Vasculitis Tx.htm - Kim

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Kim: Sorry you are experiencing so much discomfort. Are you receiving any type of treatment?

I'm sending you this article on Vasculitis and possible treatment.

It seems important right now that you get some relief.

Barb

London, Ontario, Canada

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FromSkin & Allergy News Steroids Shouldn't Be First Line for Vasculitis TxTodd Zwillich, Senior Writer [skin & Allergy News 30(2):29, 1999. © 1999 International Medical News Group.]

New York -- Don't jump right to prednisone and other glucocorticoids when treating patients with vasculitis, said Dr. Soter of the New York University department of dermatology. There are a variety of other medications that can bring vasculitis under control with a much more favorable side effect profile. In fact, prednisone should be used only after several other modalities have already been attempted, he said at an annual program on advances in dermatology sponsored by the university. Dr. Soter, who regularly sees vasculitis patients in his referral practice, starts with an H1 antihistamine combined with a nonsteroidal anti-inflammatory drug, usually indomethacin at a dosage of 25 mg or 50 mg three times/day. If the patient has no response or only a partial response, both drugs can be stopped in favor of colchicine given at 0.6 mg twice/day or three times/day. Hydroxychloroquine sulfate also may be a useful adjuvant to antihistamines. If these two steps fail, dapsone starting at 25 mg/day and increased as tolerated often results in a good response. Dr. Soter has patients taking as much as 200 mg/day, but close monitoring with complete blood counts, a complete chemistry profile, and liver function tests is essential. If none of these interventions deliver relief, then it is time to move on to prednisone or other glucocorticoids. But the risks of long-term therapy must be carefully weighed against patients' willingness to tolerate their symptoms. Many cases of vasculitis are mild enough that patient and clinicians will forgo steroid treatment. Azathioprine adjusted for patient weight and disease severity also can be useful in severe cases that do not involve the internal organs, but close laboratory monitoring is once again required (see box). Immunosuppression with cyclophosphamide has shown some efficacy, but it is reserved for cases with internal organ involvement. "In those cases, one should work with the appropriate internist or specialist," he said.

Lab TestsIn vasculitis, "You can't tell by looking at the skin whether there is also internal disease," Dr. Soter said. A range of laboratory tests is essential in the initial evaluation and for monitoring drug side effects and disease progression in these patients, he said. They include the following:

Erythrocyte sedimentation rate.

White blood cell count with differential analysis.

Platelet count.

Urinalysis.

24-hour urine protein and creatinine clearance rate.

Blood chemistry profile.

Serum protein electrophoresis.

Hepatitis B antigen and hepatitis A and C antibodies.

Cryoglobulins.

Total hemolytic complement (CH50).

Antinuclear antibodies.

Rheumatoid factor.

Antiphospholipid antibodies.

Circulating immune complexes.

Skin biopsy.

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