Vasculitis is a condition that causes the blood vessels to become inflamed. The walls of the vessels gradually become weaker, scarred, thicker, and narrower, which can cause tissue and organ damage, due to blood flow to various parts of the body being restricted. There are numerous types of this condition, and the majority are considered rare. For some individuals, multiple organs are affected, while for others, only one organ is. Vasculitis may be chronic or acute. While risk factors vary, and certain types are more often seen in certain populations, anyone can develop vasculitis. Knowing more about the treatment options is essential for patients to make the best choices for their health.
Vasculitis may lead to an aneurysm or blocked arteries. If these occur, surgery might be required to treat them. An aneurysm is like a bubbling or ballooning of an area of the wall of a blood vessel, and if it bursts, extreme internal bleeding is possible. Due to this being potentially life-threatening, surgical intervention is often necessary. This may be accomplished by closing off the aneurysm with surgical clipping or sealing it off through endovascular coiling.
There are four primary surgical options for a blocked artery. The first is placing a stent to essentially force the blocked part open so normal blood flow is possible. The second is fibrinolytic therapy, which involves directly injecting a drug into the blockage to break it apart. The third is an endarterectomy, which involves physically removing the obstruction. The fourth surgical option is bypass surgery. This includes either using a synthetic tube or a graft vessel from elsewhere in the body to divert the flow of blood around the blockage.
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The type of vasculitis a patient has ultimately determines which medication options are ideal for them. Almost all types may benefit from glucocorticoid medication, though a second one might be added for certain vasculitis types. Glucocorticoid medications focus on the inflammation that occurs with this condition. They can cause severe side effects, especially when a patient needs to take them for a long time, so when they are used long-term, patients generally receive the lowest possible dose that still effectively treats their inflammation. Certain types of this disorder might respond to rituximab, a drug administered intravenously. This drug is a monoclonal antibody that can target specific cells potentially responsible for the patient’s condition. Cyclophosphamide and methotrexate might be prescribed to target the immune system to alleviate a patient’s symptoms. Azathioprine is sometimes prescribed once a patient’s vasculitis is under control and they are in maintenance mode working to prevent a worsening of their symptoms. Other medications might be used depending on the patient’s vasculitis type and individual symptoms.
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Underlying Condition Treatment
It is believed certain conditions may trigger vasculitis in some patients. If these conditions are present, treatment for the underlying condition must occur along with the treatment for the type of vasculitis the patient has. For blood cancer, chemotherapy, radiation, and other cancer treatments are typically prescribed to kill the cancer cells and attempt to put the patient into remission. Hepatitis B and C may act as triggers to this condition. For hepatitis C, treatment may include antiviral medication, or in the most severe cases, a liver transplant. For hepatitis B, treatment may include interferon injections, antiviral medication, or a liver transplant. Autoimmune diseases may also increase a patient’s risk of developing vasculitis, and in these instances, the treatment regimens vary based on the condition but often include some anti-inflammatory drugs and immunosuppressants. If a medicine reaction caused vasculitis, stopping usage is generally sufficient to eliminate it as an underlying cause.
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Follow-Up Treatment & Care
Undergoing certain tests and following some specific lifestyle guidelines, referred to as follow-up treatment and care, are imperative for those who have vasculitis. Patients should follow their treatment plan exactly and make sure they are attending all of their doctor’s appointments. In between appointments, it is often advised patients check their blood pressure frequently at home. Getting routine vaccinations, eating a varied and healthy diet, acquiring a support system, and regular exercise are also important. When patients see their doctor, they may undergo blood tests, imaging, and urine testing. This is done to explore the progression of the disease and to determine if the patient’s current treatment regimen is effective or if changes need to be made. Imaging studies include angiography to look at the affected blood vessels, MRI, PET, general X-ray, ultrasound or CT scans. Urine tests can look for protein and red blood cells. Blood tests look at red blood cells (potentially part of a complete blood count), vasculitis-associated antibodies, and C-reactive protein (indicative of inflammation).
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Clinical trials are available for those who have vasculitis. These might be considered when patients are not responding well enough to the treatment options already available. One study is looking at creating a way to automatically be able to read a patient’s anti-neutrophil cytoplastic autoantibodies. Since these autoantibodies are critical for diagnosing and monitoring this condition, this research is hoping to be able to discover a way to allow for better disease management.
Another study is exploring the efficacy of low-dose naltrexone for vasculitis patients. Research for other conditions show this drug may be beneficial for pain, so the hope is it may also help to alleviate specific physical symptoms of vasculitis. A third trial is targeted at patients experiencing vasculitis and polymyalgia rheumatica. This research is looking at sarilumab, a type of drug, to determine if it might reduce flares and improve remission rates.