Navigating Vasculitis and its Mimics, with Anisha Dua, MD, MPH

Vasculitis poses a diagnostic challenge due to its multisystemic nature and diverse clinical manifestations, requiring careful consideration of various mimicking conditions. Medications employed for vasculitis are powerful, underscoring the importance of accurate diagnosis to avoid inappropriate treatments. Numerous conditions, including malignancies, infections, collagen vascular diseases, and prothrombotic states, can mimic vasculitis, requiring a comprehensive evaluation to differentiate and arrive at an accurate diagnosis.

In an interview with HCPLive, Anisha Dua, MD, MPH, associate professor and director of the Vasculitis Center, Division of Rheumatology, at Northwestern University Feinberg School of Medicine, discusses her upcoming Rheumatology Winter Clinical Symposium (RWCS) presentations on vasculitis mimics, central nervous system (CNS) vasculitis, and cardiac vasculitis.

Dua delves into the varied presentations of vasculitis, emphasizing manifestation depends on the affected blood vessel and the subsequent damage to the corresponding tissue or organ system. For example, small-vessel vascular diseases like granulomatosis with polyangiitis may present with skin manifestations, pulmonary hemorrhage, renal involvement, and sinus inflammation. However, these symptoms can also be mimicked by fungal or bacterial infections, which underlines the need for careful consideration and differentiation.

She mentions challenging scenarios, such as CNS vasculitis, where the potential mimics include certain types of lymphoma and reversible cerebral vasoconstrictive syndrome. Given the differences in management, a biopsy is often crucial to confirm the diagnosis, although even then, clarity may not always be immediate. The complexity of vasculitis underscores the importance of a thorough history, physical examination, blood tests, radiology studies, and biopsies in arriving at an accurate diagnosis.

Dua highlights the need for humility in approaching vasculitis cases, especially when patients do not respond to expected treatments. This situation may prompt a reevaluation of the diagnosis and a consideration of potential mimics or refractory disease. The key takeaway is the significance of an open-minded and comprehensive approach, involving a multidisciplinary team, to navigate the challenges posed by vasculitis and its mimicking conditions.

Ongoing research aims to enhance treatment regimens and diagnostic tools, emphasizing the dynamic nature of advancements in the field. Despite the difficulties posed by the complexity of vasculitis, she encourages a persistent commitment to diligent evaluation, demonstrating the evolving nature of our understanding and management of this intricate disease.

Dua consults for AMGEN, GSK, Sanofi, AstraZeneca, Abbvie, and Sandoz. She receives grant funding from the Rheumatology Research Foundation Clinician Scholar Educator Award, and serves on the board of directors at the Vasculitis Foundation and the Chicago Rheumatism Society.