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Johns Hopkins Vasculitis Center

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  • About Our Center
    • Appointments and Directions
    • Meet Our Team
    • Support Our Center
  • What is Vasculitis?
    • Types of Vasculitis
    • Causes of Vasculitis
    • Symptoms of Vasculitis
    • Diagnosing Vasculitis
  • Vasculitis Treatments
    • Prednisone
    • Avacopan (Tavneos®)
    • Apremilast (Otezla®)
    • Azathioprine
    • Colchicine
    • Cyclophosphamide (Cytoxan)
    • Dapsone
    • Supplemental Immunoglobulin (IVIG/SCIG)
    • Leflunomide
    • Mepolizumab (Nucala®)
    • Methotrexate (MTX)
    • Mycophenolate
    • Rituximab
    • Sarilumab (Kevzara®)
    • TNF Inhibitors
    • Tocilizumab (Actemra®)
  • Vasculitis Research
  • Resources
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Glossary of Vasculitis Terms

A

Active disease: Disease state characterized by active, ongoing inflammation due to vasculitis. In this state, vasculitis causes damage to organs. Treatment is initiated to induce disease remission.

Alkylating agents: A group of drugs originally used to treat cancer, now used (in lower doses) to treat some forms of severe vasculitis.

ANCA: Anti-neutrophil cytoplasmic antibodies. The abbreviation is pronounced just like the last name of the singer, Paul Anka. These antibodies are found in patients with some forms of vasculitis, particularly granulomatosis with polyangiitis, microscopic polyangiitis, and the Churg-Strauss syndrome.

Anemia: A low hematocrit (roughly corresponding to a low red blood cell count).

Anesthesic: Means literally “without feeling”. A drug administered for medical or surgical purposes, that induces partial or total loss of sensation. An anesthesic may be topical, local, regional, or general, depending on the method of administration and area of the body affected.

Aneurysms: Weakening of a blood vessel wall by inflammation. Sometimes leads to rupture of the vessel.

Angiogram: An X-ray representation of blood vessels made after the injection of a radio-opaque dye. Used to visualize the inner layer of blood vessels and to determine the location and degree of narrowing or dilation.

Antibodies: A Y-shaped protein on the surface of B cells that is secreted into the blood in response to a challenge to the immune system, such as a bacterium, virus, parasite, or transplanted organ. Antibodies neutralize foreign proteins by binding specifically to them. Antibodies are also known as immunoglobulins.

Aphthous ulcers: Ulcerations on the mucous membranes of the mouth or genitals, often caused by an infection or trauma. Aphthous ulcers also occur in Behcet’s disease and connective tissue diseases such as Lupus.

Arthralgias: Aches or pains in joints, without obvious swelling, warmth, or redness.

Arthritis: Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. Arthritis occurs in various forms, such as the arthritis associated with infections, osteoarthritis, or rheumatoid arthritis. Many forms of vasculitis can also be associated with arthritis.

Aseptic: Using sterile techniques or methods to protect against infection by microbes.

Asymmetrical: Having no balance or symmetry. Different on the left side of the body as compared to the right. “Asymmetric weakness of the left lower extremity” means that the left leg is weak but the right is not.

Autoimmune: Relating to an immune response by the body against one of its own tissues; for example, its own cells, molecules, or organs. Autoimmune diseases often involve the formation of antibodies directed against specific body tissues, such as parts of the kidney or blood vessel walls.

B

Beading: The appearance of a blood vessel as of a string of beads, with alternating areas of narrowing and dilation.

Biopsy: Removal of a piece of a tissue or organ through either surgery or sampling with a needle to determine the existence or cause of a disease.

C

Capillaries: The smallest blood vessel in the body. Capillaries connect arterioles (small arteries) with venules (small veins). Capillaries form an intricate network throughout the body for the interchange of various substances, such as oxygen and carbon dioxide, between blood and tissue cells.

Casts: A cluster of cells or proteins formed in the kidney and excreted in the urine. Red blood cell casts usually indicate the presence of active vasculitis within the kidney. Kidney vasculitis is also known as glomerulonephritis.

CAT Scan (CT scan): A Computerized Axial Tomography scan is an x-ray tube that rotates in a circle around the patient, making many pictures as it rotates. The multiple x-ray pictures are reconstructed by a computer in cross-sectional images, permitting doctors to examine “slices” through different organs.

Catheterization: The insertion of a small plastic tube into a blood vessel, for the purpose of infusing fluid or radio-opaque dye (as in angiography), or for the purpose of sampling blood.

Cavity: A hollow area within the body.

Chlorambucil: A medication used to depress lymphocytic production and maturation. The brand name for this medication is Leukeran.

Claudication: A symptom caused by lack of blood flow to the muscles caused by narrowing of the arteries. The symptom of claudication usually occurs in the calf or in an arm, and is an aching pain that resolves with rest.

Conjunctivitis: Inflammation of the most superficial layer of the eye, characterized by redness and often accompanied by a discharge. Conjunctivitis can be caused by certain infections, but is also associated with some types of vasculitis.

Constitutional: Symptoms Symptoms that relate to the entire body as a whole, rather than to an individual organ. Constitutional symptoms include fatigue, malaise, and weight loss.

Crescent: A shape resembling the curved shape of the moon in its first or last quarters. With regard to vasculitis, a crescent is a pathological finding in the kidney that is observed under the microscope. Crescents are caused by damage to glomeruli, the individual blood-filtering units within the kidney.

Cutaneous: Relating to, existing on, or affecting the skin.

Cyclophospamide: An alkylating agent used in combination with corticosteroids (such as prednisone) to treat serve cases of vasculitis.

Cystoscopy: The inspection of the interior of the bladder using a lighted tubular endoscope, inserted through the urethra. The major reason for performing cystoscopy in patients with vasculitis is to screen for bladder injury caused by cyclophosphamide.

Cytoplasmic: The protoplasm outside the nucleus of a cell.

D

Dermis: The layer of the skin located below the epidermis, containing nerve endings, sweat and sebaceous glands, and blood and lymph vessels. Small and medium-vessel forms of vasculitis affect the dermis and sometimes the layer just below the dermis; the subcutaneous fat.

Dialysis: A pathological deficiency in the oxygen-carrying component of the blood, measured in unit volume concentrations of hemoglobin, red blood cell volume, or red blood cell number.

E

Eosinophils: A type of white blood cell containing cytoplasmic granules that are stained easily by eosin or other acid dyes.

Epidermis: The protective outer layer of the skin.

ESR: Erythrocyte Sedimentation Rate is the rate at which red blood cells settle out in a tube of blood under standardized conditions; a high rate usually indicates the presence of inflammation.

Etiology: The cause or origin of a disease.

G

Gangrene: Death and decay of body tissue, often occurring in a limb, caused by insufficient blood supply and usually following injury or disease.

Glomerulonephritis: Inflammation in the kidney, characterized often by decreased production of urine and by the presence of blood and protein in the urine.

Glomerulus: A tuft of capillaries within the kidney that filters blood in order to form urine. Normally, each kidney has approximately 1 million glomeruli.

H

Hematuria: The presence of blood in the urine.

Hyperpigmented: An excess of pigment (color) in a tissue. For example, in some patients, parts of the skin affected by vasculitis become hyperpigmented after the vasculitis has resolved.

I

IgA: Immunoglobulin A. A specific subcategory of antibodies (which all individuals have). For reasons that are not understood, IgA deposits within the blood vessels of the skin, joints, kidney, and GI tract in Henoch-Schonlein purpura, leading to vasculitis.

Incident/incidence: The number of new cases of a disease in a population over a period of time. Physicians often refer to the “annual incidence” of a given disease; that is, the number of new cases occurring each year.

Infarction: Localized necrosis resulting from obstruction of the blood supply. Myocardial infarction is another name for a heart attack.

Infection: Invasion by and multiplication of pathogenic microorganisms in part of the body, or in the body’s bloodstream.

Infiltrates: A collection of inflammatory cells within a body tissue; for example, in the lung. Pulmonary infiltrates are visible on chest x-rays in pneumonia and in some forms of vasculitis.

Inflammation: A localized protective response of the body tissues to injury, irritation, or infection; characterized by pain, swelling, redness, and heat. Vasculitis is inflammation within the blood vessels.

Intravenous: A drug, nutrient solution, or other substance administered into a vein.

Invasive: Relating to a medical procedure in which a part of the body is entered, as by puncture or incision. Invasive procedures such as tissue biopsies or angiograms are sometimes necessary to diagnose vasculitis.

Ischemia: A decrease in the blood supply to an organ, tissue, or body part caused by constriction or obstruction of the blood vessels.

L

Lesion: A wound or injury. A localized pathological change in a bodily organ or tissue. An infected or diseased patch of skin.

Localized: Restricted or limited to a specific body part or region: localized pain and numbness.

Lupus: A systemic disease that results from an autoimmune mechanism. Individuals with lupus produce antibodies to their own body tissues. The resultant inflammation can cause kidney damage, arthritis, pericarditis, and, sometimes, vasculitis.

M

Meninges: The three membranes that cover the brain and spinal cord. The three layers are called the arachnoid (the “spider-like” innermost layer), the pia mater (the middle layer), and the dura mater (the “tough mother” outermost layer).

Mesenteric: Relating to folds of the peritoneum (the abdominal cavity) that connect the intestines to the abdominal wall, especially such a fold that envelops the small intestine.

Mimicker: A disease process that imitates or simulates another. For example, the lung lesions of granulomatosis with polyangiitis may be mimickers of tuberculosis.

MRI Magnetic Resonance Imaging: Another fancy x-ray, similar to a CT scan. MRI scans also provide cross-sectional images of body organs. Because MRI technology involves the use of a large magnet, people with pacemakers, metallic aneurysm clips, and other metallic inserts are not eligible to have these studies.

Myeloperoxidase Abbreviated MPO: An enzyme found in many tissues and cells throughout the body. For reasons that are unknown, many patients with granulomatosis with polyangiitis and microscopic polyangiitis make antibodies to this protein.

N

Nasal septum: A thin wall dividing the nasal cavity into two halves.

Neuropathy: A disease or abnormality of peripheral nerves, the nerves that mediate sensation and movement in the arms, legs, and other body parts.

O

Occlusion: An obstruction or a closure of a blood vessel.

Opportunistic infections: A pathological deficiency in the oxygen-carrying component of the blood, measured in unit volume concentrations of hemoglobin, red blood cell volume, or red blood cell number.

Otitis media: Inflammation of the middle ear (the space just behind the eardrum). This may occur because of an infection or as a result of some forms of vasculitis, such as granulomatosis with polyangiitis.

P

Palpable: Perceptible to touch; capable of being palpated.

Pathologist: A physician who examines tissue biopsies for the purpose of determining the precise cause of disease.

Perforation: A hole in an organ, such as the gastrointestinal tract.

Perinuclear: Of or pertaining to a nucleus; situated around a nucleus. In some forms of vasculitis (e.g., microscopic polyangiitis), anti-neutrophil cytoplasmic antibodies (ANCA) cause perinuclear staining on immunofluorescence tests.

Pneumonia: An acute or chronic disease marked by inflammation of the lungs and caused by viruses, bacteria, or other microorganisms. Forms of vasculitis that involve the lung are often misdiagnosed as pneumonia. Pneumonia is also a type of opportunistic infection that may occur in vasculitis patients under treatment.

Prevalence: The total number of cases of a disease present within a given population at a particular time. The prevalence of giant cell arteritis in the United States, for example is estimated to be 160,000.

Proteinuria: The presence of excessive amounts of protein in the urine. Proteinuria is usually caused by damage to the kidneys.

Purpura: A condition characterized by small amounts of bleeding into the skin and mucous membranes that result in the appearance of purplish spots or patches.

R

Raynaud’s phenomenon: Spasm of the arteries to the fingers and/or toes, resulting in blanching or pain.

Remission: When vasculitis has been treated to the point that there are no signs or symptoms of ongoing active inflammation. In this state, patient may experience symptoms related to damage from prior disease activity, but no active inflammation is present.

Retinal: The innermost layer of the eye. Serves as the eye’s camera, transmitting images to the brain via the optic nerve.

Rheumatologist: A physician who specializes in the diagnosis and treatment of diseases in which the immune system has gone awry, leading to inflammation in a variety of organs.

S

Sclera: The white part of the eye. “Scleritis” is a type of inflammation that occurs in the sclera in some forms of vasculitis.

Stenosis: A constriction or narrowing of a blood vessel.

Steroid-sparing drug: An immunosuppressive drug that has the benefits of prednisone but does not cause as many side effects.

Subcutaneous: Underneath the skin. Some medications, for example, are injected under the skin.

Systemic: Relating to a system or relating to, or affecting the entire body or an entire organism.

T

Teratogenic potential: The risk of causing birth defects. Some medications are said to have “teratogenic potential”.

Thrombosis: A blood clot.

U

Urinalysis: Laboratory analysis of urine, used to aid in the diagnosis of disease or to detect the presence of a specific substance. In vasculitis, the urinalysis is used to detect protein, blood, or clumps of blood cells in the urine. All of these findings may suggest kidney inflammation.

Uveitis: Inflammation within either the anterior (front) or posterior (back) part of the eye.

V

Vasculitis: What this website is all about!

Johns Hopkins Vasculitis Center

Johns Hopkins

“Vasculitis” is a general term for a group of diseases that involve inflammation in blood vessels. Blood vessels of all sizes may be affected, from the largest vessel in the body (the aorta) to the smallest blood vessels in the skin (capillaries). The size of blood vessel affected varies according to the specific type of vasculitis. There are numerous forms of vasculitis, and most are relatively rare diagnoses.

The Johns Hopkins Vasculitis Center is committed not only to the care of patients with these diseases, but to patient education as well. Most patients who meet us in clinic were not familiar with the disease “vasculitis” prior to their own diagnosis, and are faced with learning an enormous amount of new information as they begin their journey into treatment. This website is intended primarily for patients, to provide information about the diagnosis and treatment of vasculitis, and to inform readers about the Johns Hopkins Vasculitis Center.

We hope you will find this site informative, and we welcome your feedback!

Appointments and Directions

For New Patients

In order for your care to be matched to an appointment with an expert in the field of your diagnosis, it is necessary to have your records available to our physician reviewers prior to scheduling an appointment. Therefore, we ask that you have your referral and medical records faxed to 410-367-2371 or emailed to PASOnBaseRheuma@jhmi.edu. It is important to include the following: a referral from your current physician, any clinical notes, imaging reports (including x-rays and MRIs), lab results, other tests results as applicable (such as pulmonary function tests echocardiograms, pathology reports, EMG/NCS results).

Once the review process has been completed, you will be contacted by one of our intake coordinators to assist with scheduling your appointment. You may also call the scheduling office at 443-997-1552 at any time to inquire as to the status of your record review.

For International patients, please contact Johns Hopkins International for initial and return patient appointments.

Unfortunately, our physicians cannot speak with or give medical advice to patients that are not currently under our care.

On the day of your scheduled appointment, it is important to:

  • Arrive at least 30 minutes before your appointment to allow time for registration
  • Bring your insurance card
  • Bring a photo I.D.
  • Bring your co-payment
  • Bring a copy of name and address of all persons/doctors who would like to get copies of your visit materials
  • Bring the following medical records if not already sent:
    • All medical records relevant to your diagnosis (including rheumatology records, discharge summaries)
    • List of all current medications (include all over-the-counter medications)
    • Recent laboratory results
    • Any imaging results (i.e., x-rays, ultrasounds, etc.)
    • Pulmonary function tests (bring all test results)
    • Echocardiogram (bring all test results)

High resolution CT scan of lung (bring written report and copy of actual scan on CD-ROM disc)

Please forward the results of previous medical evaluations. In particular, the following information is required:

  • Referral letter from your physician
  • Summary letter from your doctor and/or hospital discharge summaries
  • Recent laboratory results
  • Biopsy slides or reports
  • Results of radiology studies

This “information gathering” is an important component of your visit. It allows the Vasculitis Center’s physicians to examine and review relevant information before your scheduled visit. This preparation greatly speeds the development of an effective plan for medical care. If time permits, we will send you a questionnaire to fill out before your appointment.

International Patients

For International patients, please contact Johns Hopkins International for initial and return appointments.

For Returning Patients

You will need to plan for a one day visit to the Center as a return patient.

  • Return appointments for the Vasculitis Center can be made by calling 443-997-1552.
  • Please arrive 15 minutes before your appointment.
  • You may also be asked to complete some additional forms to allow us to bill your insurance, to review your health, and let us know how you have been doing since your last visit.
  • Bring a copy of your insurance cards.

Late, Canceled and No Show Appointments

Late: The appointment time scheduled for you is time specifically allotted for your visit. If you are running late for an appointment, please call our scheduling office. Please note if you are more than 15 minutes late for your scheduled appointment time, we may not be able to accommodate your visit.

Canceled / No Show: If you are unable to keep your appointment we require a minimum of 24 hours’ notice. If you repeatedly do not provide our office with 24 hours’ notice, you may be subject to be discharged from our practice.

Rescheduling Appointments

Our clinic is very busy and unfortunately patients often have to wait several months for an appointment. If you need to reschedule your appointment, please call us at 443-997-1552 as soon as possible. This will allow us to schedule another patient who is waiting to be seen.

Office Hours

Our normal clinic hours are Monday – Friday 7:30am-5:00pm. Our normal phone hours are Monday – Friday 9:00 AM -4:00 PM.

Our Office is closed for the following Holidays:

  • New Year’s Eve
  • New Year’s Day
  • Martin Luther King, Jr. Day
  • Memorial Day
  • Independence Day (July 4th when it falls on a regular business day, the Friday before when it falls on Saturday, or the Monday after when it falls on Sunday)
  • Labor Day
  • Thanksgiving Day
  • Day after Thanksgiving
  • Christmas Eve
  • Christmas Day (December 25th when it falls on a regular business day, the Friday before when it falls on Saturday, or the Monday after when it falls on Sunday)

There may be other posted days that are closed due to divisional activities and/or professional development. That information will be provided on all divisional voicemails.

After-Hours, Weekends and Holidays Calls

  • If you are experiencing a medical emergency after-hours, please call 911 or go to your nearest urgent care facility or emergency department.
  • If your need is a medical management question that cannot wait until our next business day, we offer an On-Call Provider to help you. Our On-Call Provider may be paged by calling our answering service at 410-955-6070.

Inclement Weather and Unexpected Closings

  • It is the policy of Johns Hopkins Medicine to reasonably maintain outpatient clinical operations; however, due to weather or other unexpected closings, such as an area-wide power outage or water main break, there may be times when it is necessary to close our office.
  • Our closing notices will be provided for you via our voicemail recording and our staff will contact you if we are not able to keep your appointment, let you know what we are experiencing, and when we may be looking to reschedule your visit.

Insurance / Billing Information

We are participating with the following insurance payors:

  • Aetna Health Plan
  • Beech Street PPO
  • Blue Cross Blue Shield
  • CareFirst BlueChoice HMO
  • CIGNA
  • Coventry Healthcare
  • EHP
  • First Health
  • Great West/One Health PPO
  • Humana Choicecare
  • InforMed/CHP
  • Kaiser
  • MDIPA HMO
  • Maryland Medical Assistance
  • Medicare Part B*
  • Multiplan PPO
  • NCAS
  • One Net PPO
  • Optimum Choice HMO
  • Priority Partners MCO
  • Private Healthcare Systems (PHCS)
  • Tricare Reserve Select
  • Tricare Standard
  • US Family Health Plan

*We do not participate with out-of-state Medicaid or Medicare Advantage/Replacement plans.

Copayments:

It is a good idea to check with your insurance to make sure you are covered for your visit and services with us. Please be prepared to pay your copay and any balance due at the time of your visit. We accept VISA, MASTERCARD, DISCOVER, AMERICAN EXPRESS, and E-CHECKS.

Non participating insurance/self-pay:

We realize that insurance may not always cover care at Johns Hopkins. With the exception of Medicare Advantage and Medicaid plans, patients may have the ability to pay out-of-pocket for non-covered services. Patients scheduled for new patient appointments are required to pay a $600 deposit at the time of service. Patients scheduled for return visits are required to pay a $289 deposit at the time of service.

Prescription Policies and Prescription Refills

In order for our office to provide you with timely refills, please request your medication refills at least one week in advance. Refill requests may be made via a myChart message to your provider, calling our office, or by receiving a fax from your pharmacy.

Forms Completion

The only documentation regarding your health or illness required by law (and included in the office visit charge) is an office visit note. Completing paperwork for schools, camps, Family Medical Leave Act (FMLA) claims, long-term care, life insurance, the Department of Veterans’ Affairs, and other disability claims go beyond routine medical care and may require an update of your medical information or a special examination. In order to make this determination, please forward your form(s) to our office prior to your scheduled visit. For those forms that can be completed outside of a clinical visit, please allow a minimum of 5 business days for your completed form to be returned to you.

Directions to The Johns Hopkins Vasculitis Center

Please view the following link to see the driving directions and maps to The Johns Hopkins Vasculits Center and Bayview Medical Center. Once on the campus of the Johns Hopkins Bayview Medical Center, please park in the mid-campus parking lot, indicated on the campus map. The mid-campus parking lot is directly across the street from the Johns Hopkins Asthma and Allergy Center, which houses the Johns Hopkins Vasculitis Center. We are located in Room 1B.1.

Directions to the Center

Copyright Information

All information contained within this web site is Copyright © 2012 by The Johns Hopkins University School of Medicine and the Johns Hopkins Vasculitis Center.

All rights are reserved. Requests for use of content contained within this site can be emailed, replies can take a minimum of one business week for reply.

Requests for permission to reprint, reproduce, and distribute documents and related graphics that appear on this website/are hosted on this server may be submitted by fax (410)-550-2072 or e-mail to Wes Linda.

The names of the Johns Hopkins University, the Johns Hopkins University Rheumatology Division, the Johns Hopkins Vasculitis WebSite or its faculty or staff may not be used in publicity or advertising without permission. Exceptions to this include listings on web indexes, search engines, and related systems.

The Johns Hopkins University, The Johns Hopkins University School of Medicine and/or its Division of Rheumatology and faculty and staff of the Johns Hopkins University cannot be held responsible or liable for errors or inaccuracies in transcriptions, translations, or any other type of reproduction, alteration or adulteration of material presented on any page of this web site.

Causes of Vasculitis

There are many different types of vasculitis, some with different causes than others.

Certain forms of vasculitis that can be due to infection where the microbe directly invades the vessel wall. Syphilis is one example of vasculitis that can be caused by infection in the blood vessel. Treating the infection is the main goal in managing this sort of vasculitis, which is not an autoimmune disease, but rather an infection.

Other infections can provoke the immune system into causing damage in blood vessels. Here, the infection is the trigger, but the immune system is the cause of the vascular damage. Viral hepatitis (B and C) are examples of this sort: some patients with Hepatitis B may develop polyarteritis nodosa, while some patients with Hepatitis C may develop cryoglobulinemic vasculitis.

Other types of vasculitis may be due to an ‘allergic‘-type reaction to medications. For example, certain blood pressure medications (hydralazine) or thyroid medications (propylthiouracil) can trigger ANCA associated vasculitis in some patients. Cocaine is an illicit drug that is linked to vasculitis and vascular damage.

However, the causes of most vasculitides are currently unknown. While we can identify some risk factors (such as older age in giant cell arteritis), we do not know the specific causes of these diseases. These forms of vasculitis of unknown cause are considered autoimmune diseases.

Under normal circumstances, our immune system serves to defend us from infection and other threats, such as cancers. In autoimmune diseases, the immune system generates a response not against a foreign threat, but against normal “self” tissues. This abnormal immune response against “self” tissues can result in a wide array of autoimmune diseases, including relatively common diseases (such as psoriasis or thyroid disease) as well as rare conditions (such as vasculitis).

In most cases, autoimmune diseases are believed to be due to an abnormal immune response that is generated in a susceptible person, and eventually leads to a cycle of ongoing inflammation in otherwise normal tissues where no infection or other identifiable threat is present. Some interaction between the immune system and the environment is thought necessary for this to occur, and a person’s genetic background likely places some individuals at higher risk than others.

A better understanding of the specific causes of these diseases would lead to improved means of diagnosing, treating, and even preventing these conditions. Uncovering the causes of vasculitis is a major goal of vasculitis research.

While we may not know the specific causes of the vasculitidies, we do have a basic understanding of the way that the immune system causes organ damage in these conditions. In all forms of vasculitis, activation of the immune system leads to the deposition of inflammatory cells and proteins in the walls of blood vessels. As this inflammation in blood vessels continues, the vessels become damaged and no longer serve their normal function of delivering blood to the organs that they supply. Consequently, the tissues downstream of these inflamed vessels are starved of oxygen and nutrients needed for normal function. At a basic level, this is a process similar to what occurs in a heart attack or a stroke – but instead of the cholesterol plaque that blocks a coronary artery in a heart attack, the immune system is responsible for blockage of blood vessels in vasculitis.

All information contained within the Johns Hopkins Vasculitis Center website is intended for educational purposes only. Visitors are encouraged to consult other sources and confirm the information contained within this site. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.

Prednisone

Prednisone is a corticosteroid with potent anti-inflammatory effects. Corticosteroids are a cornerstone of treating most types of vasculitis, and are often used in combination with other immunosuppressive medications. Prednisone works very quickly, and is therefore used (often at high doses) at the time of initial diagnosis to bring vasculitis under control. Then, prednisone is gradually reduced (“tapered”) while another immunosuppressive drug is started for long term treatment. Over time, the “steroid-sparing” immunosuppressive drug is used to control vasculitis, and prednisone is eventually stopped.

Side Effects

Corticosteroids cause a long list of side effects, making it dangerous to use these drugs at significant doses for long term treatment. The side effects of prednisone are related to: 1) the amount of steroid a patient takes in his/her daily dose, and 2) the length of time the patient remains on the medication. We emphasize that not all side effects occur in all patients.

Despite the numerous potential side effects of corticosteroids listed below, their introduction into patient care more than 50 years ago revolutionized the treatment of many diseases, including vasculitis. When used properly, these drugs save lives and avert threats to the function of important organs.

Common Side Effects of Steroids:

  • Increased Susceptibility to Infections
  • Weight Gain
  • Glucose Intolerance
  • Hypertension
  • Bone Thinning
  • Avascular Necrosis of bone
  • Easy Bruising
  • Abdominal Striae
  • Hirsutism
  • Acne
  • Mood Swings/Insomnia
  • Cataracts

Increased Susceptibility to Infections

Patients are at increased risk for many types of infections, from minor fungal infections in the mouth (“thrush”, caused by Candida) to life–threatening infections such as Pneumocystis carinii pneumonia. The higher the steroid dose and the longer the duration of therapy, the greater the risk of infection. The risk is also increased when patients receive combinations of immunosuppressive medications, such as cyclophosphamide (cytoxan) and prednisone. The risk of some infections can be greatly reduced by taking specific types of antibiotics prophylactically (such as Bactrim).

Pictured below is woman under treatment with prednisone and methotrexate for vasculitis and a concurrent neurologic condition (myasthenia gravis) developed painful vesicles in her mouth. The vesicles were confirmed by culture to be caused by reactivation of a Herpes simplex infection, and responded to treatment with acyclovir.

Weight Gain

Weight gain is usually the most dreaded side–effects of steroids, incurred to some degree by nearly all patients who take them. The amount of weight gain varies from individual to individual. In addition to causing weight gain, prednisone leads to a redistribution of body fat to places that are undesirable, particularly the face, back of the neck, and abdomen. Pictured below is an example of redistribution of body fat to the back of the neck. Accumulation of fat in this area is sometimes referred to as a “buffalo hump”.

Another example of this “redistribution” is pictured below. Supraclavical “fat pads” are collections of fat at the base of the neck, just above the collarbones, which are common in patients on steroids. They sometimes cause concern among patients if mistaken for lymph nodes or other causes for worry, but will gradually subside as the prednisone dose is tapered to below 10 milligrams/day.

In addition to this redistribution of fat, many patients undergo loss of muscle strength (muscle atrophy) while taking steroids. Regular physical exercise is key to avoiding this type of deconditioning that often occurs with prednisone treatment.

Glucose Intolerance

High blood sugar, or steroid–induced diabetes. Patients who are “pre-diabetic” can develop diabetes and the need for insulin while taking steroids. This usually resolves when the steroids are decreased or discontinued, but can be worsened by weight gain.

Hypertension

High blood pressure. This usually improves as the corticosteroid dose is reduced.

Bone Thinning (Osteoporosis)

Prednisone may cause thinning of the bones even in people who are not usually at high risk for osteoporosis (for example: males, young people). In people susceptible to osteoporosis, prednisone may accelerate the process of bone loss. Fortunately, in the past few years, excellent treatments and preventive measures have become available for osteoporosis. All patients on prednisone for prolonged periods are candidates for these medicines. Patients should be aware of their daily intake of calcium and Vitamin D while on steroids. Bone density measurement is commonly done using DEXA scans.

Avascular Necrosis of Bone

For reasons that are not known, high dose prednisone (for example, greater than 20 milligrams a day) predisposes some patients to joint damage, most often of the hips. In avascular necrosis (or osteonecrosis, meaning “bone death”) of the hip, the part of the leg bone that inserts into the pelvis dies, resulting in pain with weight–bearing and some loss of joint function. Many patients with avascular necrosis require joint replacements.

Easy Bruising

Prednisone also causes “thin skin”. Patients on moderate to high doses of prednisone often notice that they bruise easily, even with only slight trauma. Pictured below is a patient with giant cell arteritis who suffered a skin laceration after she struck her leg against a chair.

Abdominal Striae

Abdominal striae (“stripes”), as pictured below, frequently occur in patients who take high doses of steroids for long periods of time.

Hirsutism

Hirsutism is excessive growth of body hair. Patients vary in the degree to which this side effect of steroids occurs. Although some patients experience minimal hirsutism, the patient depicted below developed this side effect after taking 10 milligrams of prednisone for a few months.

Acne

High dose prednisone predisposes some patients to acne, especially facial acne, as pictured below. The facial acne developed after several weeks of high steroid doses.

Mood Swings/Insomnia

Many patients find it difficult to fall asleep when taking high doses of steroids. Many also find that they are more irritable or anxious than usual. Steroids sometimes even induce depression or psychosis, which usually improves when the drug is decreased or discontinued.

Cataracts

Long–term steroid use may lead to cataract development in the eyes, which frequently require surgical removal.

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