Tuesday, May 31, 2011


Rare blood vessel condition is being seen locally

At the Backus Arthritis Center, our rheumatologists see other conditions as well. Over the past few weeks I have seen a few patients with a rare condition called vasculitis, which is an inflammation of the blood vessels.

There are multiple types of vasculitis — some affect only the skin and others that also affect internal organs.

The symptoms of vasulitis are based on the organ impacted. For example, when it affects only the skin, we see a rash usually on the lower extremities that does not lighten, or you can get ulcers in the legs. When it affects the lungs it can cause shortness of breath and cough. When it affects the nerves it may lead to numbness and weakness in a hand or foot.

Vasculitis takes on various forms — it can be mild or it can be life-threatening, and can be a single episode ot multiple episodes. Based on the size of blood vessels we can determine the type of vascultits. In some patients a specific cause of vasculitis cannot be determined.

We have a wide variety of tests that can help us determine the cause. One of them is called antineurophil cytoplasmic antibody (ANCA). We also tend to biopsy the area of vasculitis such as the skin, lungs, kidney or the nerves.

Sometimes it is associated with an underlying arthritic disorder like rheumatoid or lupus. Other times it is related to chronic infections like Hepatitis B and C. We have also seen it develop in some patients on certain kinds of medications.

Some types of vasculitis are age-specific. A vasculitis called Kawaski’s disease is seen only in children. Giant Cell Arteritis (GCA) develops in people over the age of 50.

Once we have figured the cause of the vasculitis, we then consider treatment options.

If it is medication-induced, we stop the medication. If the underlying problem is infection, the infection needs to be treated and the vasculitis may need to be treated at the same time depending on the severity.

One of the most commonly used medications is prednisone, which is a steroid. We also use other powerful medications to aggressively treat the vasculitis. Recently a new medication called Rituxamab has been approved for the management of Wegners Granulomatosis, which is a severe form of vasculitis.

With aggressive treatment, patients’ life expectancies have increased, but these medications have side effects, most importantly are infections and secondary malignancies. Patient education is an important part of the treatment plan, including disease-specific information and medication side effects.

Sandeep Varma, MD, is a rheumatologist and Medical Director at the Backus Arthritis Center. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or others, visit the Healthy Living blog at www.backushospital.org/backus-blogs or e-mail Dr. Varma or any of the Healthy Living columnists at healthyliving@wwbh.org

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