The treatment of vasculitis depends primarily on whether it is primary or secondary, the organs affected, and its severity. If an underlying cause can be identified (secondary vasculitis), treatment should be directed at the cause. Examples include withdrawal of a triggering drug or treatment of an underlying infection.
Since vasculitis results from an overactive immune system, treatment often involves drugs that suppress the immune system. The most commonly used drugs are corticosteroids, such as prednisone and methylprednisolone. When used long term, corticosteroids are associated with side effects such as weight gain, reduced bone density, and increased risk of diabetes and high blood pressure. In order to reduce the corticosteroid requirements and still control the disease, other immunosuppressive drugs such as cyclophosphamide, methotrexate, and azathioprine may be used.
The choice of drug for each patient should be decided after considering the severity of the disease. All immunosuppressive drugs carry an increased risk of infection and potential for reduction in blood cell counts. Frequent monitoring of the complete blood count (CBC), liver function tests, and kidney function tests (creatinine, BUN, urinalysis) can detect such side effects early.
Some types of vasculitis may require surgery to remove abnormal blood vessel bulges (aneurysms).