What is Vasculitis?

Vasculitis is a condition where there is inflammation of the blood vessels in the body. It is very rare.

The term comes from the latin word ‘vasculum’ which refers to the system of blood vessels in the body (which we call ‘the vascular system’) and ‘itis’ meaning inflammation.

There are many different types of Vasculitis and they are classified according to the size of and type of the blood vessels that they affect. These blood vessels include both veins (which return blood to the heart) and arteries (which take blood away from the heart) and capillaries which are the tiny blood vessels interacting directly with the tissues receiving the blood.

The capillaries are the place where oxygen exchange, exchange of nutrients and the transport of cells to and from the vascular system occurs. If the blood supply is affected by Vasculitis, organs in the body can be affected, depending on where the blood vessels are affected and how badly they are affected.

Vasculitis can be very mild, or it can be very serious and life threatening.

What are the different types of Vasculitis?

There are many different types of Vasculitis and they are classified according to the type of blood vessels affected.

It sounds quite complicated when you read it!! Some of the more commonly known types are:

Affecting large cell arteries:

  • Giant Cell Arteritis (also affects medium sized arteries)
  • Aortitis associated with Ankylosing Spondylitis
  • Takayasu’s arteritis

Affecting small and medium sized arteries:

  • Polyarteritis Nodosa
  • Wegeners and ANCA associated Vasculitis
  • Microscopic Polyangiitis

Affecting small arteries:

  • Sjogren’s and Rheumatoid arthritis Vasculitis
  • Henoch Schonlein Purpura

Affecting small arteries AND veins:

  • Behcet’s disease
  • Relapsing Polychondritis
How can vasculitis affect the body?

Vasculitis can range from minor to very severe.

How the body is affected depends on which part of the vascular system is affected and how serious it is.

Some people can be asymptomatic with vasculitis, but have high inflammation markers in the blood.

Some people can get a rash if the skin is affected. If the blood supply to organs like the kidneys are affected, people can get kidney failure. If the blood supply to the lungs are affected people can get breathing problems or perhaps a cough or asthma symptoms. If the blood supply to the nerves are affected people can get weakness and alterations in sensation such as numbness. And so on. Sometimes people with Vasculitis can get aches and pains and recurrent fevers and feel generally unwell as part of the systemic inflammation and the release of inflammatory mediators throughout the body.

Why do people get Vasculitis?

We don’t medically understand exactly why some people get Vasculitis, whereas most people in the world do not get Vasculitis. It is possible there is an infective trigger, for example in Henoch Schonlein Purpura, but why that would affect some and not others is not understood. It is not known if there is a specific trigger for other sorts of Vasculitis.

What we DO know is that:

Hepatitis B and C are associated with Vasculitis.

Some Rheumatic diseases are associated with Vasculitis such as Rheumatoid Arthritis, Sjogrens disease and Lupus.

How does it feel to have Vasculitis?

How people feel with Vasculitis depends on how serious it is and which part of the body is affected.

If it is minor people can feel quite well with just a rash, and at other times with the involvement of many organ systems (such as kidneys, the gut, nervous system and skin) people can feel profoundly ill and be in danger of their life.

How is Vasculitis diagnosed?

Vasculitis, like other diagnoses in Rheumatology is a clinical diagnosis that is backed up by other investigations.

If your Rheumatologist suspects that you have vasculitis, they will do blood tests and possibly some radiological investigations, depending on where clinically the vasculitis is thought to be active.

Common blood tests are inflammatory markers (ESR and CRP), biochemistry, full blood count, liver function testing and a panel of autoimmune markers. A urine sample will be done examining for signs of kidney involvement.

If there is a rash, it is possible that a biopsy of the rash will be done. Sometimes other organs require a biopsy such as the kidneys or the lungs if they are involved.

The reason biopsies are done is to confirm the diagnosis and the severity of the organ involvement.

There are different treatments and different expected outcomes for different types of vasculitis according to the severity of the organ involvement.

How is Vasculitis treated?

Vasculitis is treated according to its severity and the type of vasculitis.

It’s an autoimmune disease, so Rheumatologists use DMARDs and Corticosteroids to dampen down the immune response to control the disease.

There is no cure, there are only drugs to control the symptoms.

The common drugs that are used are:

  • Prednisolone and related steroids
  • DMARDs such as Methotrexate, Leflunomide and Mycophenolate

Rheumatologists are the specialists that oversee the diagnosis and treatment of Vasculitis.

If there is a particular organ system that is involved such as the eyes, or the kidneys then a specialist in that particular field will also be involved.

Your Rheumatologist is the best person to guide you and tailor a treatment program for you as each person is different in how disease affects them and what medications are needed.