Rheumatoid vasculitis is a condition that causes blood vessels to be inflamed. It happens in some people who have had rheumatoid arthritis (RA) for a long time. RA affects millions of people. It happens most often in women in their 40s to 60s.

RA is an autoimmune disease. RA usually first affects joints. If it also affects blood vessels, it leads to rheumatoid vasculitis. Rheumatoid vasculitis can affect both small and medium-sized blood vessels. It doesn’t affect large blood vessels, except in rare cases. Damage to blood vessels may cause blockage of blood vessels causing minimum or no supply of oxygen to cells and tissues leading to tissue death.

Rheumatoid vasculitis: Causes and risks

Due to the complexity of the immune system, researchers have not totally understood the causes. According to hypothesis, a combination of various factors in which genes play an important role lead to rheumatoid vasculitis.  As far as risk is concerned, all RA patients  fall in the same category except smokers whose risk  increases by many folds.

Signs & Symptoms of rheumatoid vasculitis

Symptoms often don’t start until several years after someone have had RA for about 10 years or more. They often start after a period when the joint disease has become less active.

Rheumatoid vasculitis can affect blood vessels in many parts of the body. For this reason, it can cause many different symptoms. It most often damages blood vessels to the skin, fingers and toes, nerves, eyes, and heart. This reduces blood flow to these areas and damages them.

Many people with rheumatoid vasculitis have general symptoms, such as tiredness, fever, and weight loss. These symptoms are common in RA as well but their severity increases in rheumatoid vasculitis condition. Other symptoms of rheumatoid vasculitis may include:

• Skin sores (ulcers)
• Purplish bruises
• Pain in fingers and toes
• Tissue death (gangrene) in fingers and toes
• Muscle weakness in parts of the body
• Loss of feeling in parts of the body
• Tingling and pain in parts of the body
• Pain in eyes
• Redness in eyes
• Blurry vision
• Chest pain
• Abnormal heart rhythms, some of which may be fatal

Diagnosis and Management of rheumatoid vasculitis

Various tests are conducted to check inflammation, infections along with this biopsy of the affected blood vessel is also done to assess the damage of the tissue. Management may vary depending on how severe the vasculitis is and which blood vessels are affected. There is no established treatment for rheumatoid vasculitis. But early measures can help control vessel damage and ease symptoms. The management regime also includes:

• Steroid   medicines   given   by   mouth   or   through   a   vein   to   reduce inflammation
• Immunosuppressant medicines such as rituximab to help control the immune system
• Other immunosuppressant medicines such as cyclophosphamide, if the vasculitis is severe

These drug possess the risk of bleeding in urinary bladder or increased risk of infection. Patients are often prescribed with Vitamin – D and calcium supplements to ward off adverse effects like bone resorption. 

New approach in management of rheumatoid vasculitis

In Ayurveda RA is conceptually very well correlated with Aamvata. It is classified as a joint disorder which is further classified into (1) Cestavanta (Mobile) and (2) Sthira (Non-mobile). It is a Krichasadhaya Vyadhi but in modern system of medicine it’s an autoimmune disease as well as a metabolic disorder because of involvement of Aama which is an intermediated product formed during abnormal metabolism of food.

During the examination of joints this information is critical because disease like Sandhivata always occur in Cala sandhis but not in Sthira sandhi, because of predominance of Vata in Cala sandhi. Absence of Slesmadhara kala in which Slesaka kapha is absent or slightly present. This is an important diagnostic features that Amavata condition prevail in Slesaka kapha sandhi (synovial joints) only. That means Amavata affects the joints in limbs, mandible and vertebrae only.

The effective management strategies of this disease is mentioned in various Ayurveda texts. One such management approach is the use of Rasonadi Kwath which is mentioned in 26^th chapter of Bhavprakash. Rasonadi Kwath contains Rasona, Shunthi and Nirgundi. The combination of these drugs is Katu pradhan tikta rasa and except Amla rasa all others rasas are present in small amounts. It is Pradhanataha Ruksha and Teekshna in Guna, Ushana veerya, Pradhanatah Katu Vipaka, Kapha- Vatahara and Deepana.

Kwath is Laghu to digest as compared to Swarasa and Kalka. Rasonadi kwath is Karshaka in nature. It acts against the Snigdha, Pichila pradhana Gunas of Ama, and it reduces the Sarrvadaihika Ama lakshanas which are nothing but Samanya lakshana of Amavata.

Other Herbs that reduce inflammation may help downregulate the autoimmune response. Several herbs that have been traditionally used for this purpose also have been investigated scientifically to determine their mechanism(s) of action. These herbs include: Hops, Artemisia annua, Sarsaparilla, Reishi Mushroom, Ashwagandha, Nettle, Rehmannia, and Chinese Skullcap (Scute). Other important herbs that may have a role in decreasing both inflammation and the overzealous auto immune response include Boswellia serrata, Green Tea, Ginger, Turmeric, White Willow, Stephania and Chinese Thunder God Vine. One such herb Rehmannia (Rehmannia glutinosa) is also mentioned in Chinese tradional medicine text and has shown promise in bringing balance to aggressive autoimmune states. It is also used as blood and kidney (adrenal) tonic. Studies have shown that this herb possesses both immune-enhancing and immune-suppressant effects. This dual activity may render Rehmannia glutinosa superior to Disease Modifying Anti-Rheumatic Drugs (DMARDs), which can suppress the immune system to an extent that susceptibility to opportunistic infections is increased.

Modern pharmacological research has isolated various components in Rehmannia, which may be responsible for its adrenal toning, immuno- modulatory, and anti-inflammatory effects. Rehmannia also reduces allergic reactions by decreasing histamine release caused by TNF-alpha activity on mast cells. Another such herb is Boswellia (Boswellia serrata) which is a tree gum extract that has been shown to inhibit Th1 cytokines and promotes Th2 cytokines, which helps to reverse the imbalance of Th1 and Th2 that increases inflammation. Ginger (Zingiber officinale) has been shown to inhibit cyclooxygenase (COX) and lipoxygenase pathways. Ginger’s high concentration of proteolytic enzymes (zingibain) are partially responsible for its ability to subdue pain and inflammation. Proteolytic enzymes block the action of several inflammatory substances, including prostaglandins and leukotrienes. Ginger has been shown to decrease pain in arthritis. Turmeric (Curcuma longa) is a bright yellow herb with powerful anti-inflammatory properties, which are credited to a chemical component, curcumin. Research suggests that Turmeric suppresses NFkB and interleukin-8, while enhancing glutathione biosynthesis. Turmeric also inhibits NFkB activation.

Ayurvedic practitioners consider that disease is due to lack of balance within the body systems. Establishing proper balance by employing the above botanicals, therapies, and lifestyle modifications may thus offer a safe and effective alternative to conventional treatment and bring new hope to patients suffering from autoimmune diseases and their complications such as rheumatoid vasculitis.