Vasculitis Treatment: Key Questions and Insights

Treatment of vasculitis

My father underwent cataract surgery on his left eye on April 9, and since then, his vision has been blurry.
During a follow-up appointment two days ago, the doctor mentioned that he has vascular occlusion and dilation of the optic nerve.
Since November of last year, my father has lost over ten pounds, feels easily fatigued, often experiences itching on his back, and has frequent nighttime urination (4-5 times a night).
He also had unexplained abdominal pain two months ago, which required a two-day hospital stay for tests that yielded no results.
Therefore, the doctor suspects he may have vasculitis.
The doctor stated that to confirm the diagnosis of vasculitis, a biopsy is necessary.
In the meantime, to prevent affecting the vision in his other eye, he recommended that my father take corticosteroids.
However, my father does not exhibit any symptoms of headaches, vascular sclerosis, or jaw pain.
Another ophthalmologist indicated that oral corticosteroids may not be very effective and suggested a treatment regimen of three days of injections followed by eleven days of oral medication.
Here, I would like to ask: 1.
Is oral corticosteroid treatment as ineffective as the other doctor suggested? 2.
Is one course of corticosteroid treatment sufficient? What is the cure rate? 3.
Will starting corticosteroids before the biopsy affect the results?

Ming, 30~39 year old female. Ask Date: 2010/05/13

Dr. Qiu Zhengbin reply Internal Medicine

Hello, I am a physician in the Department of Metabolism at Changhua Hospital.
Regarding your concerns, I would like to address them from two aspects.

First, you mentioned that your father has experienced a weight loss of 11 kilograms over the past few months, along with fatigue and nocturia.
These symptoms may suggest diabetes, so it is important to check for diabetes first.
If a diabetic patient undergoes steroid treatment, it can easily lead to a rapid increase in blood sugar levels, so blood sugar control must be managed carefully.
Second, concerning the treatment of ocular vasculitis, I recommend consulting an ophthalmologist for a more accurate assessment.
If the vasculitis is related to internal medicine, it often presents with neurological symptoms, purpura, or symptoms related to the lungs or kidneys.
Since the information you provided does not indicate these symptoms, it is difficult to make a definitive judgment.
I hope this response is helpful to you.

Reply Date: 2010/05/13

More Info

Vasculitis is a complex condition characterized by inflammation of blood vessels, which can lead to a variety of symptoms depending on the organs affected. Your father's situation, particularly following his cataract surgery and the subsequent symptoms he has experienced, raises important questions regarding the diagnosis and treatment of potential vasculitis.

1. Effectiveness of Oral Steroids: The effectiveness of oral corticosteroids in treating vasculitis can vary depending on the specific type of vasculitis and the severity of the condition. While some physicians may suggest that oral steroids are not sufficient for certain cases, they can still play a crucial role in managing inflammation and preventing further damage in many patients. The choice between oral and injectable steroids often depends on the urgency of treatment and the specific clinical scenario. In some cases, a combination of both may be recommended to achieve rapid control of inflammation.

2. Duration and Efficacy of Steroid Treatment: The duration of steroid treatment can vary widely based on the individual’s response and the severity of the vasculitis. A typical course might start with higher doses that are gradually tapered down as symptoms improve. It is essential to monitor the patient closely during this period. The cure rate for vasculitis can also differ significantly based on the type of vasculitis, the organs involved, and how early treatment is initiated. Some forms of vasculitis can be effectively managed with steroids alone, while others may require additional immunosuppressive therapies.

3. Impact of Steroid Use Before Biopsy: Starting corticosteroids before a biopsy can potentially affect the results, particularly if the biopsy is intended to assess the degree of inflammation or damage. Steroids can reduce inflammation, which might lead to a less pronounced histological picture of the disease. However, in some cases, the urgency of treating inflammation and preventing further complications may outweigh the potential downsides of starting steroids before a definitive diagnosis is made. It is crucial to have a thorough discussion with the healthcare team about the risks and benefits of this approach.

In addition to these points, it is important to consider the overall clinical picture. The symptoms your father is experiencing—weight loss, fatigue, itching, and frequent urination—could be indicative of systemic involvement, which is common in vasculitis. The need for a biopsy is often to confirm the diagnosis and to guide treatment decisions.
Moreover, the management of vasculitis typically involves a multidisciplinary approach, including rheumatologists, ophthalmologists, and possibly other specialists depending on the organs involved. Regular follow-ups and monitoring are essential to adjust treatment as necessary and to manage any side effects from medications.

In summary, while oral steroids can be effective in managing vasculitis, the specific treatment plan should be tailored to your father's unique situation, considering both the urgency of treatment and the need for accurate diagnosis. Engaging in open communication with his healthcare providers will be key to navigating this complex condition.

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