Vasculitis Treatment and Management

Corticosteroids

Glucocorticoids, such as prednisone or methylprednisolone, are the first line of defense.

• Mechanism: They rapidly reduce inflammation by suppressing multiple parts of the immune system.
• Administration: High doses are often given initially, sometimes intravenously (pulse therapy) for organ-threatening disease, followed by high-dose oral pills.
• Tapering: Once the disease is controlled, the dose is gradually reduced (tapered) over months to minimize long-term side effects like bone loss, weight gain, and diabetes.

Cyclophosphamide and Rituximab

For severe, life-threatening vasculitides (like kidney or lung involvement in ANCA vasculitis), stronger immunosuppressants are needed alongside steroids.

• Cyclophosphamide: A potent chemotherapy drug that suppresses the immune system. It is very effective but carries risks of bladder toxicity and infertility.
• Rituximab: A biological therapy that targets B cells, the immune cells responsible for making antibodies. It has become a preferred alternative to cyclophosphamide for many types of vasculitides due to a better safety profile regarding fertility.