[Treatment of systemic vasculitides]

Systemic vasculitis, which had been a consistently fatal disorder, became curable, with a sometimes chronic progression, when treatment with corticosteroids in association with immunosuppressive drugs was introduced. Treatment must be adapted according to causative factors, confirmed prognostic indicators, risk of recurrence and the need to reduce to a minimum iatrogenic side effects. Treatment of periarteritis nodosa, not linked to hepatitis B virus or to the Churg and Strauss syndrome, is based on high-dose corticosteroid treatment, associated with cyclophosphamide in intravenous bolus in severe forms. Microscopic polyangiitis and Wegener's granulomatosis usually require treatment with immunosuppressive drugs. These vasculitides have a high rate of recurrence and are responsible for high morbidity. Vasculitides associated to viral infections should receive specific treatment: plasma exchange and antiviral treatment (interferon, lamivudin) for periartiritis nodosa with hepatitis B, and interferon and ribavirin for cryoglobulinaemia associated with hepatitis C virus.