Vasculitis Overview

What Is It?

Vasculitis means inflammation of blood vessels. The inflammation can be short term (acute) or long term (chronic), and it can be so severe that it reduces blood flow to tissues and organs. This can cause significant organ and tissue damage, especially when vasculitis affects blood vessels in the brain, lungs, kidneys or other vital areas.

Although the cause of most forms of vasculitis remains unknown, many probably are related to a problem with the immune system. One theory is that the immune system attacks the blood vessels, which causes them to become inflamed. Some researchers think this immune attack might be triggered by an infection, drug or something else in the environment.

There are many different forms of vasculitis, including:

• Polyarteritis nodosa — This affects small- to medium-sized blood vessels in many different parts of the body, especially the skin, intestines, kidneys and nerves. It is a progressive illness, meaning it continues to get worse, and it can lead to death. It typically occurs in adults in their late 40s or early 50s, and it affects men two to three times more often than women.
• Hypersensitivity vasculitis — This form of vasculitis affects the smallest blood vessels (including arterioles, veins and capillaries), especially those in the skin. Hypersensitivity vasculitis can be triggered by an allergy, including a reaction to a medication or an infection.
• Giant cell arteritis (also called temporal arteritis) — This affects larger arteries, including the aorta as it travels from the heart and separates into branches leading to the neck and head. It usually affects people over the age of 55. It is rare among African-Americans, but is relatively common among whites of Scandinavian ancestry. Studies suggest that at least part of the tendency to develop this illness is genetic (inherited).
• Wegener's granulomatosis — This affects small- and medium-sized blood vessels in the kidneys and in the upper and lower respiratory tract (for example, sinuses and lungs). It can occur in any age group and affects both sexes equally. The average age at the time the disease starts is 40, with only 15% of cases occurring in children and adolescents. It is rare among African-Americans.
• Takayasu's arteritis (also called aortic arch syndrome or pulseless disease) — This vasculitis affects medium- and large-sized arteries, especially the aortic arch and its branches near the heart. It most commonly affects teenage girls and young women, and is most common in Asia.
• Kawasaki disease — This vasculitis affects the lymph nodes, skin, mucous membranes, and heart, including the coronary arteries (arteries that supply blood to the heart). It is seen most commonly in children

Symptoms

Symptoms vary depending on the specific type of vasculitis:

• Polyarteritis nodosa — Fever, weight loss, weakness, fatigue, malaise (a generally sick feeling), headache, abdominal pain, muscle aches, hypertension (high blood pressure), shortness of breath and rash
• Hypersensitivity vasculitis — Raised, purple spots on the skin, fever, joint pain
• Giant cell arteritis — Fever, jaw pain after chewing, problems with vision, headache, malaise, fatigue, poor appetite, joint pain
• Wegener's granulomatosis — A general sick feeling (malaise), weakness, joint pain, poor appetite, weight loss, sinus pain, sinus drainage, bloody nose, a cough that may produce blood, shortness of breath, chest discomfort, red eyes, skin rash or ulcers, symptoms of kidney failure
• Takayasu's arteritis — A general sick feeling (malaise), fever, night sweats, joint pain, poor appetite, weight loss, pain in one or both arms, fainting, symptoms of congestive heart failure
• Kawasaki disease — Swollen lymph nodes (swollen glands) in the neck; swelling in the skin; redness of the mouth, lips and palms; peeling skin at the fingertips; chest pain

Diagnosis

Your doctor will ask about your symptoms and will examine you. This may be followed by:

• Standard blood tests, such as a complete blood count (CBC) and sedimentation rate (a test that indicates body-wide inflammation)
• Blood tests to evaluate immune-system activity — Tests for antibodies, including those typically found in lupus and infections, and one specifically associated with many types of vasculitis, called anti-neutrophilic cytoplasmic antibody (ANCA)
• Blood tests to check for organ damage, including tests to assess liver and kidney function
• A urinalysis to evaluate possible kidney problems
• A tissue biopsy, in which a small sample of an organ (such as skin, muscle, nerve or kidney) is removed and examined in a laboratory — This is the most accurate way to diagnose vasculitis.
• A test called an arteriogram or angiogram — An X-ray test in which dye is injected into specific blood vessels to outline their path and check for areas of vessel damage or narrowing. This test generally is done only when a biopsy cannot be done or does not provide a diagnosis.

Expected Duration

How long vasculitis lasts depends on its cause. For example, most cases of hypersensitivity vasculitis or Kawasaki disease go away on their own over a period of days or weeks. Wegener's granulomatosis may respond to treatment at first, but many patients relapse and require treatment again. Giant cell arteritis typically requires therapy for a year or more.

Prevention

There is no way to prevent most forms of vasculitis. If a medication caused vasculitis, you may be able to prevent another case of vasculitis by avoiding that drug.

Treatment

The treatment of vasculitis depends on its cause:

• Polyarteritis nodosa — This form of vasculitis usually is treated with prednisone (sold under several brand names) and, in most cases, cyclophosphamide (Cytoxan, Neosar)..
• Hypersensitivity vasculitis — This form often goes away on its own without treatment. For severe cases, prednisone may be given.
• Giant cell arteritis — Treatment begins with high doses of prednisone, which gradually are reduced over many months. If symptoms return, a lower dose may be necessary for a year or more.
• Wegener's granulomatosis — Treatment begins with prednisone and cyclophosphamide, but then prednisone gradually is reduced and the person continues to take only cyclophosphamide, often for a year or more. Methotrexate (Rheumatrex, and others) or other immune-suppressing medications may be used in patients who cannot tolerate cyclophosphamide.
• Takayasu's arteritis — Prednisone is used to treat symptoms. Narrowed arteries may need to be corrected with surgery or angioplasty (inserting a balloon-tipped catheter to widen the vessels).
• Kawasaki disease — Treatment includes aspirin and a drug called gamma globulin given in high doses intravenously (into a vein) to reduce the risk of coronary artery damage.

There are a number of other types of vasculitis. Depending on the severity and type of vasculitis, other immune-suppressing medications may be recommended, including azathioprine (Imuran) or methotrexate.

When To Call A Professional

Call your doctor if you experience unexplained fever, weight loss, fatigue or malaise (a general sick feeling), with or without areas of rash, muscle weakness, breathing problems, chest pain or other symptoms described above.

Prognosis

The outlook depends on the specific type of vasculitis:

• Polyarteritis nodosa — The disease is treated successfully in up to 90% of patients.
• Hypersensitivity vasculitis — Most cases go away on their own, even without treatment. Rarely, the disease returns.
• Giant cell arteritis — The disease goes away in most people, but many require one to two years of prednisone.
• Wegener's granulomatosis — At one time, this illness was almost always fatal. Now, with proper treatment, 90% of patients have significant relief of symptoms and the disease goes away completely in about 75% of patients.
• Takayasu's arteritis — In the United States, about 90% of people with this form of vascullitis survive.
• Kawasaki disease — The outlook is excellent. Less than 3% of people with this disease develop fatal complications.

Additional Info

American College of Rheumatology

1800 Century Place, Suite 250

Atlanta, GA 30345

Phone: (404) 633-3777

< Fax: (404) 633-1870

  http://www.rheumatology.org/

National Heart, Lung, and Blood Institute (NHLBI)

6701 Rockledge Drive P.O. Box 30105

Bethesda, MD 20824-0105

Phone: (301) 592-8573

  http://www.nhlbi.nih.gov/

National Organization for Rare Disorders, Inc.

P.O. Box 8923

New Fairfield, CT 06812-8923

Phone: (203) 746-6518

Toll-Free: (800) 999-6673

Fax: (203) 746-6481

http://www.rarediseases.org/

National Institute of Allergy and Infectious Diseases (NIAID)

Building 31, Room 7A-50

31 Center Drive MSC 2520

Bethesda, MD 20892-2520

Phone: (301) 496-5717

http://www.niaid.nih.gov/