Vasculitis

Vasculitis happens when the immune system mistakenly attacks the walls of blood vessels, causing inflammation that can narrow, weaken or block them and so disturb the blood supply to the tissues beyond. In most people the trigger is never fully known, and it is not something you have caused or could have prevented. Some forms follow an infection, a medication or another autoimmune condition, while a few are linked to particular antibodies that help define the type.

Vasculitis can affect almost anyone, and the typical age and pattern depend on the form. It is not infectious and is not passed directly from parent to child, although a tendency towards autoimmune conditions can sometimes run in families. Several types overlap with related disorders such as polymyalgia rheumatica and Behçet's disease.

Because vasculitis can affect different parts of the body, symptoms vary widely. General features may include:

• Tiredness, fevers, or unintended weight loss
• Skin changes such as a rash, spots or ulcers
• Joint and muscle aches
• Symptoms relating to specific organs, depending on the vessels involved

One well-known form affecting older adults is giant cell arteritis, which involves the arteries around the head and can affect vision, and which needs urgent assessment.

Vasculitis is not a single illness but a family of conditions, usually grouped by the size of the blood vessels mainly affected. The main types include:

Large-vessel vasculitis

• Giant cell arteritis, affecting the larger arteries around the head in older adults, which can affect vision and needs urgent assessment
• Takayasu arteritis, affecting the aorta and its main branches, typically in younger adults

Medium-vessel vasculitis

• Polyarteritis nodosa, affecting medium-sized arteries and a range of organs
• Kawasaki disease, which mainly affects children

Small-vessel vasculitis

• Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), which can affect the sinuses, lungs and kidneys, among other areas
• Eosinophilic granulomatosis with polyangiitis (EGPA), often associated with asthma and allergy
• IgA vasculitis, which commonly affects the skin, joints, gut and kidneys, and is seen more often in children
• Cryoglobulinaemic and other small-vessel forms, which can affect the skin, nerves and kidneys

Some forms are limited and relatively mild, while others can be serious and need prompt, intensive treatment. Vasculitis can also occur on its own or alongside another condition. Identifying which type is present guides the whole treatment plan, which is why careful specialist assessment matters.

Diagnosis brings together your symptoms, a thorough examination, blood and urine tests, imaging, and sometimes a biopsy. Identifying which type of vasculitis is present, and which parts of the body are affected, is central to choosing the right treatment, so the assessment is detailed.

Where joints or surrounding tissues are involved, ultrasound can add useful information, and in some forms ultrasound of the arteries is helpful. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.

Treatment aims to bring the inflammation under control, protect the affected organs and prevent flares. It is highly individual, depending on the type and severity, and is reviewed regularly over time. Because vasculitis can be a long-term condition, ongoing specialist input is valuable. The plan is always discussed with you.

Vasculitis can affect many different organs, so care often needs the involvement of more than one specialty. Dr Borukhson practises within a world-renowned tertiary centre, with ready access to consultant colleagues across the other specialties that may be involved in caring for this condition. Where appropriate, she can involve those specialists directly, and bring particularly complex cases to a multidisciplinary team meeting (MDT) with minimal delay. This means that, when more than one area of expertise is needed, your care can be joined up and decisions reached promptly.

Vasculitis is usually managed by your specialist team rather than self-treated, but how you live alongside it makes a real difference. Keeping your follow-up appointments and monitoring blood tests matters, because these pick up both quiet flares and any side effects of treatment early.

• Take medicines as prescribed and never stop steroids suddenly; ask before making changes
• Ask your team which vaccinations are recommended, and report infections promptly, as treatment can lower immunity
• Look after your bones, heart and blood pressure, which long-term steroids can affect
• Pace activity, rest during flares, and build strength gently as you recover

Many people settle into long, stable periods of good health. Fatigue can linger even when inflammation is controlled, so be patient with yourself and lean on family, your GP and patient support groups.

Some features of vasculitis need same-day or emergency assessment. Seek urgent help if you develop new or sudden problems such as:

• New visual symptoms, jaw pain on chewing or a severe new headache, which can signal giant cell arteritis and risk to sight
• Coughing up blood, breathlessness, or blood in the urine or much less urine than usual
• Numbness, weakness, chest pain or a spreading purple rash, especially with fever

If you take immune-suppressing treatment and become unwell with a high temperature or signs of infection, contact your team or seek care without delay, as this can be serious quickly.

For symptoms that are new but not alarming, such as gradually returning aches, mild rash or rising tiredness, arrange a routine review rather than waiting for your next scheduled appointment. When in doubt, it is always reasonable to ask.

Vasculitis covers a wide spectrum, and the right diagnosis determines the right treatment. If you have unexplained symptoms such as persistent fevers, weight loss, skin changes or organ-related problems alongside inflammation, a specialist review can help establish what is going on.

How is vasculitis diagnosed?

There is no single test for vasculitis, so the diagnosis brings together your symptoms, a thorough examination, blood and urine tests, imaging and sometimes a biopsy. Identifying which type is present, and which parts of the body are affected, guides the whole treatment plan, which is why the assessment is detailed. Where joints or surrounding tissues are involved, ultrasound can add useful information, and in some forms ultrasound of the arteries is helpful. Dr Borukhson uses point-of-care ultrasound during the consultation, so this can often happen in the same visit.

Is vasculitis serious?

It depends on the type, as vasculitis covers a wide spectrum. Some forms are mild and limited, while others are more serious and need prompt, intensive treatment to protect the affected organs. Because the right diagnosis determines the right treatment, a careful specialist assessment is important in working out where on that spectrum your condition sits.

Can vasculitis be cured, or will I need treatment long term?

Vasculitis is often a long-term condition, and the aim of treatment is to bring the inflammation under control, protect the affected organs and prevent flares rather than to offer a one-off cure. Many people do very well, with the condition settling into a quiet phase, though flares can happen, so the plan is reviewed regularly over time. Ongoing specialist input is valuable, and the approach is always discussed with you.

Why might I need to see more than one specialist?

Because blood vessels run throughout the body, vasculitis can affect many different organs, so care often needs input from more than one specialty. Dr Borukhson practises within a world-renowned tertiary centre, with ready access to consultant colleagues across the specialties that may be involved. Where appropriate she can involve those specialists directly, and bring particularly complex cases to a multidisciplinary team meeting with minimal delay, so your care stays joined up and decisions are reached promptly.