VASCULITIS - DIAGNOSIS AND THERAPY

Vasculitis comprises a broad group of syndromes characterized by infla mmation and necrosis in the walls of blood vessels, resulting in narro wing or occlusion of the lumen. The distribution of blood vessel invol vement varies considerably and serves as the basis for one classificat ion of the vasculitic Syndromes: large vessels (Takayasu arteritis, gi ant-cell arteritis); medium and small muscular arteries (polyarteritis nodosa, Churg-Strauss syndrome, Wegener's granulomatosis, vasculitis in rheumatic diseases); and small vessels (''hypersensitivity'' vascul itis, Henoch-Schonlein purpura, microscopic polyangiitis, cryoglobulin emia). The pathogenesis of most forms of vasculitis is only beginning to be understood, but is probably varied and complex. Because of the v ariability of vasculitides, there is no single, uniform method of diag nosis and treatment. However, a detailed history, careful physical exa mination, and appropriate laboratory tests are needed in all cases to determine the type of onset, course of illness, organ systems affected , and extent of involvement. Biopsy examination of involved tissues is nearly always essential for diagnosis, except in Takayasu arteritis, when aortography is usually indicated. In most cases of vasculitis, co rticosteroid therapy is necessary. When the organ involvement is broad er and more progressive (e.g., in cases of polyarteritis nodosa or Weg ener's granulomatosis), a combination of cytotoxic drug and corticoste roids is often needed.