Acro-osteolysis as the sole skeletal manifestation of rheumatoid vasculitis.

Vasculitis is a common complication of rheumatoid arthritis (occurring in 8 to 23% of patients with rheumatoid arthritis) (Kemper et al., 1957); it may result in ischaemia and infarction of bowel, kidney, heart, liver, spleen, pancreas, gall-bladder, peripheral nerves, lymph nodes, skeletal muscle, synovium, and skin (Adler et al, 1962). Gangrene of the fingers with acro-osteolysis is not uncommon in patients having this form of “malignant” rheumatoid arthritis, but in all previously reported cases, gangrene with acro-osteolysis has occurred only in the presence of pre-existing, severely erosive, rheumatoid arthritis and, usually, peripheral neuropathy (Johnson et al., 1959; O'Quinn et al., 1965; Slocumb et al., 1967; Skrifvars et al., 1969). This is the first report of a patient with biopsy-proven rheumatoid arthritis who had digital gangrene, acro-osteolysis, and auto-amputation secondary to rheumatoid vasculitis, in the absence of radiographically detectable erosive articular disease or peripheral neur...