Let’s study joint pain and vasculitis

Some patients with vasculitis get reddish skin rashes that start small, but gradually enlarge

If the front of the eye is involved, patients suffer from painful redness and blurred vision

The reason behind vasculitis is an overactive unregulated immune system

A somewhat rare disease that we encounter in patients with joint pain is vasculitis. This condition presents with a strange combination of features that usually baffles both doctors and patients alike. Unfortunately vasculitis is detected late and by the time of diagnosis this disease has affected many organs creating more complexities with regard to treatment. I will briefly highlight some of the key features of vasculitis so as to help patients to be reviewed quite early along the course of the illness. 

Swelling
Vascular is synonymous to the term blood vessel. “itis” is inflammation or simpler terms swelling. Therefore vasculitis is vessel swelling. When blood vessels swell up, the flow of blood through that swollen up area is slowed down. Blood vessels are allocated the task of supplying blood to various organs. In vasculitis due to the  blockage of some vessels, the organs that heavily rely on blood suffer from damage.

Skin and the joints
Some patients with vasculitis get reddish skin rashes that start small, but gradually enlarge. There are a variety of skin rashes that are seen in this condition. A joint swelling mimicking arthritis can happen in vasculitis. Many patients have joint pain and difficulty in moving about. As the initial manifestation is sometimes joint pain, it is very important that the patient identifies/reports additional unusual bodily symptoms that can differentiate vasculitis from arthritis.

Kidneys and lung
The kidneys and the lungs are vital organs that should function without a pause. Vasculitis sometimes affects these organs and causes permanent damage. The symptoms are not recognised immediately when the kidneys are affected. If the patient undergoes screening tests such as estimated GFR, creatinine and quantity of proteins that are excreted in urine, certain abnormalities will surface. Lungs are important for gas exchange. Lung disease symptoms such as breathlessness, difficulty in breathing and wheezing might indicate trouble. 

Nerves and vision
Vasculitis extends across numerous systems in the body so much so that it can even change how the nerves function. If the nerves in the arms and legs are damaged, numbness and muscle paralysis could occur. In rare occasions vasculitis can lead to damage of the central nervous system, which is the brain. 

Certain changes in the eye, such as eye swelling / inflammation could be the first manifestation of vasculitis. Swelling of the eye is termed “Uveitis” and this could be at the front, the mid portion or even at the back of the eye. If the front of the eye is involved, patients suffer from painful redness and blurred vision. If the back of the eye is the affected area, patients might have loss of vision.

Diagnosis
Vasculitis is a difficult diagnosis to make; especially if the patient fails to constantly update the doctor on the weird symptoms that are encountered. Therefore vasculitis still remains a disease that is diagnosed quite late. The purpose of this article is to briefly highlight on some of the organ manifestations that patients encounter. The collective diagnosis should be done by several specialists including the nephrologist, rheumatologist, chest physician and the physician. A variety of tests will be done including special antibody blood tests and radiology assessments. 

Sub-types of vasculitis
Some of the vasculitis sub-types are, ANCA associated vasculitis, temporal arteritis, polymyalgia rheumatica, Kawasaki’s disease, Henoch-Schönlein purpura, polyarteritis nodosa, rheumatoid vasculitis, Takayasu’s disease, Beurger’s disease and cryoglobulinemia.

To identify each type of vasculitis there are specific panels of tests which are ordered by the relevant specialist doctor.

Methods of treatment
The reason behind vasculitis is an overactive unregulated immune system. Therefore treatment involves controlling the immunity using immune suppressive medication. Depending on how severe the vasculitis is, patients would receive various types of immunosuppressive medication. In life threatening diseases, high doses of steroids are injected together with potent drugs like cyclophosphamide. In mild vasculitis diseases modifying anti rheumatoid drugs in tablet form are used. Also after performing an organ assessment the specialists will attempt to stabilise individual organs using specific methods.

As a concluding statement I would like to mention that vasculitis remains a disease that is rarely diagnosed in its primitive form. Skin rashes and joint pain are sometimes attributed to drug reactions and the patients decide very late on approaching a doctor. It is very important for the patient to be aware of the squeal of abnormal symptoms, keep notes on what is wrong and then to update their doctors.

(The writer is a Fellow of American College of Rheumatology And a Consultant in Joint Disease, Rheumatology and Rehabilitation)