Vasculitis: Symptoms, Diagnosis, and Treatment Options

Vasculitis

Hello, Doctor: Two years ago, I started experiencing redness, swelling, and warmth in my knees, sometimes in my feet, toes, and heels, and occasionally in my fingers.
Most of the symptoms are located around the joints and typically 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 and provided 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.
A few days ago, my old symptoms recurred, so I switched to another hospital.
I thought gout might fall under rheumatology or immunology, so I made an appointment with that department.
At that time, I had a square centimeter of erythema near the wrist joints on both palms, which was painful when pressed, and my feet hurt while walking.
The joint of my left middle finger was swollen.
Upon examination, the doctor said this was vasculitis and ordered blood tests to rule out diseases like lupus erythematosus.
The results showed it was not lupus but simple vasculitis.
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; it is known to be an autoimmune disease and may also be related to drug or food allergies.
I also 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 vasculitis or gout? Besides uric acid tests, are there other methods to differentiate between the two? 3.
Is the incidence of simple vasculitis high? If the cause cannot be identified, what should be the future direction of treatment? Thank you, Doctor.

A-Hua, 0~9 year old female. Ask Date: 2002/07/08

Dr. Zeng Guosen reply Internal Medicine

I will start with the second question.
Based on the symptoms described by the internet user, it is neither vasculitis nor gout; it is likely recurrent rheumatism, also known as migratory rheumatism or paroxysmal rheumatism.
Clinically, it is referred to as "3" arthritis, which occurs in the joints or around the joints, with each episode affecting 1 to 3 locations, lasting about 3 days and resolving spontaneously without medication, and recurring intermittently after some time.
Additionally, consider erythema nodosum, which is a type of vasculitis primarily affecting the lower limbs, with lesions taking 1 to several weeks to resolve spontaneously.
Blood tests for ESR, CRP, ANA, HLA-B27, UA, and RF can be performed for initial screening, and a skin biopsy can be done for further evaluation.
For the first question, vasculitis has multiple causes and variable clinical symptoms, often presenting with skin lesions, urinary abnormalities, gastrointestinal symptoms, headaches, and neurological symptoms.
Generally, information obtained from biopsies is the most helpful for diagnosis, while other tests such as ESR, CRP, urinalysis, ANCA, and angiography can also provide assistance.
Tests like ANA and RF can help exclude secondary vasculitis.
Regarding the third question, the incidence of primary vasculitis is very low and quite rare.
Allergic vasculitis or secondary vasculitis caused by medications, foods, chemicals, infections, or connective tissue disorders is more common.
For idiopathic vasculitis, treatment primarily involves corticosteroids, and in some cases, immunomodulators may be added for treatment, along with long-term follow-up.

Reply Date: 2002/07/08

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 considerations regarding the diagnosis and management of your condition.

Understanding Vasculitis
1. Symptoms and Diagnosis: The symptoms of vasculitis can mimic those of other conditions, such as gout or rheumatoid arthritis. Common symptoms include joint pain, swelling, skin rashes, and systemic symptoms like fever and fatigue. In your case, the intermittent nature of your symptoms and their localization to joints suggests a possible inflammatory process. The fact that multiple doctors initially suspected gout, despite normal uric acid levels, indicates that the clinical picture can be misleading.
2. Differentiating Conditions: To differentiate between vasculitis and gout, several diagnostic approaches can be employed:
- Imaging Studies: Ultrasound or MRI can help visualize joint inflammation and assess for any effusions or other abnormalities.

- Blood Tests: Besides uric acid levels, tests for inflammatory markers (such as ESR and CRP) and specific autoantibodies (like ANCA for certain types of vasculitis) can provide additional insights.

- Synovial Fluid Analysis: If joint effusion is present, analyzing the fluid can help determine the cause of inflammation, distinguishing between gout, infection, and inflammatory arthritis.

3. Further Investigations: Given that your condition has been classified as "simple vasculitis," further investigations may include:
- Comprehensive Metabolic Panel: To assess kidney function and other systemic effects.

- Autoimmune Panel: To rule out other autoimmune conditions that may present similarly.

- Skin or Joint Biopsy: In some cases, a biopsy of affected tissue can provide definitive evidence of vasculitis.

Treatment Options
The treatment for vasculitis typically involves managing inflammation and addressing any underlying causes. Since the exact cause of your vasculitis remains unclear, your physician's approach of using anti-inflammatory and immunosuppressive medications is appropriate. Here are some common treatment strategies:
1. Medications:
- Corticosteroids: These are often the first line of treatment to reduce inflammation quickly.

- Immunosuppressants: Medications like azathioprine or methotrexate may be used for long-term management, especially if corticosteroids alone are insufficient.

- Biologics: In cases of severe or refractory vasculitis, biologic agents targeting specific pathways in the immune response may be considered.

2. Lifestyle Modifications:
- Dietary Changes: While specific dietary restrictions may not be necessary unless a food allergy is identified, maintaining a balanced diet rich in anti-inflammatory foods can be beneficial.

- Regular Monitoring: Regular follow-ups with your healthcare provider to monitor disease activity and medication side effects are crucial.

3. Long-term Management:
- If the cause of vasculitis remains idiopathic (unknown), the focus will be on controlling symptoms and preventing flare-ups. This may involve adjusting medications based on your response and any side effects experienced.

Conclusion
In summary, your symptoms and the diagnosis of simple vasculitis warrant a thorough investigation to rule out other potential causes and to tailor an effective treatment plan. It is essential to maintain open communication with your healthcare provider, discussing any concerns about medications and their side effects. Regular follow-ups and monitoring will be key to managing your condition effectively. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for guidance.

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