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Pathol Oncol Res 2008; Advance online publication
Multifocal pancreatitis is significantly associated with vasculitis in patients with rheumatoid arthritis (RA), Hungarian researchers report. Miklós Bély (Policlinic of the Hospitaller Brothers of St. John of God, Budapest) and Ágnes Apáthy (National Institute of Rheumatology and Physiotherapy, Budapest) studied a randomized autopsy population of 161 RA patients to determine the prevalence and histologic characteristics of vasculitis in the pancreas. Thirty-six (22.4%) of the 161 patients were suffering from systemic vasculitis. The researchers were able to fix and histologically stain pancreatic tissue samples from 28 of these patients. Bély and Apáthy identified non-specific, fibrinoid necrotic and granulomatous vasculitis, which existed simultaneously in different vessels or combined in the same vessel. Vessels of all sizes were affected with varying frequency and severity. Arteritis and/or arteriolitis were observed in 35.7% of the tissues examined and led to multiple focal pancreatitis in 50% of the individuals examined. “Vasculitis of the pancreatic arterioles and small arteries can lead to local ischaemia and to regressive changes in the pancreas,” say Bély and Apáthy. “Because of the recurrent nature of vasculitis with time these regressive changes accumulate within the pancreas and may contribute to an unexpected circulatory failure and sudden death of the patient.” It is therefore important to recognize vasculitis in organs affected by RA. Pancreatitis due to vasculitis was not clinically recorded in any of the patients affected in this cohort. The researchers suggest that: “Vasculogenic microinfarcts in the pancreas may be clinically characterized by unexplained recurrent abdominal symptoms and spontaneous remissions which insidiously may lead to metabolic failure resistant to therapy.” The results are published in the journal Pathology & Oncology Research. |