Res (Hoboken). 2012;64(3):331–339. PMID 22076726. https://doi.org/10.1002/acr.20689
Watts RA, Scott DGI. Vasculitis and inflammatory arthritis. Best Pract Res Clin Rheumatol. 2016;30(5):916–931. PMID 27964796. https://doi.org/10.1016/j.berh.2016.10.008
Makol A, Matteson EL, Warrington KJ. Rheumatoid vasculitis: an update. Curr Opin Rheumatol. 2015;27(1):63–70. PMID 25405822. https://doi.org/10.1097/BOR.0000000000000126

Medical disclaimer

This article is for informational purposes only and does not constitute medical advice. Rheumatoid vasculitis is a serious condition. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.