CLINICAL REPORT SMALL-BOWEL NECROSIS DUE TO ARTERITIS IN RHEUMATOID DISEASE

T H E occurrence of arteritis in rheumatoid disease is being noted with increasing frequency. Various tissues have been shown to be affected, but arteritis involving the small mesenteric arterioles seems to have been a rare finding. This may be due partly to the random post-mortem sampling, which may miss segmental arteritis, and partly to the very mild forms which escape clinical detection and therefore investigation. Mesenteric arteritis with necrosis and perforation of the gut in polyarteritis nodosa has been described by Pugh and Stringer (1956), while Pollak et al. (1958) reported its occurrence in systemic lupus erythematosus (S.L.E.). Arteritis in rheumatoid disease may be impossible to differentiate from that occurring in other collagen disorders, probably because the blood-vessels react to an offending stimulus in a uniform pattern, thus producing a similar picture to that seen in S.L.E. and polyarteritis nodosa. When a patient with rheumatoid disease develops parenchymal, serosal, or renal involvement, then the probability of necrotizing arteritis, S.L.E., or secondary amyloidosis arises. Peripheral neuritis, leg ulcers, and digital gangrene woul