0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43
Nongranulomatous Systemic Vasculitis 1059➣Oral, genital ulcers: azathioprine, thalidomide, corticosteroids
(low dose), many other meds used
➣Eye, CNS disease: azathioprine, cyclosporine, chlorambucil,
cyclophosphamide
■Other options for treatment of systemic vasculitis include TNF-alpha
antagonists, azathioprine, mycophenolate mofetilSide Effects & Contraindications
■Side effects
➣Corticosteroids: diabetes, weight gain, osteoporosis, cataracts,
hypertension, increased susceptibility to infection
➣Cytotoxic agents: cytopenias, cancers, alopecia, hepatotoxicity,
infections; use prophylaxis against P. jiroveci pneumonia w/ cyto-
toxics & high-dose corticosteroids
■Contraindications
➣Corticosteroid therapy: none absolute
➣Cytotoxics & thalidomide: pregnancy, cytopenias, active serious
infection
follow-up
■Every 2–4 weeks, assess disease activity by history & physical exam
■ESR or C-reactive protein every 1–2 months (may not normalize even
w/ good disease control)
■After 2–4 weeks, taper steroid dose by∼5 mg every 2 weeks to 10–15
mg/day, then more slowly
■Continue cytotoxic agents, slowly adjusting downward
■Watch for relapses, esp. in BD, MPA, CS, ECV, LCAcomplications & prognosis
■BD
➣Visual loss, blindness, aneurysm rupture, arterial or venous clot-
ting disorders
■MPA, ECV
➣Progressive renal failure, central & peripheral neuropathy w/
stroke & paralysis, pulmonary hemorrhage, infarction of other
arteries
■PAN
➣Renal failure, infarction of GI & other arteries; peripheral, central
neuropathies
■KD
➣Acute thrombosis of coronary artery, coronary or other ane-
urysms