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Last reviewed: 21 Apr 2025
Last updated: 29 Nov 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • constitutional symptoms (e.g., malaise, fever, arthralgia, myalgia)
  • headache and scalp tenderness (giant cell arteritis)
  • visual changes (large-vessel)
  • upper extremity or jaw claudication (large-vessel)
  • asymmetric brachial pulses (large-vessel)
  • bruits (large-vessel)
  • abdominal pain (medium-vessel)
  • foot drop, wrist drop (medium-vessel)
  • cutaneous ulcers (medium-vessel)
  • haematuria (small-vessel)
  • palpable purpura (small-vessel)
  • otorrhoea, ear pain, or muffled sensation in the ears (small-vessel)
  • nasal symptoms (small-vessel)
  • sinus pain (small-vessel)
  • wheeze (small-vessel)
  • haemoptysis (small-vessel)

Diagnostic investigations

1st investigations to order

  • erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • anti-neutrophil cytoplasmic auto-antibodies (ANCA)
  • assessment for glomerulonephritis
  • biopsy of affected tissue

Investigations to consider

  • conventional angiography or magnetic resonance angiography (MRA)
  • positron emission tomography (PET) scan

Treatment algorithm

Contributors

Authors

Brendan Antiochos, MD

Assistant Professor of Medicine

Director, Vasculitis Center

Division of Rheumatology

Johns Hopkins

Baltimore

MD

Disclosures

BA has received compensation from Paradigm Medical Communications for CME activities regarding EGPA and Giant Cell Arteritis.

Acknowledgements

Dr Brendan Antiochos would like to gratefully acknowledge Dr Phillip Seo, the previous contributor for this topic.

Disclosures

PS is an author of some references cited in this topic.

Peer reviewers

Jason M. Springer, MD, MS

Associate Professor

Vanderbilt University Medical Center

Nashville

TN

Disclosures

JMS has served as a consultant and on an advisory board for ChemoCentryx, the manufacturer of avacopan.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Ann Rheum Dis. 2020 Jan;79(1):19-30. Abstract

Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol. 2021 Aug;73(8):1366-83.Full text  Abstract

Hellmich B, Sanchez-Alamo B, Schirmer JH, et al. EULAR recommendations for the management of ANCA-associated vasculitis: 2022 update. Ann Rheum Dis. 2023 Mar 16;2022-223764.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available here.

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