Vasculitis: An Overview
Guest: Dr. Gary Gilkeson – Rheumatology and Immunology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Gary Gilkeson, who is Professor of Medicine in Rheumatology here at the Medical University of South Carolina. Dr. Gilkeson, let’s talk about vasculitis. What is vasculitis?
Dr. Gary Gilkeson: Vasculitis is a group of diseases that have in common inflammation of the blood vessels. The symptoms and characterization of the disease depends on whether it’s a small blood vessel that’s involved or whether it’s one of the big blood vessels.
Dr. Linda Austin: What causes it?
Dr. Gary Gilkeson: Unfortunately, we don’t know, in most instances, what causes it. There are a couple of types of vasculitis. One called cryoglobulinemia that’s associated with developing hepatitis C. There’s another type called polyarteritis nodosa that’s associated with developing hepatitis B. The other common varieties, Wegener’s granulomatosis, or temporal arteritis, we don’t, at this point in time, have a good understanding as to what causes them.
Probably the most common variety is the small vessel vasculitis, which is involving the little capillary blood vessels, and that’s commonly called leukocytoclastic vasculitis, or allergic vasculitis. Typically, that is a reaction to a medication. Somebody takes an antibiotic or a diuretic and they develop big red bumps on their legs. That, typically, is vasculitis of the small blood vessels due to one of the medications. It can also happen in association with different types of infections, primarily strep infections.
Dr. Linda Austin: Is Buerger’s arteritis categorized as a vasculitis?
Dr. Gary Gilkeson: Buerger’s disease is typically thought of as a vasculopathy, which is kind of splitting hairs, but there’s not a lot of inflammation in Buerger’s disease. It, primarily, is a disease where the blood vessels close off the small vessels. And that’s almost always seen in people that are smokers. And, again, why some get it and other people don’t, we don’t really understand.
Dr. Linda Austin: What are some of the symptoms of vasculitis?
Dr. Gary Gilkeson: The symptoms vary with, again, the blood vessel that’s involved. If it’s a small blood vessel, as we talked about the allergic vasculitis or the leukocytoclastic vasculitis that, primarily, is manifested as a skin rash, typically a bumpy skin rash on your legs that you can feel. Those patients might have some joint pain and muscle pain associated with it, and low-grade fever. The more serious forms of vasculitis can, as you might expect, have involvement of a large blood vessel in your stomach, or a blood vessel in your lung or heart. Obviously, that can cause more serious problems because it shuts off blood supply to those particular organs.
The other common type is what’s called giant cell arteritis, or temporal arteritis, which is a disease of individuals usually over the age of 60 who present with severe headaches, have pain around their temporal artery areas. They may have pain when they chew. They may have numbness in their mouth and on their tongue. And that’s due to enlargement of the blood vessels supplying the face and the tongue. The complication of that is that it can also involve the arteries that supply the eyes, so you can get rather rapid onset of blindness if that’s not diagnosed and treated appropriately.
Dr. Linda Austin: I would imagine, then, that the diagnosis of some of these disorders must be difficult because it sounds like they can involve very subtle portions of the anatomy, tiny blood vessels, for example.
Dr. Gary Gilkeson: Right. The small blood vessel ones can be because, as you say, it can be a variety of things that mimic it. The more serious vasculitis normally become so rapidly life-threatening that they’re not as hard to diagnose once they get going. The temporal arteritis, the danger of that is that people will ignore it for a period of time, thinking it’s just a headache, so they don’t seek medical care for it,
and then the presenting symptom may be blindness in one eye or the other.
Dr. Linda Austin: How do you go about treating these disorders?
Dr. Gary Gilkeson: The small vessel vasculitis that we talked about, that are a reaction to medication, obviously, you just stop the medication. If it’s due to infection, you treat the infection. If it’s none of those but is more of an autoimmune phenomenon, then we have to use the immunosuppressive agents, like prednisone, Methotrexate, Imuran, some of these more potent medications.
Dr. Linda Austin: And how successful is that treatment? What kind of prognosis do these patients have?
Dr. Gary Gilkeson: The small vessel vasculitis, the prognosis is excellent. For the more serious ones, involving the large blood vessels, we have good treatments for it, but it can still lead to significant morbidity, or patients can have significant problems from the disease, despite treatment, although treatment is 100 percent better than no treatment. For the temporal arteritis, in the elderly, that’s very easy to treat with the prednisone, and the prognosis for that is excellent. The only problem with it is getting around the side effects of the prednisone.
Dr. Linda Austin: So, it must be a rewarding, interesting illness to treat, for you.
Dr. Gary Gilkeson: It’s a very rewarding one. One of the diseases that’s related is a disease called polymyalgia rheumatica which, often, is the predecessor of temporal arteritis. Those patients have severe pain in their shoulders and in their hips when they wake up in the morning. And, just with a little prednisone, they feel 100 percent better, so that, especially, is a very rewarding disease to treat.
Dr. Linda Austin: Dr. Gilkeson, thank you much for talking with us today.
Dr. Gary Gilkeson: Thank you.
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