Chronic immunosuppressive therapy for systemic vasculitis

Treatment with glucocorticoids and cytotoxic agents has markedly improved the outcome in patients with systemic vasculitis. As more patients survive with these disorders, the long-term risks of these therapies have become increasingly apparent. An understanding of therapeutic toxicities is important because in some instances they can be minimized by the use of treatment strategies and monitoring techniques. Pneumocystis carinii pneumonia is associated with a high mortality rate in immunosuppressed patients but can be prevented by prophylaxis. Glucocorticoid-related avascular necrosis can incur morbidity affecting employment and daily function. Although treatment options remain limited, investigation into joint salvage procedures has continued. The frequency and longevity of urologic toxicity associated with cyclophosphamide therapy have recently been addressed. Identification of this risk has led to the development of long-term monitoring strategies in cyclophosphamide-treated patients.