There are two phases in the treatment of vasculitis – “Remission Induction” therapy (getting the disease under control) and “Remission Maintenance” therapy (keeping the disease under control). Both phases normally involve immunosuppressive drugs.
Remission Induction therapy – Usually requires a combination of immunosuppressive drugs to control the inflammation. The drugs given will vary according to the specific disease and the severity of the disease. These drugs are commonly high dose steroids (prednisolone) and additional treatment with drugs such as cyclophosphamide or methotrexate may be given.
In some types of vasculitis newer antibody treatments (eg rituximab or infliximab sometimes called “biologic therapies”) are starting to replace the older treatments such as cyclophosphamide. Usually the amount of steroid treatment will be reduced quickly over the first few weeks and then more slowly. The common side effects of drugs used in remission induction phase are infections because of the suppression of the immune system. Often additional drugs will be given to protect against infection and other side effects of the treatment. See: Glossary of Drugs and Side Effects
Remission Maintenance therapy – Once the disease is controlled or in remission (indicated by improved symptoms and blood tests), the treatment is changed (usually after several months) and maintenance therapy is commenced. The prednisolone is usually reduced to a very low dose. If cyclophosphamide has been given it is usually stopped and changed to less toxic drugs such as azathioprine. Maintenance therapy can last for many years, but in some cases can be discontinued after one or two years. How long people with vasculitis need to remain on remission maintenance therapy is very variable and will need to be discussed on an individual basis with the medical team helping look after the patient.
Which doctors will be involved in the treatment of vasculitis depends on the type of vasculitis, the organs involved, the severity of the disease and the local practice in your area. You may need several different specialists to manage your disease working as a team. This multidisciplinary team may all be present in one clinic (a multidisciplinary or “one-stop” clinic) or may be working in several clinics in one hospital or even in different hospitals. This may require many different hospital appointments to see the different specialists and good communications between the different members of the team. Information about multidisciplinary clinics may be available from the GP, local specialists or Vasculitis UK.
The treatment given to an individual patient will depend on the type of vasculitis, the severity of the vasculitis, other medical problems the patient may have, how well they have responded to treatment so far and the evidence for the current best treatment available (see section below on clinical trials and research). This means that patients who superficially may appear to have similar disease may get significantly different treatments.
Follow-up
There is no cure for many of the vasculitis diseases. The aim of treatment is to keep the disease process in remission. It is, therefore, essential that the patient is monitored periodically by blood/urine tests and outpatient appointments even when activity of disease is not present.
Taking part in research and clinical trials
Doctors treating patients with vasculitis rely on clinical trials and research being conducted and published to know what the best treatments are for different types of vasculitis. This means that the recommendations for treating some types of disease keep changing as they understand more about them and how to treat them.
Unfortunately most types of vasculitis are rare and this makes it very difficult to do useful research and conduct clinical trials to find the best treatments. Fortunately there are groups of doctors around the world interested in finding better treatments for vasculitis and by co-operating together research gets done and treatments become safer and more effective.
If you are being treated in a clinic that is involved in vasculitis research and clinical trials you may be invited to take part. If so the medical team should explain the nature of the research or clinical trial to you, give you information sheets to look at, explain the possible pros and cons for you as a patient in taking part, give you the opportunity to ask questions you might have (and give you answers) and respect your decision about taking part whether you choose to participate or not. Sometimes you may benefit directly from taking part in a clinical trial or research, sometimes only other patients in the future will benefit from you having agreed to take part.
Details about current research and clinical trials recruiting patients can be found at: Participate in vasculitis research