Systemic vasculitis - Diagnostic clues to this confusing array of diseases

Systemic vasculitides can be highly morbid, even fatal, and often require risky diagnostic and therapeutic interventions. The various types of vasculitis may present with a myriad of clinical findings. Initial evaluation is often directed at more common infectious or neoplastic conditions. Once vasculitis is suspected, evaluation must be expedient and therapy often empirical until results of diagnostic tests are available. Primary care physicians have a crucial role in diagnosis and treatment of vasculitis. They may be the first to recognize early warning signs (eg, headache, unexplained malaise, anemia). Prompt consultation with a rheumatologist is generally warranted to assist in thorough diagnostic workup and initiation of therapy. Primary care physicians also have an essential role in long-term management. Careful monitoring is needed to manage secondary complications, such as hypertension and chronic renal failure. In addition, close observation for an extended period after discontinuation of treatment is necessary to detect recurrence.