Vasculitis
MBChB (New Zealand), PGDipObstMedGyn, FRACP (New Zealand), FAMS (Rheumatology)
Vasculitis refers to a group of conditions characterised by inflammation of blood vessels. This inflammation can affect arteries, veins or capillaries, leading to narrowing, blockage or weakening of the vessel walls. This may reduce blood flow to tissue and organs leading to tissue injury and damage to organs such as the skin, nerves, lungs or kidneys. The pattern and severity of disease vary widely. Some individuals experience mild, skin-limited disease, while others may develop more widespread involvement requiring closer monitoring and treatment.
Early diagnosis and appropriate treatment enable timely control of inflammation and reduce the risk of complications. At the Centre for Rheumatology & Arthritis, Dr Poh provides comprehensive evaluation and personalised care aimed at managing disease activity and preserving long-term organ function.
Vasculitis is classified according to the size of blood vessels affected and the pattern of organ involvement.
Large vessel vasculitis affects the body's largest sized blood vessels of the body, including the aorta and its major branches, which carry blood from the heart to the rest of the body. In some cases, large veins may also be involved. Inflammation of these vessels may narrow the vessel lumen and reduce blood flow, resulting in symptoms such as headaches, visual disturbances, jaw pain, muscle aches, fever or fatigue. Examples include giant cell arteritis and Takayasu arteritis.
This affects the body's smallest blood vessels, including capillaries, venules and arterioles. It commonly involves organs such as the skin, kidneys, lungs and nerves. Symptoms vary depending on the organs involved and may include skin rash, leg swelling, frothy urine, cough, shortness of breath, numbness and weakness. Examples of small vessel vasculitis include ANCA-associated vasculitis and IgA vasculitis.
This involves medium-sized arteries and veins that supply blood to organs and tissues throughout the body. Inflammation of these vessels can reduce blood flow and cause damage to affected organs, commonly involving the skin, nerves, kidneys and gastrointestinal tract. Symptoms vary depending on the organs involved and may include skin nodules or ulcers, nerve-related pain or weakness, abdominal discomfort, fever or weight loss. Examples of medium vessel vasculitis include polyarteritis nodosa and Kawasaki disease.
Some forms of vasculitis are associated with other autoimmune diseases, infections or medications. Examples include Behçet's disease, vasculitis associated with rheumatoid arthritis or lupus, and Hepatitis C virus-associated cryoglobulinaemic vasculitis.
The exact cause of many forms of vasculitis remains unknown. In most cases, it is thought to result from an abnormal immune response that triggers inflammation and damage within blood vessel walls. This inflammation can affect blood flow and lead to injury in the organs supplied by the affected blood vessels. In some individuals, vasculitis may occur in association with infections, medications, autoimmune diseases or, less commonly, underlying cancers.
In many cases, vasculitis occurs when the immune system mistakenly attacks the body's own blood vessels, leading to inflammation and damage of the vessel walls.
Some infections or medications may trigger vasculitis by provoking an abnormal immune response that causes inflammation of the blood vessels.
Some forms of vasculitis are more likely to occur in particular age groups or genders. These patterns vary between different types of vasculitis and may influence the likelihood of developing the condition.
Individuals with certain autoimmune diseases may have an increased risk of developing vasculitis.
The symptoms of vasculitis vary depending on the type of vasculitis, the size of the blood vessels affected and the organs involved. Symptoms may develop gradually over time or appear suddenly, and can range from mild to severe.
General (Systemic) Symptoms
Early symptoms of vasculitis are often non-specific and may include persistent fatigue,
low-grade fever, unintentional weight loss and a general feeling of being unwell.
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Skin Involvement
The skin is commonly affected in vasculitis. Individuals may develop rashes, purplish
spots (purpura), small red or brown pinpoint spots, ulcers or tender nodules. These
changes most often appear on the legs but may occur elsewhere on the body.
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Joint and Muscle Symptoms
Joint pain, stiffness and muscle aches are common in vasculitis and may interfere with
daily activities. These symptoms can resemble those seen in other rheumatic conditions
and often occur alongside fatigue.
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Nerve-related Symptoms
When the nerves are affected, vasculitis may cause numbness, tingling, burning
sensations or weakness, most commonly in the hands or feet. In more severe cases, nerve
involvement can lead to weakness or impaired coordination.
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Organ-specific Symptoms
The symptoms of vasculitis depend on which organs are affected:
- Lung involvement may cause symptoms such as shortness of breath, a persistent cough or, in some cases, coughing up blood.
- Kidney involvement may lead to leg swelling, high blood pressure or frothy urine
- Gastrointestinal tract involvement may cause abdominal pain, nausea, vomiting or blood in the stool
- Eye involvement may lead to redness, pain or changes in vision
Diagnosing vasculitis requires a careful and comprehensive evaluation, as symptoms are often varied and may overlap with other conditions. Early assessment is important to identify the type of vasculitis and the extent of organ involvement.
Assessment begins with a detailed discussion of symptoms, including the onset, pattern and severity. A physical examination is then performed to look for signs of blood vessel inflammation and involvement of other organ systems.
Blood tests may help detect signs of inflammation and identify antibodies associated with specific forms of vasculitis, such as antineutrophil cytoplasmic antibodies (ANCA). They are also used to assess organ function and help monitor disease activity over time.
Imaging studies such as ultrasound, CT scans or MRI may be used to assess affected blood vessels and detect areas of inflammation, narrowing or damage. These tests help to determine the extent of disease and guide management.
In some cases, a small sample of affected tissue, such as skin, nerve or kidney, may be taken for biopsy to help confirm the diagnosis and determine the specific type of vasculitis.
Additional tests may be recommended based on symptoms, including lung function tests, echocardiogram or nerve conduction studies, to assess the extent of organ involvement.
How Do Rheumatologists Treat Vasculitis?
Treatment of vasculitis aims to control inflammation, prevent organ damage and maintain remission. Management is tailored to the specific type of vasculitis, the severity of disease and the organs involved.
Corticosteroids are often used to rapidly reduce blood vessel inflammation, particularly during disease flares or when vital organs are involved. They may be used for a short period or in combination with other long-term treatments depending on the severity and type of vasculitis.
Lifestyle and activity adjustments can support overall health and complement medical treatment in managing vasculitis.
- Stay Physically Active: Regular, moderate exercise can help maintain strength, improve cardiovascular fitness and reduce fatigue, while supporting overall health and well-being.
- Manage Fatigue: Pacing activities and allowing adequate rest can help conserve energy and improve daily functioning.
- Maintain General Health: A balanced diet, adequate sleep and regular medical follow-up support overall health and well-being.
- Reduce the risk of infection: Some treatments may affect the immune system. Practising good hygiene and staying up to date with recommended vaccinations can help reduce the risk of infection.
- Quit Smoking: Smoking can damage blood vessels and may worsen symptoms of vasculitis. Stopping smoking is strongly recommended to support vascular health and overall treatment outcomes.
Immunosuppressants are medications used to treat vasculitis by reducing the abnormal immune activity that causes blood vessel inflammation. They are commonly used to induce and maintain remission, helping to prevent disease progression and preserve organ function.
Biologics may be used in selected types of vasculitis or when additional disease control is needed. These targeted treatments work by blocking specific components of the immune system involved in inflammation and can help reduce the risk of relapse in some patients.
Our Rheumatologist
Dr Poh Yih Jia
Senior Consultant Rheumatologist
Dr Poh Yih Jia is a senior consultant rheumatologist with more than 20 years of medical experience in
New Zealand and Singapore. She has extensive experience in the diagnosis and management of autoimmune
and inflammatory conditions, including vasculitis.
Her commitment to patient-centred care has earned her multiple accolades, including the Singapore Health
Quality Service Award and the Service with a Heart Award. She remains dedicated to advancing
rheumatology through clinical practice, education and research, ensuring her patients receive current,
evidence-based care for vasculitis and other autoimmune conditions.
FAQs on Vasculitis
Vasculitis refers to inflammation of the blood vessels caused by an abnormal immune response. The condition can vary widely in severity, depending on the type of vasculitis and the organs affected. Some forms involve only the skin, while others may affect organs such as the lungs, kidneys or nerves. Early diagnosis and appropriate treatment are important to control inflammation, prevent complications and preserve organ function. Many individuals are able to achieve good disease control and maintain a good quality of life.
In many cases, the exact cause of a vasculitis flare is not clearly identified. However, flare-ups may be associated with infections, certain medications or changes in immune system activity. Regular follow-up and monitoring help detect signs of disease recurrence early, allowing timely adjustment of treatment to maintain disease control and reduce the risk of complications.
The course of vasculitis varies depending on the specific type. Some forms may occur as a single episode and resolve completely, while others are chronic or relapsing and require long-term monitoring and treatment.
Vasculitis can affect different organs throughout the body. If inflammation is severe or left untreated, it may lead to permanent damage to affected tissues and organs. Possible complications include kidney problems, nerve damage, vision loss, lung complications or cardiovascular problems. Early diagnosis and treatment can help reduce these risks.
Vasculitis cannot currently be prevented, as its exact cause is often not fully understood. The focus is therefore on early recognition, accurate diagnosis and appropriate treatment. Prompt assessment of symptoms allows inflammation to be identified and managed early, helping to maintain disease control and reduce the risk of complications.