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Vasculitis Treatment | How is Vasculitis Treated? | Johns Hopkins Medicine

March 12, 2020


(calm music) – So I think one way to think of this is part of the first time
when you meet a patient and we make a diagnosis, we are trying to understand how extensive is the injury to the body from vasculitis? In fact, for many of
our vasculitis diseases, we borrow terminology from
our cancer colleagues, like staging, and we talk
about different phases of treatment like induction
and remission maintenance. This does not mean when we use these words that a vasculitis patient has cancer, but what it does mean is
that just like cancer, vasculitis can be widely
active throughout the body, or it can be focused on
specific areas of the body, and so based on that, we would decide what is the intensity
and duration of treatment that we need to use? So when we talk about
rheumatic disease treatment in general, we talk about
different categories of drugs. There are, first off, fast-acting and slow-acting medications, and unfortunately, really the
fastest thing that we have being able to get some
sort of symptomatic relief and some biological effect
within a matter of hours to days, the only thing
we have in that category is steroids, but as many
of our patients know, the side effects of steroids long term are often much worse than
almost all of the other rheumatic drugs that we use
to treat rheumatic disease in general, not just vasculitis, and so for most patients, almost all patients with vasculitis, we end up using other, what
we call steroid-sparing or non-steroid immunosuppressive drugs to shut down or reprogram
the immune system, and then also, there is
a chemotherapeutic agent which is used for severe
forms of vasculitis called cytoxine, but these are high intensity
immunosuppressants. (calm music) So one of the things to
remember with vasculitis being injury to blood vessels, part of the healing of blood vessels really is increasing blood flow. It really comes down to all the more for purposes of healing, and also just for longterm
lifestyle and healthiness, really being vigilant about a
good cardiovascular regimen, both in terms of diet and exercise. For patients with, for
example, giant cell arteritis or Takayasu arteritis,
the vasculitis diseases which can attack the heart
and the large vessels, maintaining the overall
health of those blood vessels is key to preventing future complications. We also know that atherosclerotic disease, or cholesterol and
hypertensive vessel disease from aging and lifestyle,
that patients with vasculitis, and because of the prior
injury from previous flares sometimes can have a
harder time recovering from things like heart attack and stroke, and so for that reason,
we really emphasize that patients who have had
a history of vasculitis be vigilant about maintaining
a balanced healthy and diet and exercising regularly. So when you come to us and
we establish a diagnosis and we start treatment,
while you may not feel well, part of how well and how
quickly you recover long term is really a function of
how soon can you start getting back to regular physical activity, even if that’s just walking
for five minutes a day. Again, it really is a matter
of increasing blood flow, that there was something
about this process which enters into a
positive feedback cycle where it really can and
does make a difference of how quickly and how
well you recover long term from previous autoimmune injury. (uplifting music)

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