Vasculitis

Vasculitis ranges from conditions affecting only small skin vessels to ANCA-associated disease that damages kidney and lung, and giant cell arteritis that threatens sight. The rehabilitation plan depends entirely on which vessels were involved and what they left damaged.

We assess what the disease has actually done — nerve, muscle, joint, lung, exercise capacity — rather than planning from the diagnostic label.

Mononeuritis multiplex — inflammation cutting the blood supply to individual nerves — produces sudden weakness in one nerve territory, classically foot drop. Recovery is slow and incomplete in some patients, and this is where rehabilitation contributes most.

Work includes strengthening what the nerve still supplies, gait retraining, orthotic assessment for foot drop, and functional electrical stimulation where the pattern suits it. Sensory loss makes skin protection part of the programme rather than an afterthought.

High-dose corticosteroids cause proximal muscle weakness that patients often mistake for continued disease activity. Keeping the steroid dose as low as the disease allows comes first, and resistance and aerobic exercise appear to help, although much of that evidence comes from laboratory and animal studies 23. Distinguishing steroid myopathy from active disease is one of the useful things an assessment achieves.

Bone protection matters at the same time. Long steroid courses reduce bone density and the loading programme accounts for that rather than ignoring it.

Prolonged high-dose corticosteroid causes proximal muscle weakness that patients and clinicians frequently attribute to the disease itself.

The distinction matters because steroid myopathy responds to resistance training and to dose reduction, whereas treating it as active disease leads to more steroid and more weakness.

For life- or organ-threatening ANCA-associated vasculitis, European recommendations combine high-dose steroid with rituximab or cyclophosphamide to bring the disease under control, then reduce the steroid to 5 mg a day within four to five months 1. Avacopan may be added to cut steroid exposure, and maintenance treatment, usually rituximab, continues after remission 1.

That plan matters for rehabilitation. Steroid-related muscle weakness is common and mainly affects the legs; keeping the dose as low as the disease allows is central, and resistance and aerobic exercise have shown promise 2. Strength work therefore runs through the high-dose months rather than waiting for them to end.

Exercise has been studied far less in vasculitis than in inflammatory arthritis, where aerobic and strength training improve fitness and strength without increasing disease activity 6. European fatigue recommendations for inflammatory rheumatic diseases, a group that includes vasculitis, advise tailored physical activity and/or psychological support 45.

In vasculitis itself, a combined exercise and education programme reduced fatigue in trial data, but the review behind those recommendations rated the evidence in rarer diseases, vasculitis included, as very poor 4. Kidney function, blood pressure, lung involvement and nerve damage all change what is safe, so the programme is built around them.