This case study of recent dyspnea in a patient with granulomatosis with polyangiitis (Wegener’s) shows the value a multidisciplinary approach brings to vasculitis management.
Two highly distinct case vignettes demonstrate that multidisciplinary expertise is essential to managing the acute life-threatening complications that vasculitis can pose.
Despite advances in treating granulomatosis with polyangiitis (GPA), 50 to 70 percent of patients experience relapses after remission induction. Reduction of those relapses is a need that this study aims to meet.
Employing a low threshold for screening in vasculitis patients with signs or symptoms of venous thrombotic events can detect these important events that can be associated with morbidity and even mortality.
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Cleveland Clinic is studying the relationship between inflammatory disease in Wegener’s and the development of atherosclerosis, to understand the pathogenesis of atherosclerosis in Wegener’s.
Cost-effectiveness analysis finds weekly CBC monitoring superior to monthly monitoring for leukopenia surveillance in GPA patients treated with cyclophosphamide.
Rheumatologists should be aware of the high rate of mortality associated with Pneumocystis pneumonia and use preventive strategies in at-risk patients, such as those on an immunosuppressive-induction regimen.
Few tests have the ability to detect and potentially prevent organ and life-threatening disease the way urinalysis can. With small vessel vasculitis, its ability to detect glomerulonephritis early is particularly valuable.
In older Wegener’s patients, outcome is influenced by comorbid illnesses and enhanced risk for medication toxicities. Proactive monitoring and patient education play an important role in optimizing the potential for recovery.
Cavitary lung lesions carry a broad differential diagnosis. Even in patients who have a firmly established diagnosis of GPA, cavities may have other causes, and a thorough assessment of other organ sites is warranted.