Vasculitis (angiitis)
Vasculitis is not a single illness but a group of conditions sharing one mechanism: the immune system mistakenly attacks the walls of your own blood vessels.
On this page
- What becomes inflamed, and why organs suffer
- The rash that does not fade under a glass
- Signs that are easy to blame on being run down
- Nerves, kidneys and lungs
- When it becomes a matter of hours
- How the diagnosis is confirmed
- Treatment: how the inflammation is put out
- Living on these medicines
- Online consultation
Medicines commonly prescribed for Vasculitis (angiitis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: INJECTABLE, 50 mg/mlActive substance: methotrexateManufacturer: Medac Gesellschaft Für Klinische Spezialpräparate GmbhPrescription requiredDosage form: TABLET, 2.5 mgActive substance: methotrexateManufacturer: Orion CorporationPrescription requiredDosage form: INJECTABLE, 10 mg/0.20 mlActive substance: methotrexateManufacturer: Accord Healthcare S.L.U.Prescription required
Vasculitis is not a single illness but a group of conditions sharing one mechanism: the immune system mistakenly attacks the walls of your own blood vessels. The wall becomes inflamed, swells and narrows, blood passes through less easily, and sometimes the vessel leaks or bursts. What happens next depends entirely on which vessels are involved and what they supply. Some forms stay in the skin of the lower legs and settle on their own. Others can take your sight or destroy a kidney within days. That is why, with vasculitis, how quickly you are seen matters more than almost anything else.
What becomes inflamed, and why organs suffer
Doctors sort the vasculitides by the calibre of vessel involved, and this is not a technicality: the calibre decides which organs are at risk. Inflammation of the large arteries, the aorta and its branches, reduces blood supply to the head and the limbs. Medium-sized arteries feed the gut, the kidneys and the nerve trunks. Small vessels are the capillaries of the skin, the filtering units of the kidney, the walls of the air sacs in the lungs and the finest branches running to the nerves; when these are inflamed, trouble appears in several places at once.
There are many named forms, and you do not need to learn them. What is worth understanding is that one word covers very different scenarios, which is why a doctor will keep asking about your eyes, your urine and your breathing even though you came in with a rash on your legs.
Most of the time the cause is never found. Sometimes the trigger is hepatitis B or C, less often another infection, a medicine, an existing autoimmune disease such as rheumatoid arthritis or lupus, and rarely a tumour. Vasculitis is not contagious and is not inherited in any direct way. Children have their own forms: Henoch-Schönlein purpura, with a rash over the shins and tummy pain, and Kawasaki disease, with a high temperature lasting five days or longer.
The rash that does not fade under a glass
The most recognisable sign is tiny bleeding into the skin. It looks like reddish-purple dots and blotches, from pinhead to pea size, rather like miniature bruises. They usually appear symmetrically on the shins and feet, sometimes on the buttocks, and often sit slightly raised so that you can feel them with a fingertip.
You can tell them from an ordinary rash at home. Press a spot with your finger, or press the base of a clear glass against it and look through: an ordinary rash goes pale under pressure, bleeding into the skin does not, because the blood has already left the vessel. Photograph the spots in daylight — they may have faded by the time you are seen, but the picture will not. On brown or black skin the marks are harder to see, so look where the skin is palest: the soles, the inner forearms, the lining of the mouth.
The skin can do other things too: tender lumps under the surface, a purple net-like pattern, ulcers on the shins that will not heal, dark splinter lines under the nails, blackening of the fingertips or toes. That last one means a vessel is blocked and needs attention straight away. Vasculitis confined to the skin genuinely can be mild — but the skin cannot tell you whether the kidneys are involved. Only a urine test can.
Signs that are easy to blame on being run down
Inflamed vessels almost always come with general symptoms, and it is those that delay the diagnosis. A temperature persists, sometimes low, sometimes well above thirty-eight degrees, with no obvious source of infection. You wake in the night with a soaked shirt. Weight comes off without dieting, several kilograms over a couple of months. The tiredness is heavy enough that ordinary jobs have to be split into parts.
Added to that are aching joints and muscles, often with no visible swelling, and stiffness first thing in the morning. In people over fifty there may be marked stiffness of the shoulders and hips on waking.
The typical story sounds like "flu that never ends": six to eight weeks of feeling unwell, two courses of antibiotics with no effect, blood tests showing a high ESR and C-reactive protein and an anaemia with no source. On their own these findings prove nothing, but alongside a rash, weight loss and night sweats they mean it is time to look for systemic inflammation rather than prescribe a third antibiotic.
Nerves, kidneys and lungs
Nerve damage gives itself away by being lopsided. It is not the whole body or both legs that go numb or weak, but one foot or one hand: the foot starts to slap the ground and catch its toe on door thresholds, or the hand cannot be straightened. Often, a few days before the weakness, there is burning pain or pins and needles in the same spot.
The kidneys are the quietest of all. They do not hurt and give nothing away until late. Watch for urine the colour of strong tea or dark red, froth that persists in the toilet bowl, puffy eyelids in the morning and swollen ankles by evening, blood pressure rising in someone who never had it, and passing less urine than usual. All of that arrives late; a simple urine test finds blood and protein long before, which is why it is done at the outset and repeated afterwards.
From the chest and the ear, nose and throat, the warning signs are a drawn-out sinusitis that will not respond to usual treatment, crusting and repeated nosebleeds, a hoarse voice, a cough, growing breathlessness on the stairs, and above all streaks of blood in the sputum. The eyes announce themselves with redness, pain and blurring.
When it becomes a matter of hours
Call an ambulance — 112 is the single emergency number across Europe — if any of the following appears:
- loss or blurring of vision, a missing patch in the field of view, or double vision, including sight that went for a few minutes and came back;
- coughing up blood together with worsening breathlessness;
- sudden weakness or numbness of an arm or leg, a drooping face, slurred speech;
- severe tummy pain, especially after eating, with vomiting or blood in the stools;
- dark red urine, or a sharp drop in how much urine you pass;
- a rapidly spreading purple rash with a high temperature and confusion.
You need a doctor the same day, not next week, if someone over fifty develops an unfamiliar headache over the temples, tires and aches in the jaw muscles while chewing, and finds the scalp tender when combing their hair. That is the picture of giant cell arteritis, in which sight can be lost within a day or two and does not come back. The same urgency applies to new weakness in a foot or hand and to a rash that is visibly spreading.
Vasculitis is not a condition where it makes sense to wait a month for an appointment. Treatment here rescues what is still intact; it does not give back a kidney or an eye that has already gone.
How the diagnosis is confirmed
There is no single test that answers yes or no. The diagnosis is assembled from several sources.
- Blood: ESR and C-reactive protein as a measure of inflammation, a full blood count, creatinine to judge kidney function, liver tests.
- Urine: a sample examined under the microscope. This is the cheapest and most informative test in vasculitis, because it finds blood and protein long before there is anything to feel.
- Antibodies: ANCA supports the diagnosis in a group of small-vessel vasculitides, but neither a negative nor a positive result settles it alone. Hepatitis B and C are checked at the same time, since they can be the cause and they change the treatment.
- Imaging: ultrasound of the temporal arteries, CT of the chest and sinuses, angiography where large vessels are involved.
- Biopsy of skin, kidney or temporal artery is the strongest evidence. Earlier is better: a few weeks of steroids wipe the picture out of the tissue.
There is one important exception. When sight is under threat, treatment begins immediately and the biopsy follows while you are already on it. Nobody waits for confirmation with an eye at risk.
Treatment: how the inflammation is put out
The mainstay is glucocorticoids, that is, steroid medicines. They act quickly — in severe disease the improvement shows within days — and that is precisely the job of the first stage: put the fire out.
A second medicine that suppresses the overactive immune response is then added in almost every case, either a cytotoxic drug or a modern targeted agent. It is not a replacement for the steroid; it exists so that the steroid dose can be brought down without the disease returning. The choice depends on the form of vasculitis and on which organs are affected; severe kidney or lung involvement calls for more intensive regimens, including plasma exchange.
Mild forms limited to the skin sometimes need only observation and removal of the cause: stopping the medicine that started it, treating the hepatitis.
Treatment runs in two phases: first getting the disease into remission, a matter of weeks to months, then a maintenance phase lasting a year or more. Flares happen, and that is exactly why follow-up continues after you feel perfectly well. Doses are chosen by your doctor for your form and your test results — the person in the next bed may have a completely different vasculitis.
Living on these medicines
The drugs that put vasculitis out also dampen your defence against infection, and you should be told that plainly in advance. On this treatment an infection runs muted, often without a high temperature. So any rise in temperature, a new cough, stinging when passing urine, a reddened cut, is a reason to contact your doctor the same day rather than sit out the weekend. Flu and pneumococcal vaccination is discussed with the doctor in advance; live vaccines are not given during this treatment.
Some complications are headed off deliberately. Your doctor may prescribe a medicine to prevent pneumocystis pneumonia, protection for the bones — calcium and vitamin D, and specific bone drugs where needed — and something to protect the stomach. Blood count, creatinine, urine, glucose and blood pressure are checked at the intervals your doctor sets: steroids push both sugar and pressure up, and that is picked up by testing, not by how you feel.
Steroids must never be stopped abruptly. After a few weeks of treatment your own adrenal glands are working at half power, and sudden withdrawal causes a severe drop in blood pressure and profound weakness that can be life-threatening — while the vasculitis flares back at the same time. The dose comes down only on the schedule your doctor sets. Carry a note or a card saying that you take steroids: during surgery, injury or serious infection the dose is temporarily raised, not stopped.
One more thing: long-standing inflammation of the vessels raises the risk of heart attack and stroke by itself. Stopping smoking and keeping blood pressure and cholesterol in check are not general advice here — they are part of the treatment.
Online consultation
A doctor on a video call can look at photographs of the rash and judge whether it fades under pressure, gather scattered complaints — the temperature, the weight loss, the numb foot — into one picture, and say how much this looks like systemic inflammation. They can tell you which tests are worth having before a face-to-face appointment, go through results you already have, explain what ANCA means on your report, and help you work out which specialist to see and how urgently. If you are already on treatment, a consultation is a good place to go over the tapering schedule, the side effects, and which symptoms mean contacting your own doctor without delay.
What an online appointment does not replace: examination, biopsy and emergency care. If you lose vision, cough up blood with breathlessness, develop sudden weakness in a limb or find you are passing far less urine, call an ambulance rather than open a chat window.
This material is for information only and does not replace medical advice.
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