Small vessel vasculitis

Question

My biopsy reads as “small vessel leukocytoclastic vasculitis with osinophiles”. I have taken Prednisone for three months with different doses (pills per day in a week: 4/w1, 3/w2, 2/w3, 1/w4, 1.5/w5, 1.5/w6, 3/w7, 3/w8, 3/w9, 3/w10, 2.5-2/w11, 1.5~1/w12, 0.5/w13). In the three months my symptoms have never come to a level of full control, though the situation changed up and down. When I increased the doses, the severity level (size and scope of the rashes on my skin) was decreased in the first two weeks; When I kept a constant dose, it started to get worse after about 2 weeks; When I reduced the dose, it quickly became much worse. Why and what should I do?

Answer

Hi bob,

Small vessel vasculitis can be very benign and not require treatment, or it can be the harbinger of more serious involvement in the kidneys, gut and other organs.  The treatment really depends on which of the two your picture fits.  If the first, the prednisone might do more harm than good.  If the second, you might need something stronger such as an immunosuppressive drug.  You will need to discuss this with your rheumatologist.  good luck.

Joan Bathon, M.D.

About Joan Bathon, M.D.

Dr. Bathon was a Co-Deputy Director of the Division of Rheumatology at Hopkins Bayview. She was also the founder and director of the Hopkins Arthritis Center.