Lupus & Vasculitis: Connection, Types, Symptoms & Treatment

The Lupus-Vasculitis Link

Vasculitis = blood vessel inflammation. In SLE, immune complexes and autoantibodies deposit in vessel walls, activating complement and recruiting leukocytes → vessel damage. Occurs in ~10–30% of SLE patients.

Types of Lupus Vasculitis

1. Cutaneous (Small Vessel) Vasculitis

• Most common lupus vasculitis.
• Palpable purpura (lower extremities), urticarial vasculitis (lesions >24 hr, residual hyperpigmentation), livedo reticularis.
• Ulcers, digital infarcts, nailfold infarcts.
• Skin biopsy: leukocytoclastic vasculitis (neutrophils, nuclear dust, immune complexes).

2. Systemic (Medium/Large Vessel) Vasculitis

• Rare but serious.
• Polyarteritis nodosa (PAN)-like: mesenteric, renal, coronary, cerebral arteries.
• Takayasu-like: large vessel (aorta, subclavian) stenosis/aneurysm.
• CNS vasculitis: stroke, encephalopathy.

Clinical Presentation

• Skin: Purpura, ulcers, livedo, nodules.
• Constitutional: Fever, fatigue, weight loss.
• Organ-specific: Abdominal pain (mesenteric), hematuria/renal failure, mononeuritis multiplex, stroke, cardiac ischemia.
• Labs: Elevated ESR/CRP, low complement, anemia, elevated creatinine.

Diagnosis

• Clinical context + labs + imaging (CT angiography, MRA).
• Biopsy of affected tissue (skin, nerve, kidney) — gold standard.
• ANCA usually negative (distinguishes from primary AAV).
• Exclude infections, malignancy, drug reactions.

Treatment

Severity-driven:

• Mild cutaneous: Sun protection, topical steroids, hydroxychloroquine, colchicine, dapsone.
• Moderate-severe / systemic: High-dose glucocorticoids + immunosuppressant (cyclophosphamide, mycophenolate, azathioprine, rituximab).
• Refractory: IVIG, plasma exchange, belimumab, anifrolumab.
• Antiphospholipid syndrome overlap: Anticoagulation (not immunosuppression).

Prognosis

• Cutaneous: Generally good; recurrent flares manageable.
• Systemic: Guarded; depends on organ involvement, treatment response.
• Early diagnosis and aggressive immunosuppression improve outcomes.
• Long-term: Monitor for atherosclerosis (accelerated by vasculitis + steroids).