Vasculitis: Symptoms, Diagnosis, and Treatment Options

Vasculitis

Hello Doctor,
I have been experiencing issues with redness, swelling, and heat in my knees for the past two years.
Sometimes it affects my feet, toes, and heels, and occasionally my fingers, mostly around the joints.
Typically, the symptoms resolve on their own within 2-3 days without medication.
I suspect it is related to the joints.
I have visited three orthopedic clinics, and the doctors suggested it might be gout, providing dietary advice for managing gout.
However, my uric acid tests have consistently shown normal levels.
I did not restrict my diet afterward, and my condition has been fluctuating.
Recently, my old symptoms flared up again, prompting me to visit another hospital.
I believe gout falls under the realm of rheumatology and autoimmune conditions, so I consulted that department.

At that time, I had redness about one square centimeter on the palms of both hands near the wrist joints, which was painful upon pressure.
I also experienced pain in my feet while walking, and my left middle finger joint was swollen.
The doctor examined me and diagnosed it as vasculitis, ordering blood tests to rule out conditions such as lupus erythematosus.
The results indicated it was simple vasculitis, and I was advised to be hospitalized for further examination.

I have researched some information online and found that the causes of vasculitis are currently unknown, but it is known to be an autoimmune disease, possibly triggered by drug or food allergies.
I noticed that the medications prescribed by the doctor include antihistamines, immunosuppressants, and anti-inflammatory drugs.

My questions are:
1.
If the cause of the vasculitis is currently unknown, what further tests should be conducted?
2.
Based on the doctor's clinical experience, is this indeed vasculitis or gout? Besides uric acid tests, are there other methods to differentiate between the two?
3.
Is the occurrence of simple vasculitis common? If the cause cannot be identified, what should be the future treatment direction?
Thank you, Doctor.

Ah Hua, 30~39 year old female. Ask Date: 2002/07/09

Dr. Liu Hongxiang reply Internal Medicine

Vasculitis refers to the inflammation of blood vessels, leading to damage and resulting in tissue hypoxia, with no definitive cause of onset.
Diagnostic evaluations may include medical history, X-rays, blood tests, biopsies, and angiography.
Blood tests typically include complete blood count, erythrocyte sedimentation rate, creatinine, antinuclear antibodies, and rheumatoid factor.
The incidence of vasculitis is not precisely defined, and treatment options include corticosteroids and immunosuppressive medications, administered according to the severity of symptoms.
The diagnosis of gout is determined based on symptoms and the presence of uric acid crystals in joint fluid obtained through aspiration.

Reply Date: 2002/07/09

More Info

Vasculitis is a complex group of disorders characterized by inflammation of blood vessels, which can lead to a variety of symptoms depending on the vessels involved and the organs affected. Your experience with joint pain, swelling, and redness, particularly in the knees and fingers, raises important questions about the underlying cause of your symptoms and the appropriate treatment options.

1. Further Investigations: Since the exact cause of your vasculitis is currently unknown, additional tests may be warranted to rule out other potential causes. These could include:
- Imaging Studies: Ultrasound or MRI can help visualize inflammation in the joints and surrounding tissues.

- Blood Tests: Comprehensive panels can assess for markers of inflammation (like ESR and CRP), autoimmune markers (such as ANCA, anti-dsDNA, and others), and specific infections that could trigger vasculitis.

- Biopsy: In some cases, a biopsy of affected tissue may be necessary to confirm the diagnosis and rule out other conditions.

2. Differentiating Vasculitis from Gout: While gout is characterized by elevated uric acid levels and typically presents with sudden, severe pain in joints (often the big toe), vasculitis can present with more systemic symptoms and may not always correlate with uric acid levels. To differentiate between these conditions:
- Clinical History: The pattern of joint involvement and associated symptoms (like fever, fatigue, or skin changes) can provide clues.

- Synovial Fluid Analysis: Aspiration of the joint fluid can help identify crystals associated with gout or signs of inflammation consistent with vasculitis.

- Response to Treatment: Gout typically responds to medications like colchicine or NSAIDs, while vasculitis may require corticosteroids or immunosuppressants.

3. Incidence and Management of Idiopathic Vasculitis: The incidence of idiopathic vasculitis varies, but it is generally considered less common than other inflammatory conditions like rheumatoid arthritis or gout. If the cause remains elusive, management focuses on controlling symptoms and preventing complications:
- Medications: Corticosteroids are often the first line of treatment to reduce inflammation. Immunosuppressive agents may be added if symptoms persist or if there is significant organ involvement.

- Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage symptoms and improve overall health.

- Regular Monitoring: Ongoing follow-up with your healthcare provider is crucial to monitor disease activity and adjust treatment as necessary.

In conclusion, while the diagnosis of vasculitis can be daunting, understanding the condition and working closely with your healthcare team can lead to effective management. It’s essential to communicate openly with your doctor about your symptoms and any concerns you may have regarding your treatment plan. This collaborative approach will help ensure that you receive the most appropriate care tailored to your specific needs.

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