Malignant rheumatoid arthritis (MRA) is RA complicated with vasculitis. The symptoms of vasculitis include cutaneous ulcers/infarctions/necrosis, mononeuritis multiplex, pericarditis, coronary vasculitis, pulmonary vasculitis, episcleritis, and other symptoms of systemic vasculitis, which often are refractory and severe. Apheresis therapy for MRA is covered by insurance in Japan.