Vasculitis
The treatment of the vasculitis depends on
In some cases, if an underlying cause can be identified, then treatment should be addressed towards this cause. This may include the withdrawal of a triggering drug. If infection is the underlying cause, then this should be treated. An example of an underlying course of vasculitis is hepatitis C which can cause a particular form called cryoglobulinaemic vasculitis.
The treatment often involves the use of drugs which suppress the immune system, because vasculitis is caused by an immune system behaving in a hyperactive and inappropriate fashion. This involves the use of corticosteroids, often together with a specific immunosuppressive drug. Corticosteroids, not to be confused with anabolic steroids used by athletes, are normally produced by the body’s own adrenal glands. There are synthetic forms given by mouth (e.g. prednisolone) or intravenously (e.g. methylprednisolone), which are very effective in treating vasculitis. However in the long term they have side effects such as weight gain, reducing bone density, and increased risk of diabetes and high blood pressure. In order to reduce the steroid requirements, and to control the disease, immunosuppressive drugs are often also given.
For patients with primary systemic vasculitis, immunosuppressive drugs are always required. More intensive regimens are used if there is kidney involvement, or there is life-threatening organ involvement. Examples of the immunosuppressive drugs used in vasculitis are cyclophosphamide, methotrexate, and azathioprine.
These drugs do carry side effects, but vasculitis is potentially very serious. The choice of drug in each patient is only decided after paying due consideration to the severity of the disease. All immunosuppressive drugs carry an increased risk of infection, potential for reduction in blood cell counts – low red blood cells, low white cells, low platelets. Frequent monitoring of blood tests, such as blood cell counts and liver function tests, helps to detect such side effects early. The use of other medications, such as folic acid in patients taking methotrexate, can protect the individual from some of the side effects.
