Is it possible to offer evidence-based treatment for systemic vasculitis?

The evidence base for treatment of systemic vasculitis is reviewed in this article. Accurate diagnosis and evaluation of disease status is crucial to the appropriate management of these cases and disease status should be empl oyed as a means of staging so that appropriate therapy can be offered tailo red to the individual requirements of each case. Large vessel vasculitides are almost exclusively managed with corticosteroids. Small vessel vasculiti s with internal organ involvement usually requires more aggressive immune-s uppression; by contrast, small vessel vasculitis without internal organ inv olvement rarely requires intervention. Despite our current efforts, the lon g-term morbidity of patients with systemic vasculitis remains high. We need better therapeutic strategies in order to limit or control disease rapidly and thereby prevent the accumulation of subsequent damage. Large-scale ran domised trials comparing different therapeutic strategies offer the only ho pe of establishing a firmer evidence base for the optimal management of the se diseases.