The course of systemic vasculitis differs considerably from one patient to another. For example, a
patient with early Wegener’s granulomatosis in the nose, ear or sinuses may not have detectable lung or renal involvement. Early diagnosis and treatment would aim to reduce upper airway damage and hearing Selleckchem Vadimezan loss. If involvement of the lungs or glomeruli were to occur later the clinical situation would alter significantly, as more potent and potentially toxic immunosuppressive therapy would be necessary to rescue vital organ functions. If the clinical onset is manifested mainly by renal disease, the underlying systemic vasculitic condition may take longer to diagnose. The consequences can be detrimental because kidney function is often lost very quickly, and irreversible changes in the glomeruli may have occurred by the time diagnosis is made [5]. Missed or delayed diagnosis influences prognosis strongly if critical organs are involved,
and less so when structurally and functionally less critical organs are affected. Careful management, with long-term follow-up, attempts to preserve health. Economic consequences Crenolanib nmr will depend on the health cost for the patient and society as a result of damage. A systematic approach to diagnosis and follow-up will take into account the relapsing remitting nature of the disease, damage caused by low-grade grumbling disease and side effects of medication. Active inflammation requires an aggressive approach, which is entirely inappropriate in quiescent disease with extensive scarring, although the features of the clinical presentation may overlap. The initial assessment will be to make a diagnosis, categorize disease severity and formulate old a management plan. Subsequent assessments review the success of treatment and detect new organ involvement. The Birmingham Vasculitis Activity Score (BVAS) may be used to summarize this information systematically.
Assessment of damage provides clinical and prognostic information on organ scarring caused by the disease and its treatment but does not represent ongoing active inflammation. Suitable tools for this include the Vasculitis Damage Index (VDI) and Disease Extent Index (DEI). Finally, assessment of function considers the overall impact of the disease on the physical, social and psychological function, including quality of life and employment. Tools include the Short Form 36 (SF36) and Health Assessment Questionnaire (HAQ), which are questionnaire-based. Clinical assessment of patients with giant cell arteritis and Takayasu’s arteritis includes palpation of peripheral pulses for asymmetry, bilateral blood pressure assessment, auscultation for bruits and laboratory tests for evidence of systemic inflammation. Further diagnostic information is provided by temporal artery biopsy (TAB) in giant cell arteritis and imaging of the arterial tree by conventional angiography, magnetic resonance imaging (MRI) or positron emission tomography (PET) [17].
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