Treatment Pathway
Treatment of Vasculitis
Vasculitis is inflammation of blood vessel walls, causing a spectrum of diseases based on the size of affected vessels. Symptoms depend on the organs involved and can include skin purpura, peripheral neuropathy, and organ ischemia.
ACR (American College of Rheumatology)EULAR (European League Against Rheumatism)BSR (British Society for Rheumatology)NICEOARSI (osteoarthritis)
Managing Vasculitis effectively requires a combination of medical treatment, lifestyle modification, and regular monitoring. With a structured management plan, most people with Vasculitis can maintain a good quality of life and prevent serious complications.
First-Line Treatment Principles
- ✓Treat-to-target (T2T) strategy in RA and SpA: aim for remission or low disease activity
- ✓Disease-modifying antirheumatic drugs (DMARDs) initiated early in RA — methotrexate first-line
- ✓Biologic DMARDs (anti-TNF, anti-IL-6, JAK inhibitors) when csDMARD inadequate
- ✓Hydroxychloroquine and low-dose prednisolone for SLE; immunosuppressives for organ-threatening disease
- ✓Analgesia stepped approach: paracetamol → NSAIDs → opioids (short-term); topical agents in OA
What to Do Now
- Learn your personal risk factors for Vasculitis (family history, age, lifestyle)
- Attend regular health check-ups and screening tests appropriate for your age and risk
- Track new or changing symptoms, especially those associated with Vasculitis
- Use our AI symptom checker to assess whether your symptoms fit an early Vasculitis pattern
- Discuss preventive strategies and early monitoring with your GP
- Build a personalised management plan with your GP or specialist
- Adhere consistently to prescribed medications — do not stop without medical advice
- Adopt a Vasculitis-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)
Non-Pharmacological Management
- •Physical therapy: joint protection, range-of-motion exercises, strengthening — essential in OA and RA
- •Weight management: reduces mechanical load on hips/knees; reduces systemic inflammation
- •Occupational therapy: joint protection aids, assistive devices, workplace adaptations
- •Hydrotherapy and aquatic exercise: low-impact joint rehabilitation in OA
- •Dietary: Mediterranean diet reduces RA disease activity; omega-3 supplementation may reduce inflammation
- •Smoking cessation: major independent risk factor for RA initiation and worse disease course
- •Sun protection in SLE (UV can trigger flares)
Treatment Goals
🎯Remission or low disease activity (DAS28 <2.6 or <3.2) in RA
🎯Prevention of joint damage: minimal erosion progression on X-ray/MRI
🎯Functional preservation: HAQ score improvement; work and activity maintenance
🎯Control of systemic manifestations: uveitis, enthesitis, skin in SpA/PsA
🎯Minimise corticosteroid dose and long-term toxicity
Monitoring Parameters
- ◆Disease activity scores: DAS28 (RA), BASDAI/ASDAS (SpA), SLEDAI (lupus) — at 1, 3, 6 months
- ◆Shared care monitoring for methotrexate: FBC, LFTs monthly × 6, then every 3 months
- ◆Anti-TNF monitoring: TB screening (IGRA) before initiation; LTBI prophylaxis if positive
- ◆Bone mineral density: DEXA scan at baseline and every 2 years on long-term corticosteroids
- ◆Anti-dsDNA and complement (C3/C4) in SLE flare surveillance
- ◆Opthalmology: hydroxychloroquine retinopathy screening annually after 5 years use
Red Flags — When to Escalate
- ⚠Any of the characteristic symptoms of Vasculitis — even mild — in a high-risk individual
- ⚠Progressive worsening of early warning signs over weeks
- ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
- ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
- ⚠Strong family history of Vasculitis combined with new relevant symptoms
- ⚠Sudden worsening of Vasculitis symptoms despite established treatment
Escalation Criteria
- →Inadequate response to methotrexate at 3 months → add hydroxychloroquine/sulfasalazine or switch to biologic
- →Lupus nephritis → high-dose prednisolone + mycophenolate or cyclophosphamide
- →Vasculitis with organ involvement → IV methylprednisolone + cyclophosphamide or rituximab
- →Septic arthritis: urgent joint aspiration + IV antibiotics; surgical washout if joint destruction
Special Populations
Pregnancy: methotrexate, leflunomide, mycophenolate contraindicated — switch before conception; hydroxychloroquine and sulfasalazine continued
Elderly: increased infection risk with immunosuppressives; bone protection mandatory with steroids
Children: paediatric rheumatology specialist; treat early to preserve growth and development
Vaccinations: ensure up to date (pneumococcal, influenza, shingles) before biologic initiation
Clinical Insights
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