Description
The systemic vasculitides are associated with considerable mortality and morbidity. Treatment is aimed at inducing remission, maintaining remission and preventing relapse whilst avoiding unacceptable drug toxicity. Cyclophosphamide and corticosteroids remain the drugs of choice for generalised disease especially with significant renal involvement. Cyclophosphamide may be given either as a daily low dose regimen or by intermittent intravenous pulses. Induction rates are probably similar but relapse rate is higher and toxicity lower with the pulse regimen. Mesna and trimethoprim/sulphamethoxazole should be considered to reduce risk from cystitis and Pneumocystis carinii infection respectively. Cyclophosphamide should only be given until remission is induced; to maintain remission therapy should be changed to azathioprine or methotrexate. Therapy may
then be gradually reduced. Vigilance must be maintained to detect relapse which can occur at any time.
