How to diagnose Vasculitis




Diagnosing vasculitis begins with an understanding of what vasculitis is and thus how it can present. Once it is known how vasculitis can present then you are well on your way to being able to suspect a vasculitis. If you don’t know what vasculitis is or how it presents then you are not able to suspect it as a possible diagnosis when people including yourself have certain and particular symptoms.


Vasculitis as I described in my last post is inflammation of the blood vessels. The symptoms and clinical signs of vasculitis differ according to which blood vessels are affected and the cause of the inflammation of those blood vessels.


Typically vasculitis can have non-specific constitutional symptoms such as fatigue, fever weight loss and non-specific aches and pains. More particularly symptoms depend on which organs are affected such as the skin.


A rash can be a typical feature of vasculitis.


Other symptoms can be cough, coughing up blood, blood in the urine, gut disturbances such as diarrhoea and abdominal pain, or headaches or neurological disturbances such as numbness and pins and needles in different parts of the body.


Sometimes joints can be involved with swelling and pain.


Diagnosing vasculitis first begins on clinical suspicion that a vasculitis may be a possibility.

Next it involves specific tests, based on the suspicion of WHAT TYPE of vasculitis may be suspected. There are many conditions that can cause similar symptoms and getting the correct diagnosis is key.


Your GP will do introductory tests, and a specialist Rheumatologist and autoimmune disease specialist doctors like myself will do more specialised testing as vasculitis is their field of interest and expertise.


Tests include:


Blood tests:


  • ESR and CRP – vasculitis will have high. Markers of inflammation in the blood

  • Autoimmune markers – ANA, ENA and ANCA, sometimes ACE, and sometimes HLA B 52 or B51 if Behcet’s disease is suspected.

  • Urine testing for blood and protein


Imaging:

  • Will be done depending on where the symptoms are.

  • Vascular imaging for Giant Cell Arteritis and possible internal vasculitis where there is no obvious rash

  • Potentially CT Chest Abdo Pelvis depending on your symptoms


Biopsy:

  • Biopsy of any rash if it can be seen as the type of inflammation in the rash may help confirm a diagnosis.

  • Biopsy of affected organ such as kidneys which is very typically involved – the type of pattern of inflammation can be key in making the diagnosis.


The most important thing when suspecting vasculitis is to be referred to a specialist rheumatologist who can specifically investigate you and rule out vasculitis.

It is a rare condition and there are many different types of vasculitis.

It takes a lot of expertise to diagnose vasculitis correctly and to rule out many things which can cause similar symptoms.

Vasculitis can be life and organ threatening. It is well worth the referral to a specialist to ensure that your symptoms are not missed and that you get a thorough evaluation.


Stay tuned for more in the series on vasculitis where I will go through different types of vasculitis 😎