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The wide range of symptoms seen in vasculitis reflects the potential for damage from poor blood flow to a variety of affected tissues throughout the body. For example, vasculitic damage to the lungs may cause shortness of breath and cough; damage to nerves may lead to numbness or weakness in a hand or foot; and damage to skin may produce red spots (purpura), nodules, or ulcers. On the other hand, vasculitis of the kidneys may produce no symptoms at first but is a quite serious problem.
Vasculitic diseases can be mild or life-threatening, and either limited to a single episode, or multiple ones.
Most patients with vasculitis can be diagnosed with a specific vasculitic disease based on the size of the affected blood vessels and the organs most commonly involved (see table). However, for some patients, a specific type of vasculitis cannot be determined.
Types of Vasculitis | ||
Largest arteries: aorta and major branches |
| |
Medium-sized arteries | Kawasaki’s disease Polyarteritis nodosa | |
Small and medium-sized arteries | ANCA-associated vasculitis Wegener’s granulomatosis Microscopic polyangiitis Churg-Strauss syndrome Primary angiitis of the central nervous system | |
Small arteries | Henoch-Schönlein purpura Vasculitis associated with rheumatoid arthritis, lupus, Sjögren’s syndrome Cryoglobulinemic vasculitis Goodpasture’s syndrome Drug-induced vasculitis | |
Arteries and veins of various sizes | Behcet’s disease Relapsing polychondritis | |
This list includes the most frequently diagnosed forms of vasculitis but is not complete and does not include some forms of vasculitis associated with other diseases such as cancer-associated vasculitis or come types of infection-associated vasculitis. | ||
Most patients with vasculitis can be diagnosed with a specific vasculitic disease based on the size of the affected blood vessels and the organs most commonly involved.
Physicians consider the possibility of vasculitis when a patient has symptoms, physical exam signs, and/or laboratory tests suggesting damage to one or more organ systems in the absence of another clear cause.
Methods to diagnose vasculitis depend on the size of the vessel involved. Small-vessel vasculitis is usually diagnosed by biopsy (for example, of skin or kidney). Medium-vessel vasculitis is diagnosed by either biopsy (for example, of skin, nerve, or brain) or angiography (a type of x-ray in which dye is used to look for abnormalities of blood vessels). Large-vessel vasculitis is also often diagnosed by angiography, although giant cell arteritis is usually diagnosed by biopsy of the temporal artery in the scalp.
A few forms of vasculitis, such as Behcet’s disease and Kawasaki’s disease, are usually diagnosed on the basis of a collection of clinical findings rather than biopsy or angiography. Some blood tests are so suggestive of a particular type of vasculitis that a positive test can sometimes allow for diagnosis without biopsy or angiography. The most useful of these tests is for anti-neutrophil cytoplasmic antibodies (ANCA); a positive ANCA test can be extremely helpful in establishing a diagnosis of Wegener’s granulomatosis, microscopic polyangiitis, or Churg-Stauss syndrome. Other laboratory tests are important for showing damage to internal organs but the tests are not enough to establish a diagnosis of vasculitis.
Glucocorticoids (prednisone, prednisolone, or other similar drugs), often referred to as “steroids,” are an important part of therapy for most forms of vasculitis, but dose and duration vary with the severity and chronicity of the disease.
Other immunosuppressive agents are used either because the disease is so severe that glucocorticoids alone are insufficient treatment, or because the long-term side-effects of these other drugs are less severe than those of glucocorticoids (“steroid-sparing”). Cyclophosphamide is the strongest of these immunosuppressive drugs and is used to treat severe disease that endangers vital organs. Rituximab, methotrexate, and azathioprine are also used to treat non-life-threatening vasculitis and are useful as steroid-sparing agents. Plasma exchange (plasmapheresis) and intravenous immunoglobulin (IVIG) are sometimes used in severe cases of particular forms of vasculitis that are thought to be caused by circulating autoantibodies.
Finally, permanent damage from severe vasculitis sometimes requires surgical treatment, such as vascular bypass grafting, sinus surgery, or kidney transplantation.
Vasculitis can be a temporary or a life-long problem, and symptoms and complications of vasculitis vary from being merely annoying, to disabling, to life-threatening.
Physicians often focus, with good reason, on preventing permanent damage to critical organ systems such as the lungs, kidneys, brain, and nerves. It is crucial to work to prevent death and long-term disability from vasculitis, but other issues often trouble patients with vasculitis more on a day-to-day basis, including fatigue, pain, arthritis, nose and sinus problems, and many other problems. Side effects from medications, especially glucocorticoids, can be particularly troubling.
With current treatment strategies, the outcome for patients with vasculitis is often quite good. Patients with vasculitis are encouraged to try to live completely normal lives, but to remember that they may be at risk of recurrence of vasculitis, or at risk of infection if they need to remain on immunosuppressive medications.
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