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Vasculitis

Vasculitis is a group of rare conditions in which the immune system inflames blood vessels. Some types mainly cause fatigue and aches; others can threaten sight, kidneys, lungs or nerves. Treatment is medical — steroids, immune-calming medicines and newer biologics — and warning signs such as sudden vision change, a new severe headache with a tender scalp, or blood in the urine need care right away.

Call 911 or go to an emergency room for the signs below. If you already have vasculitis, call your specialist the same day for anything new or worse. Vasculitis can damage the eyes, brain, heart, lungs, kidneys and gut, and some of that damage can be permanent if it is not treated quickly (NHS (opens in a new tab), ACR (opens in a new tab)).

  • Sudden vision loss, double vision or blurred vision. Blindness in one eye may be the first sign of giant cell arteritis (NHLBI (opens in a new tab)). The American College of Rheumatology (ACR) says permanent vision loss can occur suddenly but proper treatment can prevent it (ACR (opens in a new tab)). The NHS says a person with vision problems should have a same-day appointment with an eye specialist (NHS (opens in a new tab)).
  • A new, severe headache with a tender scalp or temples, or jaw pain when chewing or talking. These are the main signs of giant cell arteritis, which the NHS calls serious and in need of urgent treatment because it can lead to stroke and blindness (NHS (opens in a new tab)).
  • Stroke signs: sudden confusion, trouble speaking, numbness or weakness especially on one side, a sudden severe headache with no known cause, or sudden trouble seeing or walking — call 911 (NHLBI (opens in a new tab)). See our stroke guide.
  • Chest pain or pressure, or shortness of breath. Vasculitis can lead to heart attack; NHLBI says to call 911 right away if you think you or someone else is having one (NHLBI (opens in a new tab), NHLBI (opens in a new tab)).
  • Shortness of breath with coughing up blood. The NHS lists this for granulomatosis with polyangiitis and microscopic polyangiitis (NHS (opens in a new tab)); NHLBI lists bleeding within the lung (NHLBI (opens in a new tab)). The sources do not give a US instruction here, so MBHA’s advice is to go to an emergency room.
  • Blood in the urine, foamy urine, new leg swelling or high blood pressure can mean the kidneys are involved (MedlinePlus (opens in a new tab), NHS (opens in a new tab)). The ACR warns that vasculitis may seriously affect the kidneys without many symptoms at first (ACR (opens in a new tab)), so MBHA suggests not waiting for the symptoms to become obvious.
  • Sudden, strong pain in the belly, chest or back, with light-headedness, paleness or a racing heart. NHLBI says these can be signs of an aneurysm tearing or rupturing; call 911 (NHLBI (opens in a new tab)). Vomiting blood or blood in the stool also needs urgent care (NHLBI (opens in a new tab), NHS (opens in a new tab)).
  • Fever with a new rash. The NHS says a rash that does not fade when a glass is pressed on it, along with feeling very unwell (for example, pain from bright lights or a stiff neck), could be something serious like meningitis and needs emergency care (NHS (opens in a new tab)). In a child, a fever of five days or more with a rash, red eyes, swollen neck glands, red lips or red hands and feet can be Kawasaki disease and needs urgent medical attention (NHS (opens in a new tab)). The NHS advice is written for the UK; in the US, call your doctor right away or go to an emergency room.
  • Fever, chills or a sore throat while on steroids or other immune-lowering medicine. Prednisone can reduce your ability to fight infection and can prevent the usual symptoms of one, so call your doctor immediately (MedlinePlus (opens in a new tab)).

Do not wait for a chiropractic, acupuncture or massage appointment, or try a home remedy first, if you have any of these signs. If you take steroids, never stop them suddenly on your own (NHS (opens in a new tab), MedlinePlus (opens in a new tab)).

What is vasculitis?

Vasculitis is the name for a group of rare conditions that damage blood vessels by causing inflammation. It can affect any size and type of blood vessel, arteries and veins, anywhere in the body (NHLBI (opens in a new tab)). In most types the immune system attacks healthy blood vessels by mistake, making them swollen and narrow (NHS (opens in a new tab)). An inflamed vessel can narrow, close off completely, or stretch and weaken until it bulges into an aneurysm (MedlinePlus (opens in a new tab)). It ranges from a minor problem confined to the skin to a serious illness affecting organs such as the heart or kidneys (NHS (opens in a new tab)).

NHLBI calls vasculitis primary when the cause cannot be identified and secondary when something else causes it. Possible triggers include infections, trauma, some drugs and autoimmune disorders (NHLBI (opens in a new tab)). The National Institute of Neurological Disorders and Stroke (NINDS) adds that smoking and cocaine can raise the risk, that certain medicines have been linked to vasculitis (hydralazine, levamisole, and tumor necrosis factor inhibitors), and that hepatitis B or C, lymphoma and autoimmune diseases such as lupus can trigger it (NINDS (opens in a new tab)). See our lupus and hepatitis guides. With treatment, vasculitis can go into remission, a period when the disease is not active (NHLBI (opens in a new tab)).

The main types

There are many types, and each affects different parts of the body (NHLBI (opens in a new tab)). One useful way to sort them is by where they mainly strike. The sources we read describe vessel size for some types but not all, so treat the groups below as a guide rather than a strict classification.

Mainly the large arteries

  • Giant cell arteritis (GCA, temporal arteritis). NHLBI says it mostly affects the aorta and its major branches, often the temporal artery in the head, and may lower blood flow to the optic nerve, causing vision loss (NHLBI (opens in a new tab)). It occurs only in adults, usually over 50, and more in women (ACR (opens in a new tab)). Some people also have polymyalgia rheumatica (NHS (opens in a new tab)); see our polymyalgia and giant cell arteritis guide.
  • Takayasu arteritis. A rare form that inflames the walls of large arteries and can weaken or remove the pulse in an arm or leg (“pulseless disease”). Common symptoms are fever, fatigue and limb pain with activity; some people have no symptoms until it is advanced, and blood pressure may read differently in the two arms (ACR (opens in a new tab)). It most often affects adolescent girls and young women and is more common in Asia (NHLBI (opens in a new tab)). The 2021 ACR and Vasculitis Foundation guideline treats GCA and Takayasu as examples of large vessel vasculitis (Maz et al., 2021 (opens in a new tab)).

Mainly medium-sized arteries

Mainly small and medium vessels: ANCA-associated vasculitis

Three conditions are linked with antineutrophil cytoplasmic antibodies (ANCA), autoantibodies that attack the body’s own tissues (MedlinePlus (opens in a new tab)):

  • Granulomatosis with polyangiitis (GPA), formerly Wegener’s, mainly affects the ears, nose, sinuses, lungs and kidneys. The NHS says it can be serious if untreated but medicines can help manage it (NHS (opens in a new tab)). Symptoms can include crusting and nosebleeds, a cough that will not go away, coughing up blood, and kidney problems (NHS (opens in a new tab)).
  • Microscopic polyangiitis (MPA) affects small to medium-sized vessels, often in the kidneys and lungs (NHLBI (opens in a new tab)), and can also involve nerves and skin (NHS (opens in a new tab)).
  • Eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss, often brings asthma, nasal allergy symptoms and a high count of white blood cells called eosinophils, and can affect nerves, kidneys and the heart muscle (NHS (opens in a new tab), MedlinePlus (opens in a new tab)). See our asthma guide.

Other forms

  • IgA vasculitis (formerly Henoch-Schönlein purpura) is one of the most common types in children but also affects adults. IgA builds up in blood vessels of the skin, joints, intestines and kidneys (NHLBI (opens in a new tab)). The NHS describes a rash of raised red or purple spots, joint and tummy pain; it is not usually serious, but can sometimes lead to kidney problems, so kidney check-ups continue for 6 to 12 months (NHS (opens in a new tab)).
  • Behçet’s disease involves vasculitis and typically causes mouth and genital sores, eye inflammation and joint pain; there is no cure, and treatment aims to reduce pain and prevent serious problems (MedlinePlus (opens in a new tab), NHS (opens in a new tab)). See our Behçet’s guide.
  • Others include Buerger’s disease (closely linked to smoking), cryoglobulin- associated vasculitis (sometimes after hepatitis C), hypersensitivity vasculitis (usually a reaction to a medicine, with a temporary rash) and rheumatoid vasculitis (NHS (opens in a new tab)).

What does it feel like?

NHLBI says symptoms depend on the type and the organs involved. Some people have few symptoms, while others become very sick; it can develop slowly over months or quickly over days or weeks. General symptoms are tiredness, fever, aches and pains, loss of appetite and weight loss (NHLBI (opens in a new tab)). More specific problems can include sinus and ear trouble, eye changes, belly pain, headache and scalp tenderness, joint pain, shortness of breath, numbness or weakness, skin rashes with purple or red spots, and swollen hands and feet (NHLBI (opens in a new tab)). The ACR adds rashes, nodules or sores, headaches with vision changes, and numbness or weakness in a hand or foot (ACR (opens in a new tab)). NINDS lists pain while chewing or swallowing, transient ischemic attacks (TIA, a warning sign for stroke), seizures and trouble speaking when the nervous system is involved (NINDS (opens in a new tab)).

How it is diagnosed

NHLBI says diagnosis can be difficult, and some types cannot be diagnosed with a single test. Your provider may use symptoms, blood tests, a biopsy (a small tissue sample from a vessel or organ), imaging such as ultrasound, CT or PET scans, a urine test to check the kidneys, and other tests, sometimes with specialists such as rheumatologists, nephrologists, neurologists or ophthalmologists (NHLBI (opens in a new tab)).

Keeping watch: monitoring and flares

After diagnosis, NHLBI advises routine follow-up to check for medicine side effects, and regular tests such as blood tests and heart imaging when needed. Flares can happen after remission, and your provider may carefully stop medicines but will still monitor you for flares (NHLBI (opens in a new tab)). In ANCA-associated vasculitis, ANCA results may be used to see whether treatment is working (MedlinePlus (opens in a new tab)). The outlook with treatment is good for many people, according to the ACR (ACR (opens in a new tab)). Giant cell arteritis can return after treatment (ACR (opens in a new tab)), although MedlinePlus says that, properly treated, it rarely comes back (MedlinePlus (opens in a new tab)); the two sources differ, so ask your doctor what to expect.

When to see a provider (not an emergency): the NHS says to see a doctor if you have symptoms of granulomatosis with polyangiitis, and, if you have a diagnosis, to see your specialist about new or returning symptoms (NHS (opens in a new tab)). MBHA suggests keeping a short log of fevers, rashes, headaches, vision changes, and urine or breathing changes, with dates, to bring to every appointment.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

Vasculitis: six approaches compared
ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A rheumatologist (often with a kidney, lung, eye, nerve or heart specialist) confirms the type and treats it with corticosteroids plus, depending on the type, immune-calming medicines such as methotrexate, azathioprine or cyclophosphamide, or biologics such as rituximab, tocilizumab, upadacitinib or mepolizumab. Kawasaki disease is treated with IVIG in hospital. Medicare Part B covers medically necessary outpatient physical therapy: after the deductible you pay 20% of the Medicare-approved amount. Specialist visits, blood tests, scans and medicines: cost estimate being researched. Many people reach remission, but treatment is often long, flares can happen, and the medicines carry real risks, especially infection and bone thinning. Regular monitoring is part of care.
Chiropractic Spinal and soft-tissue manual therapy. We found little research on chiropractic care for vasculitis, and no source we read describes it as a treatment. About $55 to $100 for a self-pay follow-up visit and $90 to $200 for a first visit, per The Pricer. Medicare covers only spinal adjustments for a subluxation. No known role in treating vasculitis. Aching in the neck, jaw or back needs a medical diagnosis first, because giant cell arteritis can cause jaw and head pain. Avoid forceful neck manipulation if you have unexplained head or neck symptoms.
Acupuncture Fine needles at acupuncture points. We found little research on acupuncture for vasculitis; one published protocol plans a review for IgA vasculitis belly pain. About $90 to $185 per follow-up visit paying cash, per The Pricer. Medicare covers acupuncture only for chronic low back pain. Evidence is lacking, so MBHA cannot say it helps. If you try it, use sterile single-use needles and tell the practitioner about every immune-lowering medicine you take.
Herbal medicine No herb or supplement is shown to treat vasculitis in adults. Some reviews of traditional Chinese herbal formulas for IgA vasculitis in children report benefits, but the trials are mostly low quality. The main concern is safety with steroids and immune-lowering medicines. Cost estimate being researched. Use only after checking with your prescriber. Licorice, St. John’s wort and “immune-boosting” herbs can interact with the medicines used for vasculitis.
Massage therapy Hands-on bodywork for tight muscles and relaxation. We found little research on massage for vasculitis. One national chain: about $125 to $160 for a 60-minute massage for non-members and memberships of about $70 to $90 a month, per The Pricer. Medicare does not cover massage. May ease muscle tension and stress, but it does not treat the inflammation. Ask for gentle pressure: steroids can thin skin and bones, and skip massage over a new rash, ulcer or swollen, painful limb until a doctor has seen it.
MBHA Wellness Coach Daily habits that support treatment: taking medicines as prescribed, a symptom and appointment log, pacing for fatigue, gentle movement, infection prevention, sleep and stress habits, and not smoking. Cost estimate being researched. Supports — never replaces — medical care. A small feasibility study found a coached physical activity programme acceptable to people with ANCA-associated vasculitis who had lingering fatigue.

Approach 1 of 6

Conventional medicine (AMA)

Treatment aims to slow the inflammatory attack on the blood vessels (NHLBI (opens in a new tab)). Which medicines you need depends on the type and how serious it is. We don’t list doses; your specialist sets and adjusts them. Guidelines are mostly “conditional” because the underlying evidence is limited: the 2021 ACR and Vasculitis Foundation guidelines for GCA and Takayasu, and for ANCA-associated vasculitis, say most recommendations are conditional (Maz et al., 2021 (opens in a new tab), Chung et al., 2021 (opens in a new tab)).

Corticosteroids (steroids)

  • What they do. Steroids lower the activity of the body’s defense system in the blood vessels; for some types you need them for months or years, and they can lower bone density, raise blood sugar and blood pressure, and thin the skin (NHLBI (opens in a new tab)). The ACR calls glucocorticoids the treatment used for inflammation in many types of vasculitis (ACR (opens in a new tab)).
  • Giant cell arteritis. The NHS describes a high initial steroid dose for a few weeks, then a lower dose over a longer period, possibly several years; treatment starts before the diagnosis is confirmed because of the risk of vision loss (NHS (opens in a new tab)).
  • ANCA-associated vasculitis. Steroids are combined with rituximab or cyclophosphamide, and European guidelines recommend tapering to a low target within about 4 to 5 months (Hellmich et al., 2024 (opens in a new tab)). In the PEXIVAS trial of 704 people with severe disease, a reduced-dose steroid regimen was not worse than standard dose for death or kidney failure, and serious infections were less common at one year (Walsh et al., 2020 (opens in a new tab)). A BMJ guideline strongly recommends a reduced-dose regimen (Zeng et al., 2022 (opens in a new tab)).
  • Never stop suddenly. Without enough natural steroids you can get extreme tiredness, weakness and upset stomach; carry a card or wear a bracelet saying you take steroids, and tell every doctor and dentist (MedlinePlus (opens in a new tab)). Mood changes and sleeplessness can occur; report them.

Conventional immune-calming medicines

The ACR says methotrexate, azathioprine and other immunosuppressants may be used for milder vasculitis, and cyclophosphamide for life-threatening disease (ACR (opens in a new tab)). For GPA, the NHS says mild disease may be treated with a steroid, possibly with methotrexate, while severe disease may call for rituximab, or cyclophosphamide, a chemotherapy-type medicine (NHS (opens in a new tab)). Safety matters with all of them:

  • Methotrexate. MedlinePlus warns of life-threatening birth defects, a drop in blood cells that raises infection risk, and severe liver damage (MedlinePlus (opens in a new tab)). It lists other uses, not vasculitis; its use here is described by the ACR and NHS.
  • Azathioprine. It can lower blood-cell counts, raise the risk of skin cancer and lymphoma, and may harm a fetus (MedlinePlus (opens in a new tab)). European guidelines list azathioprine and methotrexate as alternatives to biologics for keeping ANCA-associated vasculitis in remission (Hellmich et al., 2024 (opens in a new tab)).
  • Cyclophosphamide. MedlinePlus warns of bladder problems (call right away for pink or red urine), possible permanent infertility, harm to a fetus, and a higher risk of other cancers (MedlinePlus (opens in a new tab)). In the RAVE trial of 197 people, rituximab was not worse than cyclophosphamide for starting remission and may have been better in relapsing disease (Stone et al., 2010 (opens in a new tab)).

Biologics and other targeted medicines

What it costs

Physical therapy: Medicare Part B covers medically necessary outpatient PT; you pay 20% of the approved amount after the deductible (Medicare.gov (opens in a new tab)). Specialist visits, blood tests, scans and medicines: MBHA cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors treat neck, back and joint pain with manipulation, soft-tissue work and exercise. We found little research on chiropractic care for vasculitis, and none of the medical sources we read describes manipulation as a treatment for it. MBHA therefore cannot say chiropractic helps vasculitis.

Safety questions specific to vasculitis

  • Get the diagnosis first. Jaw pain when chewing and head or scalp pain are warning signs of giant cell arteritis (NHS (opens in a new tab)). They need the same-day medical care described at the top of this guide, not an adjustment.
  • The neck. NCCIH says a type of neck manipulation has been linked to rare tears in neck arteries that can lead to stroke, though experts disagree on whether manipulation causes them, and that serious problems may be more likely in people with underlying health problems (NCCIH (opens in a new tab)). Because some vasculitis types inflame arteries of the head and neck, MBHA suggests avoiding forceful neck manipulation and sharing your diagnosis. See our stroke guide.
  • Bones and steroids. Steroids can lower bone density (NHLBI (opens in a new tab)). MBHA suggests telling your chiropractor you take steroids and asking about gentle, low-force techniques. See our osteoporosis guide.

What it costs

The Pricer lists about $55 to $100 for a self-pay follow-up visit and about $90 to $200 for a first visit (The Pricer (opens in a new tab)). Medicare Part B covers only spinal adjustments by a chiropractor to correct a subluxation (Medicare.gov (opens in a new tab)).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture uses fine needles at specific points. We found little research on acupuncture for vasculitis, and NCCIH’s summary of the evidence does not mention it (NCCIH (opens in a new tab)). One 2025 protocol describes a planned systematic review of acupuncture for belly pain in IgA vasculitis; it states that clinical studies suggest acupuncture can ease the pain, but it is a plan, and we did not find results (Zhao et al., 2025 (opens in a new tab)). MBHA therefore cannot say acupuncture helps, and it does not treat the inflammation.

Safety

What it costs

The Pricer lists about $90 to $185 per follow-up visit, up to about $230 for a first private visit, and community acupuncture around $50 to $90 (The Pricer (opens in a new tab)). Medicare Part B covers acupuncture, including dry needling, only for chronic low back pain (Medicare.gov (opens in a new tab)).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found no herb or supplement shown to treat vasculitis in adults, and we found little research on herbal remedies for most types. The exception is IgA vasculitis, where reviews of traditional Chinese herbal medicine exist, mostly in children. A 2015 review of 15 trials in 1,112 children with IgA vasculitis (then called Henoch-Schönlein purpura) without kidney damage found that adding herbs to standard care was linked with less later kidney damage and faster fading of rash and pain, but the trials were low in quality and no reliable conclusion on safety was possible (Yang et al., 2015 (opens in a new tab)). A 2026 review of 19 trials in 1,764 children with IgA vasculitis kidney involvement reported short-term benefits on some measures, with certainty of evidence from moderate to very low (Gou et al., 2026 (opens in a new tab)). These were formulas used in China, not a single product you can buy, and the NHS notes that IgA vasculitis often gets better without treatment (NHS (opens in a new tab)). If a child has this condition, the kidney check-ups still matter.

Herbs that can interact with your medicines

  • Licorice. NCCIH says interactions between licorice and corticosteroids have been reported, and that the glycyrrhizin in licorice can cause serious problems such as irregular heartbeat, especially in people with high blood pressure or heart or kidney conditions (NCCIH (opens in a new tab)). Steroids can already raise blood pressure (NHLBI (opens in a new tab)); vasculitis itself can involve the kidneys and heart (NHLBI (opens in a new tab)).
  • St. John’s wort. MedlinePlus names it as a herbal product that may interact with prednisone (MedlinePlus (opens in a new tab)); NCCIH says it can interact in dangerous, sometimes life-threatening ways with many medicines (NCCIH (opens in a new tab)).
  • “Immune-boosting” herbs. NCCIH says cat’s claw might make the immune system more active, which could increase autoimmune symptoms and interfere with immunosuppressants, and that Asian ginseng may worsen autoimmune disorders (NCCIH (opens in a new tab)). The ACR notes that vasculitis may be an autoimmune disease (ACR (opens in a new tab)); ask your rheumatologist before taking any such product.
  • Turmeric and curcumin. NCCIH says we do not know enough to conclude turmeric or curcumin helps any health purpose, and highly absorbable curcumin products have been linked to liver damage (NCCIH (opens in a new tab)). Methotrexate and avacopan also call for liver monitoring (MedlinePlus (opens in a new tab), FDA label (DailyMed) (opens in a new tab)), so tell your doctor if you use it.

Supplements in general

NCCIH notes that strong evidence behind supplement claims such as “supports a healthy immune system” is often lacking (NCCIH (opens in a new tab)). Your doctor may recommend calcium or vitamin D for bone protection (ACR (opens in a new tab)); ask what is right for you rather than self-dosing. Also see our medication safety guide.

Approach 5 of 6

Massage therapy

Massage can ease tight muscles and help you relax. We found little research on massage for vasculitis, and it does not treat the underlying inflammation. For aching muscles and stress it may feel good, but treat it as comfort care alongside medical treatment.

Safety

NCCIH says the risk of harm from massage appears low, but rare serious problems such as a blood clot, nerve injury or bone fracture have been reported, some with vigorous deep-tissue work or in people at higher risk of injury, such as older adults (NCCIH (opens in a new tab)). Steroids can thin the skin and lower bone density (NHLBI (opens in a new tab)), and vasculitis can cause rashes, sores, ulcers and blood clots such as deep vein thrombosis (NHLBI (opens in a new tab)). MBHA suggests telling the therapist about your diagnosis and medicines, asking for gentle to moderate pressure, avoiding deep work, and not massaging a new rash, sore, or a swollen, painful or discolored limb until a doctor has looked at it. MBHA also suggests skipping massage during a fever or illness.

What it costs

Prices vary by location. At one national chain, franchise price lists show about $125 to $160 for a 60-minute massage for non-members, and memberships run about $70 to $90 a month (The Pricer (opens in a new tab)). Tips are extra. Original Medicare does not cover massage therapy (Medicare.gov (opens in a new tab)).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Vasculitis treatment can last a long time, and the daily habits around it matter. An MBHA Wellness Coach can help you build them, alongside — never instead of — your medical care.

  • Take medicines as prescribed and keep every appointment. NHLBI stresses following your treatment plan and routine follow-up care, and reporting side effects (NHLBI (opens in a new tab)). A coach can help with pill schedules and reminders. Never stop steroids on your own (MedlinePlus (opens in a new tab)).
  • Keep a symptom log. Note fevers, rashes, headaches, vision, urine and breathing changes so you notice early flares (NHLBI (opens in a new tab)).
  • Fatigue and movement. People with ANCA-associated vasculitis often have fatigue even in remission. In a small randomized feasibility study, a 12-week programme of coached physical activity sessions and phone calls was acceptable to participants, though recruitment and adherence needed improvement before a full trial (Harper et al., 2021 (opens in a new tab)). It did not test whether the fatigue improved. Check with your doctor before starting an exercise plan, and stop and call if exercise brings on chest pain, breathlessness or new symptoms.
  • Heart-healthy habits. NHLBI says treating other conditions such as high blood pressure or high cholesterol and adopting healthy lifestyle changes can help prevent flares (NHLBI (opens in a new tab)). NINDS also recommends quitting smoking and avoiding illegal drugs (NINDS (opens in a new tab)). See our blood pressure and heart guides.
  • Avoid infections. Stay away from sick people, wash hands often, and avoid anyone with chickenpox or measles while on prednisone (MedlinePlus (opens in a new tab)). NHLBI says to keep vaccines current and follow hand-washing guidance (NHLBI (opens in a new tab)).
  • Sleep and mood. Steroids can bring mood changes (MedlinePlus (opens in a new tab)). A coach can help with a bedtime routine and stress habits and encourage you to tell your doctor about low mood. See our sleep problems and depression guides.

Another approach

Infections, bones, vaccines and pregnancy

Medicines that calm the immune system protect your blood vessels, but they have costs. These are the points the sources emphasise; ask your specialist which apply to you.

  • Infection. The ACR says people on immunosuppressants need to take precautions to reduce infection risk (ACR (opens in a new tab)). In an analysis of the RAVE trial, most severe infections happened within 6 months of starting treatment, and use of a preventive antibiotic against Pneumocystis pneumonia was linked to a lower risk of severe infection (Odler et al., 2023 (opens in a new tab)). A US records study found the pneumonia itself was uncommon with current treatment, and that the preventive medicines were linked to side effects such as low white-cell counts and rash (Nettleton et al., 2024 (opens in a new tab)). The rituximab label recommends prophylaxis for GPA and MPA (FDA label (DailyMed) (opens in a new tab)). Whether you need prophylaxis is a decision for your doctor.
  • Bones. The 2022 ACR guideline for adults taking steroids for more than 3 months strongly recommends an assessment of fracture risk soon after starting, and drug treatment for those at medium or higher risk, chosen by shared decision-making (Humphrey et al., 2023 (opens in a new tab)). The ACR also mentions a bone density test and vitamin D, calcium or bisphosphonates for GCA (ACR (opens in a new tab)). See our osteoporosis guide.
  • Vaccines. The 2022 ACR vaccination guideline gives advice on which vaccines to use and whether to hold or time immune-lowering medicines, including safe use of live vaccines; recommendations are mostly conditional with low-quality evidence (Bass et al., 2023 (opens in a new tab)). The rituximab label advises against live vaccines and, where possible, non-live vaccines at least 4 weeks before a course (FDA label (DailyMed) (opens in a new tab)). NHLBI notes people with vasculitis may have a higher risk of serious COVID-19 and should keep vaccines current (NHLBI (opens in a new tab)). Never get a shot while on prednisone without talking to your doctor (MedlinePlus (opens in a new tab)). See our shingles guide.
  • Pregnancy. NHLBI says most people whose vasculitis is under control or inactive can have a healthy pregnancy, but vasculitis can raise the risk of high blood pressure disorders, miscarriage, slow growth of the baby and early birth, and flares are more likely with some types. It recommends making a plan with your provider, getting the disease into remission first, and not stopping medicine without advice because some medicines can harm a developing baby and may need changing (NHLBI (opens in a new tab)). The 2020 ACR reproductive health guideline supports pre-pregnancy counseling, safe contraception, and conceiving during quiet disease while on pregnancy-compatible medicines (Sammaritano et al., 2020 (opens in a new tab)). See our pregnancy guide.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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