VASCULITIS

What does this mean?

Vasculitis is a medical term for inflammation of blood vessels. There are several different types of vasculitis, but their causes and their treatment are all very similar. The names of some the various types of vasculitis are: microscopic polyarteritis, Wegener's granulomatosis, Henoch Schonlein purpura, and polyarteritis nodosa.

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What causes vasculitis?

The cause is immunological. That is, the white blood cells and antibodies you have to fight off infection are damaging your own body by mistake. The body's defences against infection are very powerful, and many diseases are due to their overactivity, such as asthma, rheumatoid arthritis and diabetes in young people.
Vasculitis is different from these other diseases because blood vessels in particular are damaged. We do not understand fully why this happens, and the condition is quite rare. Vasculitis with kidney involvement affects 20-30 people per million population per year. In other words, 7-10 people per year in Coventry, or 35 in Warwick and Leamington.
The trigger that starts vasculitis varies from person to person. Sometimes it is a 'flu-like infection, sometimes it appears to be an operation or a bacterial infection. The condition is commoner in the spring and autumn than in the summer, and is commoner in older people.

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What are the Symptoms?

These are variable, and almost every case is different from each other. Often the only symptom is a feeling of tiredness and general ill health. Blood vessels in all parts of the body can be affected, here are some of the commoner symptoms:-

Kidneys: the specialised small blood vessels in the kidney which filter blood to make urine seem especially sensitive to vasculitis. The damage to the kidney can cause blood to appear in the urine, and can cause kidney failure in severe cases.
This is a serious condition and when it is suspected we would normally recommend a kidney biopsy test to confirm the diagnosis and to help plan treatment.

Skin: small blood vessels in the skin can become damaged by vasculitis, causing them to burst, causing a rash with small red blotches. This is most commonly seen on the lower legs.

Joints: inflammation around the joints can cause pain and stiffness.

Nose: the inside of the nose is often affected by vasculitis, so there can be nosebleeds. these may even occur for some time before the kidneys are affected.

Lungs: bleeding can occur inside the lungs in vasculitis. If you cough up blood, it is important that you are seen and treated urgently.

Other parts of the body:we see almost every part of the body affected in some cases of vasculitis. It can rarely cause stroke, heart attack or damage to the bowel. Fortunately, once treatment has been started, it is unusual for such problems to start.

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What is the Treatment?

Fortunately this condition responds very well to treatment. We use a combination of steroids (prednisolone) and cyclophosphamide. These are both powerful drugs that reduce the activity of the immune system, reducing the activity of vasculitis. High doses of these drugs are normally given for the first 3-6 months, and then the dosages are reduced to maintenance levels. Some treatment is needed for at least 2 years, and in many cases for the rest of your life.
These drugs can cause serious side effects, and very careful monitoring is required for the sake of safety. The main side effect is infection. There is a risk of severe urine infection or pneumonia during the first few months of treatment, and any fevers or possible infection should be reported urgently to your doctor.

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How Effective is the Treatment?

If vasculitis is caught at an early stage, the treatment is very effective. However, it does cause serious damage to the kidneys, and the kidney function does not often go back to 100% normal. However, you can lead a normal life with even quite badly damaged kidneys, so this may not matter too much.
In some cases, the kidneys are so badly damaged before we see the patient that there is little point in giving a lot of treatment, and it is best to leave the patient on dialysis treatment, and not to risk lots of serious side effects if there is little benefit to be gained.

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What can I do?

Unfortunately it seems there is nothing you can do in your lifestyle or diet that will stop you getting vasculitis. Similarly, there is little you can do that would prevent you getting a relapse. However, what you do still makes an enormous difference to your health:
• Remember to take your medication at the times prescribed. We often change the doses of tablets, so make sure you know exactly what has been advised. If in doubt about the dosage of tablets, 'phone up and check.
• Report possible complications of treatment such as symptoms of infection at an early stage.
• Take regular exercise. People with vasculitis lose a lot of muscle strength during illness. Ask for advice about sensible regular exercise.
• Eat well. You will probably lose some body weight with vasculitis in its early stages. Even if you have a weight problem, this weight loss is usually a bad thing, because it is your muscle and not your fat that is lost! Please take advice from our dietitians about regulating you diet properly.

This factsheet provided by Walsgrave Hospital, Coventry, UK

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