Vasculitis

What is Vasculitis?

Vasculitis is a group of diseases defined by inflammation of blood vessel walls, which damages organs when blood flow is reduced or vessels weaken.^[1] More than 30 distinct types exist. They are grouped by vessel size, from large-vessel types such as giant cell arteritis and Takayasu arteritis to medium-vessel types such as polyarteritis nodosa and Kawasaki disease, and small-vessel types such as ANCA-associated vasculitis and IgA vasculitis.^[1] Vasculitis may be primary or secondary to another illness.^[1]

Common symptoms

Symptoms vary with the type of vasculitis and the organs involved. General symptoms include fatigue, fever, weight loss and muscle or joint pain.^[1] Organ-specific symptoms include skin rash or purple spots, numbness or weakness, cough or shortness of breath, blood in the urine, abdominal pain and vision changes.^{[1, 2]}

Causes and risk factors

The cause is often unknown. Autoimmune reactions are the main mechanism, and vasculitis can also follow infections such as hepatitis B or C, reactions to medicines, or occur alongside rheumatoid arthritis, lupus or cancer.^[1] In ANCA-associated vasculitis, activation of the complement system and of neutrophils is thought to drive the inflammation.^[2]

How it is diagnosed and treated conventionally

Diagnosis combines an examination, blood tests for inflammation and antibodies such as ANCA, urine tests, imaging and often a biopsy, and doctors use classification criteria updated in 2022 for several forms.^{[1, 2]}

Treatment depends on the type. For ANCA-associated vasculitis, care has moved from cytotoxic drugs toward targeted biologic medicines, with steroid toxicity a continuing concern and long-term kidney and cardiovascular disease now a major focus.^[2] In large-vessel vasculitis, targeted therapies that allow remission with less steroid exposure are emerging, though many patients still develop vascular damage over time.^[3] Early diagnosis has improved survival in ANCA-associated vasculitis.^[2]

Why Vasculitis calls for a whole-person approach

Vasculitis can involve the skin, nerves, kidneys, lungs, eyes and blood vessels at once, and treatment itself carries burdens. This is why care by specialists comes first, and why supportive care is aimed at how a person feels, not at the vessel inflammation.^{[1, 2]}

The factors below are areas where supportive care may add comfort.

Chronic inflammation and fatigue

Fatigue and aches are part of the general picture in many types.^[1] Persistent inflammation and the treatment needed to control it can both contribute, and this is a symptom people often bring to supportive care.

Treatment side effects

Reducing glucocorticoid toxicity is a priority in ANCA-associated vasculitis, because long-term steroid use contributes to the illness burden.^[2] Long-term kidney and cardiovascular disease are also leading concerns, which is why regular specialist monitoring matters.^[2]

Vascular damage over time

Many people with large-vessel vasculitis develop vascular damage over time, even when inflammation is treated, which is why follow-up imaging and monitoring continue.^[3]

Sleep, stress and mood

Living with a rare, relapsing disease can strain sleep and mood. Sleep and stress have been studied on their own, as described below.

Acupuncture as supportive care in Vasculitis

What the research shows

The research on acupuncture for vasculitis is very limited. No systematic review or well-controlled trial in a major form of vasculitis was found. One older randomized study from China of 80 people with aortitis affecting arteries of the head and arms compared acupuncture-moxibustion with Chinese and Western drugs and reported a higher response rate with acupuncture. It was a small trial with limited reporting, and we cannot judge its quality from the abstract.^[4]

A single case report describes a woman with long-standing Takayasu arteritis whose fatigue and breathlessness were reported to improve with acupuncture and a form of moxibustion.^[5] One case cannot show that a treatment works.

For general symptoms, research in other groups exists. A review of 24 trials of acupuncture for insomnia found that in 15 trials comparing it with drug treatment, sleep scores were better after about three weeks, with large differences between trials.^[6] A 2024 review reported better sleep and less fatigue, while noting weaknesses in study methods.^[7] These studies did not include people with vasculitis.

How acupuncture may work

For sleep, researchers propose effects on brain chemicals, inflammatory signals and the stress hormone axis, mostly from animal studies.^[7] These are proposed explanations. No study has shown that acupuncture reduces vessel inflammation in people with vasculitis.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the arms, legs, back and abdomen, usually left in place for about 20 to 40 minutes. A short course of visits is followed by reassessment. Tell the practitioner about any active rash or skin ulcers so needle sites can be chosen with care.

In prospective studies, about 9 in 100 patients had a minor reaction such as bleeding, pain or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[8] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). Because immune-suppressing drugs raise infection risk, tell us about any recent infection or skin breakdown.

Ayurvedic medicine as supportive care in Vasculitis

The Ayurvedic view

Ayurveda does not describe vasculitis as a single condition. Classical texts describe blood-related disorders under the term Raktapitta and similar categories, which are traditionally linked to aggravated Pitta and impure blood (rakta dushti). These are traditional categories for choosing care, not biomedical diagnoses.

Therapies that may be used

Ayurvedic support is individualized and may include:

• Cooling, regular meals and steady sleep hours intended to ease stress and fatigue
• Relaxation practices such as breathing exercises and gentle yoga
• Herbs such as turmeric (curcumin) chosen individually, only after review of your medicines and your specialist's plan

Panchakarma, the traditional cleansing program, is not appropriate for people with vasculitis. The disease can cause organ damage, many patients take high-dose steroids or other immunosuppressants, and some are frail or acutely ill. It is also not appropriate during pregnancy.

What the research shows

The evidence for Ayurvedic medicine in vasculitis is very limited. No trials of Ayurvedic treatment for vasculitis were found. The nearest research is on curcumin, the active compound of turmeric. A small placebo-controlled trial in 36 people with Behçet disease, a variable-vessel vasculitis, found that nanocurcumin raised regulatory T-cell measures and lowered disease activity scores over 8 weeks.^[9] A systematic review of curcumin in autoimmune diseases found only one trial each for Behçet disease and arteritis, too few for firm conclusions.^[10]

Herbal medicine as supportive care in Vasculitis

Herbs and formulas that have been studied

Most research on herbs in vasculitis concerns Behçet disease and IgA vasculitis. Herbal decoctions have been studied in Behçet disease, Nigella sativa (black seed) oil has been tested in a randomized trial in Behçet disease, and Danshen (Salvia miltiorrhiza) formulations have been studied in children with IgA vasculitis (Henoch-Schönlein purpura).^{[11, 12, 13]}

What the research shows

The evidence is limited. A systematic review of 8 trials of herbal decoctions in Behçet disease found higher response rates and lower recurrence with herbs, but rated the certainty as low or very low, with poor study quality.^[11] A one-year placebo-controlled trial of Nigella sativa oil in 71 people with Behçet disease found no significant difference in disease activity.^[12]

A meta-analysis of 5 trials in 513 children with IgA vasculitis found Danshen formulations reduced later kidney disease, but the evidence was low quality and the authors did not recommend strong use.^[13] These findings may not apply to adults or to other types of vasculitis.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines, including the immune-suppressing drugs central to vasculitis care. A literature review found that St John's wort lowered blood levels of ciclosporin and tacrolimus, with many of the reported herb-drug interactions coming from case reports.^[14] Case reports describe bleeding when warfarin was combined with herbs including dang gui, dan shen, ginger, ginseng and Boswellia.^[15] This matters because Danshen is among the herbs studied in vasculitis.

Herbal and dietary supplements account for about 20% of cases of liver toxicity in the United States, which matters if you take drugs such as methotrexate or azathioprine.^[16] About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic.^[17] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding or have liver or kidney disease.

Ashwagandha has trial evidence for stress and sleep in other adults. A meta-analysis of 12 trials found lower anxiety and stress scores than with placebo, though with low certainty and large differences between trials.^[18] A meta-analysis of 5 trials found a small improvement in sleep, with limited long-term safety data.^[19] Its effect in vasculitis or on immunosuppressive drugs has not been established, so it is a question for your physician first.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine might describe vessel inflammation as heat in the blood or blood stasis, and Ayurveda as Pitta imbalance with impure blood. Researchers describe the same picture as immune-driven inflammation of vessel walls involving neutrophils, complement and other immune cells.^[2]

The research that touches these ideas is small. In the Behçet curcumin trial, the measured change was in regulatory T cells and related signals.^[9] This is a laboratory marker in 36 patients, not evidence that traditional patterns correspond to a biological process.

How this care fits with your medical care

Complementary care is a supplement to your rheumatologist's and other physicians' treatment, never a substitute. Do not stop or change steroids, immunosuppressants, biologics or blood pressure medicines without your prescriber, and keep every blood test, urine test and follow-up. For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care.

We do not diagnose or monitor vasculitis. Please bring your diagnosis and type, recent blood and urine results, a full list of medicines and supplements, and your specialist's contact details.

When to seek urgent medical care

Vasculitis can damage organs quickly, and some forms need emergency treatment.^{[2, 3]}

• Sudden loss of vision or double vision, or a new severe headache with scalp tenderness or jaw pain
• Coughing up blood or new shortness of breath
• Blood or foamy urine, or sharply reduced urine
• New weakness, numbness or foot drop, or signs of stroke such as facial droop or trouble speaking
• Severe abdominal pain or black or bloody stools
• Chest pain, or fever with other signs of infection while taking immune-suppressing medicine

If any of these occur, call 911 or go to the nearest emergency department.