Vasculitis
Also known as: Blood Vessel Inflammation
A group of autoimmune conditions causing inflammation of blood vessels. Ranges from skin-limited disease to life-threatening organ involvement. Requires prompt diagnosis and treatment.
Key Facts
- Vasculitis can affect vessels of any size — large, medium, or small
- Giant cell arteritis is a medical emergency — can cause permanent vision loss
- ANCA antibodies help identify certain vasculitis types (GPA, MPA)
- Kidney involvement can progress rapidly and requires aggressive treatment
- Relapse is common — long-term monitoring is essential
What is vasculitis?
Vasculitis is a group of disorders characterized by inflammation of blood vessels. The inflammation can narrow, weaken, or scar blood vessels, restricting blood flow and damaging organs. Vasculitis can affect vessels of any size — from large arteries (giant cell arteritis) to tiny capillaries (small vessel vasculitis).
The presentation and severity vary widely depending on which vessels are involved:
- Large vessel — giant cell arteritis (GCA), Takayasu arteritis
- Medium vessel — polyarteritis nodosa
- Small vessel — granulomatosis with polyangiitis (GPA, formerly Wegener’s), microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
- Variable — Behçet’s disease
Symptoms
- Fatigue, fever, weight loss
- Skin rashes — purpura (purple spots), ulcers, nodules, livedo reticularis
- Joint and muscle pain
- Numbness or weakness in hands or feet (nerve involvement)
- Sinusitis, nosebleeds, or cough (upper and lower airway involvement in GPA)
- Blood in urine or elevated creatinine (kidney involvement)
- Headache, jaw pain, visual changes (giant cell arteritis — requires urgent evaluation)
- Shortness of breath (lung involvement)
How we diagnose it
- Blood work — ANCA antibodies (PR3-ANCA, MPO-ANCA), inflammatory markers (ESR, CRP), complete metabolic panel, urinalysis
- Biopsy — Skin, kidney, nerve, or other affected tissue to confirm vessel inflammation
- Imaging — CT angiography or MR angiography for large vessel disease; CT chest for lung involvement
- Urinalysis — Screening for glomerulonephritis (active sediment with red blood cell casts)
- Temporal artery biopsy or ultrasound — For suspected giant cell arteritis
How we treat it
- Corticosteroids — High-dose for acute disease, tapered as immunosuppression takes effect
- Immunosuppressants — Cyclophosphamide for severe organ-threatening disease; methotrexate or azathioprine for maintenance
- Biologic therapies — Rituximab for ANCA-associated vasculitis; tocilizumab for giant cell arteritis
- Plasma exchange — In severe cases with kidney or lung hemorrhage
- Monitoring — Regular blood work, urinalysis, and organ function testing to detect relapse early
- Bone protection and infection prophylaxis — Given the intensity of immunosuppression often required
At Synergy Rheumatology
Vasculitis is uncommon but serious. Diagnosis requires a systematic approach, and treatment involves potent immunosuppression that demands close monitoring. We manage vasculitis patients with regular laboratory surveillance and coordinate with nephrology, pulmonology, and other specialists based on organ involvement.
Have questions about vasculitis?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.