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The prognosis for systemic vasculitides is usually good and has improved over the years thanks to diagnostic and therapeutic advances. Other factors that clearly improve the prognosis, in terms of overall survival and the preservation of certain organs, are the early identification of clinical manifestations and treatment in specialised centres.
Acute complications related to systemic forms of vasculitis stem from vascular occlusion or rupture, which result in a lack of blood supply or bleeding, respectively.
Therefore, large-vessel vasculitides (GCA and TKA) can have a direct effect on the aorta (in the form of dilation, aneurysm or rupture) and other organs and regions such as the brain (stroke or haemorrhage), eyes (vision loss or double vision), limbs (weakness or paleness), heart (angina or heart attack), kidneys and intestines (lack of blood supply, ischaemia and haemorrhages). Cases of medium-vessel vasculitis (PAN) can suffer similar complications, especially those affecting the intestines and kidneys. In small-vessel vasculitides (GPA, MPA, EGPA and cryoglobulinaemic vasculitis) both the lungs and kidneys may be affected diffusely and suffer acute failure. In PAN and some small-vessel vasculitides (such as GPA, MPA, EGPA and cryoglobulinaemic vasculitis), the peripheral nerves are often affected due to a lack of blood supply which causes altered sensitivity and/or weakness in the limbs that may even develop into a disabling condition. The skin may also suffer a range of lesions (purpura, nodules or ulcers) depending on the type of small-vessel vasculitis. The nose (blockage or secretions), paranasal sinuses (sinusitis), ears (otitis) and tear glands (inflammation) are commonly affected in cases of granulomatosis with polyangiitis (GPA).
The chronic complications stem from the irreversible damage vasculitis causes to the organs and tissues during the initial stage and any subsequent periods of activity (or flare-ups). Therefore, it is important to establish a diagnosis and install a treatment as early as possible. These complications worsen the prognosis for the disease and, above all, the patient’s quality of life. For example, in cases of neurological damage or visual impairment (due to a stroke, disabling peripheral neuropathy or damage to the optic nerve), alteration or destructuration of the nasal drainage area or the respiratory tract, or a residual kidney problem after chronic kidney disease, the patient must live with these negative aftereffects and the possibility of suffering a progressive worsening of the initial lesion (e.g., kidney failure) or an increased risk of infection (sinusitis, otitis or pneumonia in the case of damage to the respiratory tract).
In addition to the acute and chronic complications arising from the actual vasculitis, there are also those associated with the side effects of the treatment with corticosteroids and immunosuppressants.