Vasculitis is a collective term for a wide variety of forms of vascular inflammation. Accordingly, the possible symptoms are also different. In the following, we inform you about the signs of vasculitis as well as the diagnosis and treatment of the disease.
What are the symptoms of vasculitis?
The symptoms and signs of vasculitis vary widely and are sometimes so nonspecific, at least initially, that it often takes some time before a diagnosis is made. Common symptoms or conditions caused include:
- Fever and weight loss, feeling sick (as a sign that there is a systemic disease and inflammation).
- Smaller (purpura) or larger, sometimes oddly shaped bluish-red skin spots (as a sign of increased vascular fragility)
- Joint or muscle pain (if the inflammation there).
- Inflammation of various nerves, inflammation of the eyes.
- Stroke, heart attack, hypertension, circulatory disorders of the legs (arterial occlusive disease).
- Severe nosebleeds, sinusitis, hemoptysis (especially in granulomatosis with polyangiitis, formerly: Wegener’s granulomatosis), allergy (in eosinophilic granulomatosis with polyangiitis, formerly: Churg-Strauss syndrome).
- Abdominal pain, blood in the stool
- Inflammation of the renal corpuscles (glomerulonephritis).
- Leg ulcers (in cryoglobulinemia).
How is the diagnosis made?
The diagnosis of vasculitis is often difficult, because almost any organ can be affected and the disease manifests itself in many different ways. After questioning (history) and physical examination, the physician will first draw blood. The inflammation parameters in particular are elevated, and depending on the organ involvement, corresponding blood values and the blood count are also altered. In addition, autoantibodies, especially ANCA, are determined. Further examinations such as X-ray contrast imaging of the vessels (angiography) or magnetic resonance imaging (MRI) depend on the suspected diagnosis; the final diagnosis can only be made with a tissue sample of an affected vessel. Other causes of the changes must be ruled out, for example, malignant tumors, infections with sepsis, or coagulation disorders.
What therapy is available for vasculitis?
Vasculitis that is recognized in time cannot be cured, but it can be stopped or mitigated. Therapy for vasculitis is best done in a specialty clinic. Treatment focuses on suppressing or modulating the immune response in order to contain the inflammation. This is usually done initially by administering cortisone preparations. In more severe cases, stronger immunosuppressants such as azathioprine, immunoglobulins, interferons and/or low-dose chemotherapeutic agents (cytostatics) such as methotrexate or cyclophosphamide may also be used. In certain severe forms of vasculitis, such as granulomatosis with polyangiitis, so-called biologicals (artificially produced antibodies) such as rituximab may also be used. If vital organs are involved, blood plasma exchange (plasmapheresis) may be necessary. Tocilizumab has also been approved for the treatment of giant cell arteritis since September 2017.
Vasculitis: what can I do myself?
Diseases caused by vasculitis, such as a heart attack, receive additional treatment. Unfortunately, self-therapy or preventive measures (other than quitting smoking) are not possible. It is possible that a diet rich in omega-3 fatty acids or taking fish oil capsules should have a positive effect on vasculitis.
What is the course and prognosis?
Even with necrotizing vasculitis, the prognosis is relatively good with optimal therapy. The risk for myocardial infarction and renal failure is particularly increased after prolonged disease, and for blindness in giant cell temporal arteritis. In a form of vasculitis detected early, life expectancy is not significantly less than in a healthy person.
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Wolf., D. (2018): Vasculitis – rheumatic disease with many facets. A guidebook for those affected. Deutsche Rheuma-Liga Bundesverband e. V., 2nd edition.
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Anvil: Vasculitides. (Retrieved: 02/2020)
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S1 Guideline of the Commission on Guidelines of the German Society of Neurology: Cerebral vasculitis and cerebral involvement in systemic vasculitides and underlying rheumatic diseases. AWMF Register No. 030/085. (As of 04/2018).
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Schirmer, J. H. et al. (2017): S1 guideline diagnosis and therapy of ANCA-associated vasculitides. In: Journal of Rheumatology, Vol. 76(3), pp. 77-104.
