REVIEW article
Front. Immunol.
Sec. Autoimmune and Autoinflammatory Disorders : Autoimmune Disorders
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1628504
This article is part of the Research TopicCommunity Series in Prognostic and Predictive Factors in Autoimmune Connective Tissue Disorders Volume IIView all 7 articles
Clinical Heterogeneity and Prognostic Determinants in Rheumatoid Vasculitis: A Systematic Analysis of Organ-Specific Manifestations, Therapeutic Outcomes, and Biomarker Correlations
Provisionally accepted
- 1Affiliated Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
- 2Nanjing University of Chinese Medicine, Nanjing, China
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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.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.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.
Keywords: Rheumatoid Vasculitis, Biologic DMARDs, anti-CCP antibodies, Multi-organ involvement, Prognostic biomarkers, infection risk stratification
Received: 14 May 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 Wang, Lu, Shen, Zhang and Shang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei Shang, Affiliated Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
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