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Rheumatology 2000; 39: 585-595
© 2000 British Society for Rheumatology
Review |
Evidence-based treatment of systemic vasculitis
Vasculitis/Series Editor: R. Watts
South West Thames Institute for Renal Research, Renal Unit, St Helier Hospital, Carshalton, Surrey SM5 1AA, UK
| The first 150 words of the full text of this article appear below. |
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Introduction |
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The systemic vasculitides are potentially fatal if untreated and immunosuppressive therapy now saves lives and salvages organ function. Treatment has changed the outcome of vasculitis to that of a chronic disorder with accumulating morbidity and incapacity. Current treatment is toxic and contributes to morbidity and mortality. Balancing the dangers of disease against those of treatment requires detailed knowledge of both, knowledge that has been confused by differences in classification or is lacking due to a paucity of long-term outcome studies. There have been relatively few randomized-controlled trials in vasculitis, although their number is increasing. Much of the evidence supporting therapeutic decisions derives from small prospective studies or larger, usually single centre, retrospective experiences. More recently, consensus discussions have contributed to evidence on classification and existing treatment practice.
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Classification |
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Diagnosis
This review will focus on the primary systemic vasculitides which are distinct from those related to infection, drugs, cancer or other systemic disorders,
Clinical subgrouping
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Outcome |
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Treatment by clinical subgrouping |
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Early systemic disease
Generalized/renal disease
Other remission drugs.
Plasma exchange.
Intravenous pulse cyclophosphamide.
Severe renal disease
Refractory and relapsing disease
Infection and relapse.
ANCA and relapse.
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Newer approaches to treatment |
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Adverse effects |
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Cyclophosphamide toxicity
Glucocorticoid toxicity
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Other vasculitides |
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Conclusions |
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