Is it possible to offer evidence-based treatment for systemic vasculitis ?

• Published in: Scandinavian journal of rheumatology Vol. 29; no. 4; pp. 211 - 215
• Main Author: LUQMANI, Raashid A
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Colchester Taylor & Francis 2000
• Subjects: Biological and medical sciences; Diagnosis, Differential; Evidence-Based Medicine; Humans; Immunomodulators; Medical sciences; Pharmacology. Drug treatments; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Vasculitis - classification; Vasculitis - epidemiology; Vasculitis - physiopathology; Vasculitis - therapy; Human; Corticosteroid; Treatment efficiency; Stage classification; Cardiovascular disease; Wegener granulomatosis; Systemic; Vascular disease; Immunosuppression; Vasculitis; Systemic disease; Polyarthritis; Decision aid; Diagnosis; Immunosuppressive agent; Azathioprine; Methotrexate; Therapeutic protocol
• ISSN: 0300-9742; 1502-7732
• DOI: 10.1080/030097400750041334

The evidence base for treatment of systemic vasculitis is reviewed in this article. Accurate diagnosis and evaluation of disease status is crucial to the appropriate management of these cases and disease status should be employed as a means of staging so that appropriate therapy can be offered tailored to the individual requirements of each case. Large vessel vasculitides are almost exclusively managed with corticosteroids. Small vessel vasculitis with internal organ involvement usually requires more aggressive immuno-suppression; by contrast, small vessel vasculitis without internal organ involvement rarely requires intervention. Despite our current efforts, the long-term morbidity of patients with systemic vasculitis remains high. We need better therapeutic strategies in order to limit or control disease rapidly and thereby prevent the accumulation of subsequent damage. Large-scale randomised trials comparing different therapeutic strategies offer the only hope of establishing a firmer evidence base for the optimal management of these diseases.