Conclusions
The assessment and treatment of vasculitis remains empirical because of the general absence of known etiologies and essential pathophysiology. The value of combining oral corticosteroid therapy with cyclophosphamide has stood the test of time in WG; however, relapse of disease and efforts to limit side effects spur the search for other therapies. Many alternatives for the treatment of vasculitis are available, but insufficient experience does not permit recommendation. Because many vasculitic syndromes are relatively rare, the possibility of accumulating sufficient numbers of patients for double-blind trials is low. Therefore, the clinician must weigh the risk and benefits of the various treatment options without the benefit of definitive trial data. This remains one of the major challenges in treating patients with vasculitis.
Keywords
Vasculitis Mycophenolate Mofetil Systemic Vasculitis Tumor Necrosis Factor Inhibitor Polyarteritis Nodosa
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Preview
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.Jennette JC, Falkf RJ, Andrassy K, et al.: Nomenclature of systemic vaculitides: proposal of an international consensus conference. Arthritis Rheum 1994, 37:187–192.PubMedCrossRefGoogle Scholar
- 2.Jayne DR, Rasmussen N: Treatment of antineutrophil cytoplasm autoantibody-associated systemic vasculitis: initiatives of the European Community Systemic Vasculitis Clinical Trials Study Group. Mayo Clin Proc 1997, 71:737–747.CrossRefGoogle Scholar
- 3.Hagen EC, Daha MR, Hermans J, et al.: Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis. Kidney Int 1998, 53:743–753.PubMedCrossRefGoogle Scholar
- 4.Haubitz M, Schulzeck P, Schellong S: Complexed plasma elastase as an in vivo marker for leukocyte activation in antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 1997, 336:411–414.Google Scholar
- 5.Schultz DR, Tozman EC: Antineutrophil cytoplasmic antibodies: major autoantigens, pathophysiology and disease associations. Semin Arthritis Rheum 1995, 25:143–159.PubMedCrossRefGoogle Scholar
- 6.Langford CA, Klippel JH, Balow JE, et al.: Use of cytotoxic agents and cyclosporine in the treatment of autoimmune disease: inflammatory bowel disease, systemic vasculitis and therapeutic toxicity. Ann Intern Med 1998, 129:49–58.PubMedGoogle Scholar
- 7.Haubitz M, Schellong S, Göbel U: Intravenous pulse administration of cyclophosphamide versus daily oral treatment in patients with antineutrophil cytoplasmic antibody-associated vasculitis and renal involvement. Arthritis Rheum 1998, 41:1835–1844.PubMedCrossRefGoogle Scholar
- 8.Stegeman CA, Cohen Tervaert JW, de Jong PE, Kallenberg CG:Trimethoprim-sulfamethoxazole (co-trimoxazole) for the prevention of relapses of Wegener’s granulomatosis: Dutch co-trimoxazole Wegener’s study group. N Engl J Med 1996, 335:16–20.PubMedCrossRefGoogle Scholar
- 9.Gross WL: New concepts in treatment protocols for severe systemic vasculitis. Curr Opin Rheumatol 1999, 11:41–46.PubMedCrossRefGoogle Scholar
- 10.Hoffman GS, Leavitt RY, Kerr GS, Fauci AS: The treatment of Wegener’s granulomatosis with glucocorticoids and methotrexate. Arthritis Rheum 1992, 35:1322–1329.PubMedGoogle Scholar
- 11.Jayne DR, Lockwood CM: Intravenous immunoglobulin as sole therapy for systemic vasculitis. Br J Rheumatol 1996, 35:1150–1153.PubMedCrossRefGoogle Scholar
- 12.Lockwood CM: New treatment strategies for systemic vasculitis: the role of intravenous immune globulin therapy. Clin Exp Immunol 1996, 104(Suppl 1):77–82.PubMedGoogle Scholar
- 13.Levy Y, Shere Y, George J, et al.: Serologic and clinical response to treatment of systemic vasculitis and associated autoimmune disease with intravenous immunoglobulin. Int Arch Allergy Immunol 1999, 119:231–238.PubMedCrossRefGoogle Scholar
- 14.Present DH, Rutgerts PR, Targan S, et al.: Infliximab for the treatment of fistulas in a patient with Crohn’s disease. N Engl J Med 1999, 340:1398–1405.PubMedCrossRefGoogle Scholar
- 15.Lockwood CM, Elliott JD, Brettman L, et al.: Anti-adhesion molecule therapy as an interventional strategy for autoimmune inflammation. Clin Immunol 1999, 93:93–106.PubMedCrossRefGoogle Scholar
- 16.Lhote F, Guillevin L: Traitement des vascularites virales. Pathologie Biologie 1999, 47:257–264.PubMedGoogle Scholar
- 17.Guillevin L, Lhote F, Gherarardi R: The spectrum and treatment of virus-associated vasculitides. Curr Opin Rheumatol 1997, 9:31–36.PubMedCrossRefGoogle Scholar
- 18.Haubitz M, Koch KM, Brunkhorst R: Cyclosporin for the prevention of disease reactivation in relapsing ANCA-associated vasculitis. Nephrol Dial Transplant 1998, 13:2074–2076.PubMedCrossRefGoogle Scholar
- 19.Waiser J, Budde K, Braasch E, Neumayer HH: Treatment of acute c-ANCA-positive vasculitis with mycophenolate mofetil. Am J Kidney Dis 1999, 34:9.Google Scholar
- 20.Elliott JD, Lockwood CM, Hale G, Waldmann H: Semi-specific immuno-absorption and monoclonal antibody therapy in ANCA positive vasculitis: experience in four cases. Autoimmunity 1998, 28:163–171.PubMedGoogle Scholar
- 21.Tesar V, Jelikova E, Masek Z, et al.: Influence of plasma exchange on serum levels of cytokines and adhesion molecules in ANCA-positive renal vasculitis. Blood Purif 1998, 16:72–80.PubMedCrossRefGoogle Scholar
- 22.Hidada T, Suzuki K: Efficacy of filtration leukocytapheresis on rheumatoid arthritis with vasculitis. Therap Apheresis 1997, 1:212–214.Google Scholar
Copyright information
© Current Science Inc 2000