Intestinal infarction in rheumatoid arthritis. Three cases due to unusual obliterative vascular lesions.

During a ten-year period, we observed three patients with complicated rheumatoid arthritis (RA) and bowel infarction in which the distal mesenteric vessels were occluded by proliferative endarteritis characterized by intimal proliferation, without vessel wall necrosis or inflammation. Proliferative endarteritis was originally described in patients with RA and digital infarcts and has only rarely been noted in patients with visceral infarcts. Our three patients' pathologic features suggested that these vascular lesions were progressive and rendered patients vulnerable to bowel infarction during periods of decreased cardiac output. Two of the three patients had intestinal infarction without clinical or pathologic evidence of systemic vasculitis. Proliferative endarteritis of visceral arteries rarely causes morbidity and mortality in patients with RA.