Vasculitis - 2001 National Meeting Reports (cont.)

Below are perspectives on key reports on vasculitis diseases presented at the recent national meeting of the American College of Rheumatology:

Wegener's Granulomatosis

Wegener's granulomatosis classically involves inflammation of the arteries that supply blood to the tissues of the lungs, the nasal passages (sinuses), and the kidneys. There are "incomplete" forms of the disease that only involve one of these areas. Symptoms of Wegener's granulomatosis include fatigue, weight loss, fevers, shortness of breath, bloody sputum, joint pains, and sinus inflammation (sinusitis). Nasal ulcerations and even blood nasal discharge can occur. Other areas of the body that can also become inflamed in patients with Wegener's granulomatosis include the eyes, the nerves (neuropathy), the middle ear (otitis media), and the skin, which results in skin nodules or ulcers.

Cytoxan (cyclophosphamide) that is taken by mouth with prednisone until the disease is in remission and then switched to methotrexate for 2 years and tapered off was effective and less toxic than the traditional long-term Cytoxan treatment.

Dr. Shiel's Perspective: This was an important paper presented at this meeting. Methotrexate has recently been introduced as a drug for Cytoxan treatment failures. I have several patients doing very well on it for this purpose in my practice. The significance of this paper is twofold. First, while Cytoxan is very effective, it is also toxic. It now appears that Cytoxan will not be necessary in order to maintain long-term remission and that doctors can convert to the less toxic methotrexate for maintenance. Secondly, the report also demonstrates that methotrexate can eventually be tapered off entirely after 2 years. This is good news for patients with Wegener's granulomatosis.

Behcet's Disease

Behcet's syndrome is classically characterized as a triad of symptoms that include recurring crops of mouth ulcers (called apthous ulcers), genital ulcers, and inflammation of a specialized area around the pupil of the eye, the uvea. The inflammation of the area of the eye that is around the pupil is called uveitis. Behcet's syndrome is also sometimes referred to as Behcet's disease.

Mouth and genital ulcers healed and were reported as less frequent in 9 or 12 patients who were treated with Trental (pentoxifylline).

Dr. Shiel's Perspective: Trental also seemed to maintain the healed ulcers for up to the 29 months of the study. The effectiveness of Trental, the researchers said, seemed to be enhanced by the combination with colchicine in some patients. I felt this paper was significant because, to date, colchicine has been the mainstay of treatment of these often terribly painful sores. Now, it appears that we have other options.