How is vasculitis treated

How is vasculitis treated

• Identify and remove inciting agents (medications, infection, etc.).

• Treat the primary underlying disease associated with the vasculitis (antibiotics for endocarditis, antiviral therapy for hepatitis B or C).

• Initiate antiinflammatory and/or immunosuppressive therapy commensurate with the extent of the vasculitis. Small-vessel vasculitis confined to the skin usually needs less aggressive treatment than systemic vasculitis involving large- and/or medium-sized arteries.

• Large-vessel vasculitis is treated initially with glucocorticoids. biologic therapy (e.g., tocilizumab for GCA) has shown great effectiveness enabling rapid tapering of glucocorticoids and reduction of steroid side effects.

• The combination of cyclophosphamide and prednisone is often regarded as the first choice for induction therapy of generalized and severe types of medium and ANCA-associated vasculitis. New targeted biologic agents may replace cyclophosphamide as induction therapy for some forms of vasculitis (e.g., rituximab for GPA and MPA, mepolizumab for EGPA). Maintenance therapies are less well-defined but typically involve the use of azathioprine, methotrexate, or mycophenolate mofetil.

• Prevent complications such as infection (purified protein derivative, pneumovax, and other immunizations; trimethoprim–sulfamethoxazole prophylaxis if on high-dose prednisone), osteoporosis, and atherosclerosis (control blood pressure and lipids).


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