Assessment of disease activity and damage for clinical decision making in vasculitis

RESUMO

The progress in many aspects of vasculitis has emphasised the need for detailed assessment to dissect the components of each individual case as it progresses and to use this to determine progressive therapeutic regimes tailored to the current disease status. Assessment of the extent of organ involvement and the degree of disease activity have obvious value in determining the need for initial therapy at disease presentation. The control of acute mortality has revealed a persistent morbidity, most clearly documented in patient self-assessment of their functional status. The high tendency to relapse also stresses the need for continuing assessment during long-term follow-up. Newer drugs may allow specific control of ongoing activity to be achieved at lower risk of toxicity. The problem of accumulating disease scars has not yet been solved although the detailed description of organ damage has revealed the important contribution which damage makes to later mortality. Finally, there are new techniques to look at the function of the endothelium itself the important target tissue in vasculitis. These will hopefully provide opportunities to assess non invasively the state of blood vessels and their potential to respond to further therapy