What is Vasculitis?
Vasculitis is a group of diseases in which blood vessel walls become inflamed, narrowing or blocking the vessel and starving the tissue it supplies. Which organ is affected depends entirely on the size and location of the vessels involved.
Large-vessel disease includes Takayasu arteritis — notably more common in young Indian women — and giant cell arteritis in older adults. Small-vessel disease includes the ANCA-associated vasculitides, which threaten kidneys and lungs.
Vasculitis is one of the few genuine emergencies in rheumatology. Untreated giant cell arteritis can cause irreversible blindness within days; untreated ANCA vasculitis can destroy kidney function within weeks.
IllustrativeSymptoms of Vasculitis
Early signs
- Persistent fever, night sweats, weight loss and fatigue with no infective cause found
- New severe headache with scalp tenderness, or jaw pain while chewing (giant cell arteritis)
- Arm claudication, absent or unequal pulses, or a blood pressure difference between arms (Takayasu)
- A purpuric rash over the legs that does not blanch
- Persistent nasal crusting, bloody discharge, sinusitis or hearing loss
If left untreated
- Sudden painless loss of vision in one eye
- Coughing blood or rapidly worsening breathlessness (pulmonary haemorrhage)
- Rapidly rising creatinine with blood and protein in the urine
- Foot drop or wrist drop (mononeuritis multiplex)
- Digital gangrene, stroke or bowel infarction
Causes & risk factors
- Autoimmune attack on vessel walls, often ANCA-mediated in small-vessel disease
- Genetic susceptibility with distinct ethnic patterns — Takayasu is notably prevalent in South Asia
- Infection-associated vasculitis: hepatitis B (polyarteritis nodosa), hepatitis C (cryoglobulinaemia)
- Drug-induced vasculitis: hydralazine, propylthiouracil, levamisole-adulterated cocaine
- Association with other autoimmune disease and, rarely, underlying malignancy
How Vasculitis is diagnosed
No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.
ANCA testing with specific antigens
Immunofluorescence plus anti-PR3 and anti-MPO ELISA — these define the subtype and guide both treatment intensity and relapse risk.
Urgent urine microscopy
Dysmorphic red cells and red cell casts indicate active glomerulonephritis. This simple test frequently determines the urgency of everything that follows.
Vascular imaging
CT or MR angiography and PET-CT for large-vessel disease; Doppler ultrasound of temporal arteries showing the halo sign in giant cell arteritis.
Tissue biopsy
Kidney, skin, nerve, lung or temporal artery biopsy where feasible — histology guides intensity of immunosuppression and avoids treating the wrong disease.
Rigorous infection exclusion
In India, tuberculosis, infective endocarditis and deep fungal infection can mimic vasculitis closely. Excluding them before starting high-dose immunosuppression is mandatory.
Organ damage mapping
ENT, ophthalmology, chest imaging, nerve conduction and cardiac assessment to establish the true extent at baseline.
Treatment options
Emergency high-dose glucocorticoids
In suspected giant cell arteritis with visual symptoms, steroids are started immediately — before biopsy — because delay costs sight permanently.
Remission induction
Rituximab or cyclophosphamide combined with steroids for organ-threatening ANCA-associated vasculitis, with plasma exchange in selected severe cases.
Steroid-sparing agents
Tocilizumab for giant cell arteritis and Takayasu arteritis, dramatically reducing cumulative steroid exposure; avacopan as a newer C5a receptor antagonist in ANCA vasculitis.
Maintenance therapy
Scheduled rituximab, azathioprine or methotrexate for 24–48 months, since relapse risk is high — particularly with PR3-ANCA disease.
Infection prophylaxis and vaccination
Co-trimoxazole for Pneumocystis prevention, latent TB screening and treatment, and full vaccination before deep immunosuppression.
Vascular and cardiovascular protection
Blood pressure control, statins, antiplatelet therapy where indicated, and vascular surgical input for critical stenosis once inflammation is controlled.
Seek urgent medical attention if you have
- Any sudden visual loss or transient blurring in a patient over 50 with headache — same-day emergency
- Coughing up blood or rapidly worsening breathlessness
- Rapidly rising creatinine or visibly bloody urine
- New foot drop or wrist drop
- Blackening of fingers or toes
Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.
Frequently asked questions about Vasculitis
Is vasculitis curable?
Why do I need so many tests before starting treatment?
Is Takayasu arteritis common in India?
Get an expert opinion on Vasculitis in Pune
Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.
Part of a wider group
VasculitisThe one group in rheumatology where days of delay cost sight, kidneys or life.Related conditions
Lupus (SLE)
A multi-system autoimmune disease where early kidney screening changes the entire prognosis.
Polymyalgia Rheumatica
Sudden shoulder and hip stiffness after 50 that responds to steroids within days.
Rheumatoid Arthritis
Symmetric small-joint swelling that responds best when treated within the first 12 weeks.