Inducing remission in patients with less-severe vasculitic disease

Immunoglobulin A vasculitis and Kawasaki disease are managed differently; see specific management in the separate topics.

For patients with less-severe vasculitis (eg upper airway, skin or joint involvement), without manifestations that threaten organs or body systems, intensive induction therapy is not required. Treatment must be started urgently and include high-dose oral corticosteroids; discuss with a specialist.

An additional immunomodulatory drug (eg azathioprine, methotrexate, leflunomide or mycophenolate) may be used in combination with systemic corticosteroidsMustapha, 2021. The preferred combination therapy for patients with microscopic polyangiitis or granulomatosis with polyangiitis is high-dose oral corticosteroids plus methotrexate or mycophenolate.

Patients with less-severe vasculitis should be frequently monitored for the onset of organ- or body system–threatening disease (eg for kidney disease—monitor kidney function, urinary sediment and urinary protein 3- to 6-monthly). See the specific topics for recommended monitoring. Organ dysfunction may develop later and if so, warrants more intensive treatment.