Feature Article

Systemic vasculitides. Part 2: Small vessel diseases



© health care/stock.adobe.com
© health care/stock.adobe.com


Small vessel vasculitides often manifest as neurological, renal, pulmonary and dermatological symptoms. Clinical features of systemic vasculitides are often nonspecific; therefore, it is important that GPs be aware of the range of symptoms that can help in the differential diagnosis, treatment and management of this diverse group of conditions.

Key Points

  • The two main categories of small vessel vasculitis are antineutrophil cytoplasmic antibody-associated and immune complex-associated disease, best diagnosed with renal and/or pulmonary biopsy.
  • Severe renal failure and pulmonary haemorrhage are high-risk features that require urgent management.
  • Eosinophilic granulomatosis with polyangiitis can be associated with severe cardiac disease including heart failure, conduction abnormalities and pericarditis. These complications account for half of the mortality associated with this disease.
  • Hypocomplementaemic urticarial vasculitis and cryoglobulinaemic vasculitis are commonly associated with underlying systemic conditions including inflammatory rheumatological disease, chronic viral hepatitis and haematological malignancies. These should be screened for at the time of diagnosis.
  • Leukocytoclastic vasculitis is the most common vasculitis encountered in clinical practice, only involves the skin and is most commonly associated with medication use.
  • Patients receiving long-term corticosteroid or immuno-suppressive therapy require dedicated screening for chronic iatrogenic complications such as diabetes mellitus, osteoporosis, hypertension, obesity, opportunistic infections and secondary malignancies.