Clinical review: Vasculitis on the intensive care unit -- part 2: treatment and prognosis.
Citations Over Time
Abstract
The second part of this review addresses the treatment and prognosis of the vasculitides Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and polyarteritis nodosa. Treatment regimens consist of an initial remission phase with aggressive immunosuppression, followed by a more prolonged maintenance phase using less toxic agents and doses. This review focuses on the initial treatment of fulminant vasculitis, the mainstay of which remains immunosuppression with steroids and cyclophosphamide. For Wegener's granulomatosis and microscopic polyangiitis plasma exchange can be considered for first-line therapy in patients with acute renal failure and/or pulmonary haemorrhage. Refractory disease is rare and is usually due to inadequate treatment. The vasculitides provide a particular challenge for the critical care team. Particular aspects of major organ support related to these conditions are discussed. Effective treatment has revolutionized the prognosis of these conditions. However, mortality is still approximately 50% for those requiring admission to intensive care unit. Furthermore, there is a high morbidity associated with both the diseases themselves and the treatment.
Related Papers
- → Brief Report: Childhood‐Onset Systemic Necrotizing Vasculitides: Long‐Term Data From the French Vasculitis Study Group Registry(2015)59 cited
- → New Features of Disease After Diagnosis in 6 Forms of Systemic Vasculitis(2013)51 cited
- → Epidemiologic Features of Systemic Vasculitides in the Southeast Region of Brazil(2019)23 cited
- → Treatment Guidelines in Vasculitis(2022)15 cited
- → Analysis of the clinical course, complications and causes of mortality at the onset of the primary necrotizing systemic vasculitis(2023)1 cited