JOP1

The journey of a patient

with small vessel vasculitis

Meet Mary she lives with one of the small vessel vasculitis conditions. Early diagnosis and appropriate timely access to treatment is essential to avoid irreversible organ damage. There are several different types of small vessel vasculitis, those which have anti-neutrophil cytoplasm antibodies – ANCA associated vasculitis (Granulomatosis with Polyangiitis, (GPA), Eosinophillic granulomatosis with Polyangiitis, (EGPA), Microscopic Polyangiitis, (MPA)) and non ANCA associated vasculitis (Henoch Schönlein Pupura/ IgA and Cryoglobulinemic Vasculitis). The main organs affected are kidneys, lungs and sinuses, but as these small vessel vasculides are systemic, there can be involvement of any organ.

Symptoms description

ENT

Sinusitis
Nose bleeds
Crusting
Repeated infections
Loss of hearing
Hoarseness
Saddle Nose

ORAL HEALTH

Bleeding gums
Ulcers

CARDIOLOGY

Arrythmia
Spasm of blood vessels
Heart failure
Heart Oedema

GASTRO-
ENTEROLOGY

Diarrhoea
Nausea
Bleeding
Pain
Perforated bowel (rare)

NEPHROLOGY

Haematurea
Frequent kidney infections
Urine foaming
Increased Blood pressure

NEUROLOGY

Loss or alteration of sensation Difficulty with co ordination Difficulty moving around

OPHTHALMOLOGY

Bloodshot eyes
Sensitivity to light
Inflammation of eye and eye structures
Conjunctivitis Changes to vision

RESPIRATORY

Wheeze
Difficulty breathing Cough
Coughing up blood Asthma
Repeated chest infections

DERMATOLOGY

Rash
Ulcers
Necrosis

NUTRITION

Loss of appetite
Loss of weight

INFECTIONS

Swollen glands
Feeling unwell Fever
Recurrent infections
not responding to antibiotic treatment

RHEUMATOLOGY

Joint pain
Joint swelling
Fatigue
Muscle pain

REQUIRED PRACTITIONERS

General /Healthcare Practitioner

Nurses

A range of organ specialists linked to main presenting symptoms

Emergency ward/ A&E/ ICU

Medical assessment unit

Physiotherapy

Dentist

Optician

Alternative medicines

Symptoms Challenges

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

These are rare conditions so there is poor awareness of Vasculitis within the healthcare system especially primary care.

Symptoms come and go and a lot of symptoms are dismissed – regarded as psychosomatic.

Vasculitis mimics other illnesses.

ACCESS TO EARLY, ACCURATE DIAGNOSIS

Symptoms come and go and a lot of symptoms are dismissed – regarded as psychosomatic.

Risk of permanent organ damage without timely intervention.

No definitive diagnostic tool.

COMMUNICATION AND COORDINATION

These are systemic conditions resulting in many HCPs being involved in care. These may not always be aware of each other’s intervention.

HEALTH IMPACT

A wide range of very diverse physical symptoms. 

Wide range of variation between individuals.

Symptoms can come and go.

Appears in childhood, adolescence as well as adulthood (peak incidence is age 50-60 years)

PSYCHOLOGICAL & SOCIAL IMPACT

Impact on both patient and carer

Anxiety, Depression Isolation and loss of self-confidence as symptoms increase and interfere with independence.

Financial challenges.

Absences from work or from school.

Costly health interventions.

QUALITY OF LIFE

Uncertainty re what is happening and what the future holds

Reduced independence

Symptoms Needs

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

Increase awareness of small vessel vasculitis amongst the healthcare professionals.

Embedding Vasculitis in HCP and Medical student education modules. 

Increase awareness and encourage attendance of existing specialist Vasculitis courses. 

COMMUNICATION AND COORDINATION

Improve onward referral to other disciplines and improve communication between the same.

Collaboration between healthcare professionals involved in care to achieve earlier diagnosis and access to treatment. 

Encourage holistic view of the patient, not the individual symptoms.

Symptoms can come and go.

DIGITAL HEALTH

All involved healthcare professionals to have access to health care records to ensure continuity of care.

SUPPORT & ADVOCACY

Support patient and family at this difficult time as they await a diagnosis .

Refer to local agencies who may be able to help with support and financial challenges.

Diagnostic description

ENT
Biopsy
Granulomas
Audiogram

CARDIOLOGY
Echocardiogram

GASTROENTEROLOGY
Colonoscopy

HEMATOLOGY
Raised ESR
Increased levels of white blood cells Increased CRP levels
Low HB (anaemia)
Positive ANCA test

NEUROLOGY
Nerve conduction tests
Electromyography test

OPHTHALMOLOGY
OpHthalmology tests

RESPIRATORY
Bronchoscopy
Respiratory tests
Lung granulomas

NEPHROLOGY
Proteinuria in urine
Red or white cells
in the urine
Kidney biopsy

IMAGING TECHNICS
X-ray, MRI, PET,
CT scans, Ultrasound

REQUIRED PRACTITIONERS

General/ Healthcare practitioner

Specialist discipline clinics depending on organ involvement

Emergency ward/Accident and Emergency / Medical assessment units

In patient units including Intensive care unit

Outpatient clinics

Private clinics

Radiology

Phlebotomy clinics

.

Diagnostic Challenges

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

Lack of awareness leads to delayed access to appropriate tests, results and Diagnosis.

Unfortunately, small vessel vasculitis can mimic some illnesses which leads to misdiagnosis. 

HEALTH IMPACT

Vasculitis mimics other illnesses.

A wide range of very diverse physical symptoms.

Symptoms can come and go.

Appears in childhood, adolescence as well as adulthood (peak incidence is age 50-60 years).

ACCESS TO EARLY, ACCURATE DIAGNOSIS

Delayed diagnosis can lead to permanent organ damage.

There is no definitive diagnostic test and so we rely on combining results from various tests to get an accurate picture. 

Delayed diagnosis can lead to chronic repeat infections which reactivate the disease causing more damage.

COMMUNICATION AND COORDINATION

Many specialists are involved and need to have clear communication (digital health systems) in place to ensure holistic picture of patient and efficient use of available resources.

PSYCHOLOGICAL AND SOCIAL IMPACT

Impact on both patient and carer

Anxiety, Depression Isolation and loss of self-confidence as symptoms increase and interfere with independence.

Financial challenges.

Absences from work or from school.

Costly health interventions.

QUALITY OF LIFE

Uncertainty re what is happening and what the future holds

Reduced independence

Diagnostic Needs

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

Increase awareness of signs of small vessel vasculitis amongst the healthcare professionals. 

Embedding Vasculitis in HCP and Medical student education modules. 

Increase awareness and encourage attendance of existing specialist Vasculitis courses. 

COMMUNICATION & COORDINATION

Collaboration between clinics.

Clear explanations of what is happening to patient and carer. 

QUALITY OF LIFE

Access to support services as outlined above.

Reassurance that one can recover a good quality of life with treatment.

RESEARCH

National and International cooperation – establishment of networks.

Data Sharing and interoperability. 

Further research in genomics and biomarkers to establish clear diagnosis tools.

Registries

Reevaluation of diagnosis in time given the progress in the field including genomics and biomarkers.

ACCESS TO EARLY, ACCURATE DIAGNOSIS

Access to tests and prompt results. Timely intervention.

Access to specialist Clinicians/specialist small vessel vasculitis clinic.

SUPPORT & ADVOCACY

Patient needs to feel able to advocate for themselves to ensure getting the right diagnosis. 

Signpost to relevant local services to help with all practicalities of diagnosis, physical, psychological and social.- including advise re work, education, or planning for early retirement. 

Signpost to any benefit system that may assist with any associated financial costs of diagnosis.

Psychological support via counselor, psychologist, and/or self-help groups.

Uncertainty re what is happening and what the future holds

Reduced independence

Treatment description

IMMUNOSUPPRESSION 

Immunosuppression
by Steroids,
Chemotherapy and
Biological drugs
DMARDS Disease
modifyin ganti-
rheumatic drugs

ANTIBIOTICS 

either prophylactic
or to treat infection

PAIN, FATIGUE AND
BREATHLESSNESS 
MANAGEMENT

KIDNEY DIALYSIS
AND TRANSPLANT

PSYCHOLOGICAL
SUPPORT

SURGICAL
INTERVENTION

PHYSIOTHERAPY

OCCUPATIONAL
THERAPY

ALTERNATIVE
THERAPIES

SENSORY SUPPORT
APPLIANCES

TREATMENT OF
SIDE EFFECTS
AND
PROPHYLACTIC
MEASURES 

to prevent escalation
of same:ospeoporosis,
gastriculcers, 

VACCINATIONS 

Flu, Pneumonia,
Covid-19

PODIATRY

REQUIRED PRACTITIONERS

General/ Healthcare practitioner

Specialist discipline clinics depending on organ involvement

In patient clinics

Outpatient clinics

Phlebotomy clinics

Family planning clinics

Private clinics

Specialised nurses

Community nurses

Hospital and community pharmacists

Physiotherapist

Occupational Therapist

In Podiatrist

Dentist

Dietitian

Social worker

Psychological support 

Alternative therapies clinics

Treatment Challenges

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

Lack of awareness leads to delays in treatment and possible organ damage. 

ACCESS

Sometimes special permission/approval/funding is required to access novel treatments 

May need travel to clinics to have treatments and these may be some distance from home.

COMMUNICATION AND COORDINATION

Because so many different disciplines are involved, we need to have clear communication between the all disciplines involved.

CHRONICITY
OF TREATMENT

Immunosuppression leads to increased risk of infection and so restrict quality of life (education, employment, social situations)

Use of chemotherapy has implications on fertility and can induce early menopause.

Many treatments have side effects which need further monitoring /treating.

Long term use of steroids leads to development of cushingoid appearance.

Long term use of treatments leads to development of co morbidities i.e., osteoporosis, diabetes, glaucoma, increased risk of developing cancer.

QUALITY OF LIFE

Determined by organ involvement, independence, and ability to resume previous roles.

PATIENT EMPOWERMENT

Patient and their families are adjusting to a new life with small vessel vasculitis, how it impacts them, how the treatment impacts them and the changes that are needed in their lives. This is a very isolating and vulnerable time.

PSYCHOLOGICAL AND SOCIAL IMPACT

Lack of psychological support leads to anxiety re life changes, loss of independence, confidence, and self-esteem, stress related flare ups, and poor social interaction.

Treatment Needs

HEALTHCARE PROFESSIONALS AWARENESS & EDUCATION

Increase awareness of treatment of small vessel vasculitis amongst the healthcare professionals.

Embedding Vasculitis in HCP and Medical student education modules. 

Increase awareness and encourage attendance of existing specialist Vasculitis courses.

PATIENT
ENGAGEMENT

Need to have clear communication with the patient and their carer to plan, explain and execute the appropriate treatment plan for the individual. 

Information leaflets are usually available on the specific conditions and drugs, but these need reinforced by one-to-one discussion.to explain importance of drug /treatment regime, expected side effects, and precautions to be aware of. 

The care team should be aware of the implications of small vessel vasculitis and its treatment on the life of the individual and their family –to this end the treatment plan should be a collaboration between the individual (and their family in the case of a child) and their clinicains.

ACCESS

Clear procedures in place to enable appropriate and timely access to current treatments.

COMMUNICATION AND COORDINATION

Clear established communication between all disciplines involved (i.e.  electronic healthcare records).

CHRONICITY OF TREATMENT

Clear guidance on how to avoid exposure to infections.

Appropriate prophylactic measures in place to avoid development of co morbidities.

Advise re fertility, and options available re egg/sperm storage.

Advise on managing the menopause for women exposed to chemotherapy.

Treatment /management of side effects.

SUPPORT
AND ADVOCACY

Involvement in support group and/or self-help groups to empower the individual and their family in managing their condition and the related issues. 

QUALITY OF LIFE

Determined by organ involvement, independence, and ability to resume previous roles.

Patient and their families are adjusting to a new life with small vessel vasculitis, how it impacts them, how the treatment impacts them and the changes that are needed in their lives. This is a very isolating and vulnerable time.

RESEARCH

Clinical trial to test new drugs/interventions and regimes of treatment to improve quality of life and manage small vessel vasculitis. 

National and International cooperation – establishment of networks

Data Sharing and interoperability.

Further research to establish tools to identify flares, how to avoid flares and new treatments. – genomics, biomarkers

Registries to determine incidence, disease progression and effective treatments. 

Follow up & Ageing description

INDIVIDUAL AWARE

of symptoms of relapse
and what to do when
felling unwell

DEVELOPMENT
OF CO
MORBIDITIES

and address issues

SHARED CARE

between specialist
clinics and general
healthcare practitioner

REFERRAL TO
FURTHER CLINICS
AS INDICATED 

REGULAR REVIEWS 

by general healthcare
practitioner, the named
specialist consultant,
and their team at all
discipline. Clinics involved
in care

REQUIRED PRACTITIONERS

General Healthcare practitioner.

In patient clinics 

Out patient clinics 

Specialist nurses

Community nursing 

Pharmacist 

Emergency ward

Healthcare professionals involved in care.

Social worker 

Transition clinics

Gerontologist

Follow up & Ageing Challenges

MEDICAL
FOLLOW UP

Regular monitoring, access to test results and ability to quickly report symptoms to medical team to avoid unnecessary worry.

SUPPORT AND ADVOCACY

Access financial help/benefits and help to adjust to new life within the family. 

Housing/school/workplace adaptations.

Physical/financial and psychological support systems in place

HCP FOLLOW UP

Multi system illness so need access to many different disciplines.

Access to HCPs as needed.

Access to Transition clinic for children.

Access to gerontology services in old age.

PATIENT EDUCATION

Awareness of what to do if symptoms change.

Awareness of how to manage condition by medication, lifestyle, and self-help.

CHRONICITY OF TREATMENT

Immunosuppression leads to increased risk of infection and so restrict quality of life (education, employment, social situations).

Use of chemotherapy has implications on fertility and can induce early menopause.

Many treatments have side effects which need further monitoring /treating.

Long term use of steroids leads to development of cushingoid appearance.

Long term use of treatments leads to development of co morbidities i.e., osteoporosis, diabetes, glaucoma, increased risk of developing cancer.

Follow up & Ageing Needs

MEDICAL
FOLLOW UP

Care needs to be coordinated by one clinician – rheumatologist, nephrologist or immunologist, and the individual patient. .

MEDICAL AWARENESS AND EDUCATION

Need to be aware of the changes that accompany aging and how to address these. 

Plan for smooth transition of care from childhood services to adult and from adult to gerontology.

SUPPORT AND ADVOCACY

Support individual, carer and families in adjusting.

HCP FOLLOW UP

Good communication to exist between all involved in patient care.

PATIENT EDUCATION

Individuals and their family need to have more information on medications, treatments and living with small vessel vasculitis long term.

DIGITAL HEALTH

IT tools like dedicated smartphone apps allowing for real time reporting about disease symptoms and treatment complications to medical team.

Virtual clinics when condition is stable to avoid having to travel to busy clinics.

RESEARCH

Need registries to gather information on effective management of small vessel vasculitis, effective treatments, disease progression and geographical incidence.

Clinical trials.

Exploration of genomics and biomarkers in small vessel vasculitis.