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Vasculitis

Vasculitis

Vasculitis

Vasculitis

Caused by inflammation of the blood vessels themselves, including arteries and veins. With this disease, the actual vessel walls themselves are damaged, including thickening, weakening, narrowing or scarring, all which can restrict blood flow and lead to organ and tissue damage. Vasculitides have the potential to be very serious illnesses, so prompt diagnosis and treatment is very important. Common types of vasculitis are:

Giant Cell Arteritis

Giant Cell Arteritis (GCA) is also known as temporal arteritis. This condition is caused by inflammation of the large arteries in the head and neck. Patients commonly present with symptoms such as temporal headache, scalp tenderness, jaw pain, vision problems, and it can even lead to blindness if left untreated. This condition only occurs in older adults, mainly those over age of 50. A biopsy of the temporal artery is most often done to make a definitive diagnosis, to look for “giant cells” under the microscope which is characteristic of this condition. Treatment for GCA should begin as soon as possible because of the risk of loss of vision. High dose corticosteroids have been the mainstay of treatment, but newer biologic medications have recently been approved to treat this condition.

Takayasu Arteritis

This is a rare condition involving inflammation of the aorta that more often affects women more than men. It characteristically affects young women starting in their mid 20s. The aorta is the largest artery of the body and it supplies blood from the heart to the head, arms and legs, and internal organs. In Takayasu arteritis, the aorta and its main branches get inflamed and damaged. Chronic inflammation can cause thickened, narrowed, blocked, or weakened artery walls. Patients can present with arm or chest pain, high blood pressure, dizziness or fainting, heart attack or stroke. Treatment is geared toward reducing the inflammation of the artery and preventing permanent damage to the blood vessel wall. In certain cases if the blood vessel is already too narrowed, a vascular surgeon evaluates to determine if surgery could help reopen it and improve blood flow.

ANCA-Associated Vasculitis

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a classification term for several conditions, each distinctive but unified by their association with ANCA positivity. ANCA is a blood test. These conditions are: granulomatosis with polyangiitis (GPA) formerly known as Wegener’s, eosinophilic granulomatosis with polyangiitis (EGPA) formerly known as Churg-Strauss Syndrome, and microscopic polyangiitis (MPO). These conditions are characterized by neutrophil cells attacking and causing inflammation, damage, and narrowing of the smaller and medium sized blood vessels in the body. Symptoms depend on what organ system is involved, which can range from petechiae and palpable purpura (skin), mononeuritis multiplex (nerve), glomerulonephritis (kidney), diffuse alveolar hemorrhage (lung), just to name a few. ANCA-associated vasculitis can be a potentially very serious illness, so prompt diagnosis and initiation of treatment is very important. It is also a relapsing-remitting disease, which means it can alternate between disease flare up then go into remission, then flare back up, and go into remission, etc. Because of the variable course of this condition, it is prudent to have regular follow up to watch for any warning signs before the disease becomes active again.

IgA Vasculitis

Also known as Henoch Schönlein Purpura (HSP), this form of vasculitis causes blood vessel inflammation primarily in the small capillaries of the skin, joints, intestines and kidneys due to an abnormal immune system response. The characteristic symptom is a tender, burning, raised, reddish-purplish rash which looks like bruising that commonly appears on the legs and buttocks, called purpura. HSP can also manifest as arthritis, kidney failure, and intestinal ischemia. In children, symptoms can last a month or two with most patients recovering on their own, but in adults the vasculitis has a higher likelihood to persist.z

Polyarteritis Nodosa

Polyarteritis Nodosa (PAN) is a rare systemic vasculitis characterized by necrotizing inflammatory lesions primarily affecting small and medium sized muscular arteries, which can result in microaneurysm formation, aneurysmal rupture with hemorrhage, and thrombosis. Necrotizing means that a segment of the blood vessel wall has died. An aneurysm is an abnormal bulge or ballooning of a blood vessel. PAN can affect nearly any organ system and therefore can present with a wide range of symptoms, including but not limited to decreased appetite and weight loss, abdominal pain and bloody stools, excessive fatigue, fever, muscle and joint aches, nerve problems and kidney failure. Moderate and severe PAN will typically require high dose steroids at first followed by some type of immunosuppressive medication for maintenance treatment. In patients with PAN who have been found to have an associated hepatitis B or C infection, treatment is geared toward treating the underlying viral infection.

Relapsing Polychondritis

A rare condition characterized by recurrent inflammation of cartilaginous tissues throughout the body. This condition causes inflammation, pain, and swelling of cartilage in the ears, nose, trachea (windpipe), joints, heart valves, and eye. The initial symptom is typically pain in the affected cartilage area, and if left untreated can progress to deformity, destruction, and collapse of the cartilage.

Cryoglobulinemia

Cryoglobulins are abnormal antibody proteins in the blood that clump together and form immune complexes which are even bigger clumps of protein. When these gelatinous protein clumps form they can block blood circulation, which can damage the skin, joints, nerves, and internal organs particularly the kidneys and liver. Cryoglobulinemia can be due to many different causes such as an underlying autoimmune disease, viral hepatitis, and cancers of the bone marrow and blood. Patients found with underlying chronic hepatitis C need to be treated for their infection.

Behcet’s Disease

This is a rare disorder that can cause blood vessel inflammation throughout the body. Behcet’s can lead to numerous signs and symptoms that may seem unrelated at first. Symptoms can include recurrent mouth and genital ulcers not due to an infection, eye inflammation, skin rashes and lesions, and in severe cases brain, spinal cord, and large blood vessel involvement. Behcet’s was historically identified in the Turkish population and surrounding areas of the ‘silk road’ and has been found to be associated with the gene HLA B51.

How does Lomibao Rheumatology & Wellness Care treat Vasculitis?

The approach to treatment of vasculitis is based on current evidence-based guidelines. Treatment is customized based on what body part is currently affected and symptomatic to the patient, prevention of serious organ involvement, and patient preference. Initial fast-acting treatments are typically oral or injection corticosteroids such as prednisone or NSAIDs. DMARDs and Biologics are used as ‘steroid sparing agents’ and are more specific and targeted treatment for the disease. Depending on the patient’s needs, sometimes DMARDs and Biologics may be combined. Common DMARDs used for vasculitis include methotrexate, Cellcept, and Imuran. Subcutaneous Actemra has been recently approved for treatment of GCA. Cytoxan, an infusion chemotherapy treatment, is sometimes used for very severe refractory cases of vasculitis, administered in the hospital outpatient infusion clinic. Infusion biologic offered by Lomibao Rheumatology & Wellness Care for treatment of vasculitis is Rituxan. Wellness services for vasculitis – coming soon!

What Our Patients Are Saying

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Most Personable Rheumatologist

Dr. Lomibao has been my Rheumatologist for over 4 years. I have had RA for 25 years, and Dr. Lomibao by far is the best doctor I have seen. She is an excellent and experienced physician who truly listens and cares. She has developed a treatment plan that has given me my life back.

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I am so thankful to be under the care of Dr Lomibao! I could honestly write an essay about her and how wonderful she is. From my first visit to the present she is always thorough and has a incredible bedside manner. I don't think I've ever waited more than 10-15 minutes in the office either. They are so efficient. I have recommended her to many people and will continue to do so. I love Dr Lomibao!

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Exceptional Physician

I am so thankful to have found Dr Lomibao. She's been my rheumatologist since the very beginning of my autoimmune illness journey and I can't say enough good things about her. She spent so much time at my initial getting to know me and my symptoms and now I've been a patient of hers for over two years and she still spends all the time with me I need to get my questions and concerns addressed. She is so thorough and has the best bedside manner. I have recommended her to many friends. Dr lomibao is a fantastic physician.

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I could write a whole story. I won't because you may stop reading. Dr. Lomibao is the best I've came across during my search for a rheumatologist. She isn't like most doctors. She listens to you. She doesn't force meds on you and actually cares about your well being. I'm a lupus and arthritis patients. She has assisted me in getting my condition under control. If you want a caring doctor come see her and I promise you will not be disappointed.

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Great Rheumatologist

I was diagnosed with lupus almost 4 years ago and after searching. I finally found a rheumatologist who listened. She was compassionate and caring. She has never tried to force a treatment or force meds. Dr. Lomibao has the best bedside manner and communicates with all my other doctors so we are all on the same page. She's such a great doctor I pay out of my pocket to see her because she isn't in my insurance network. That should tell you my true thoughts about Dr. Lomibao. If you are looking for a doctor who will listen and help you find a solution. Go see her.

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She helped me knock my arthritis to the curb!

I had some difficulty with my arthritis and I wasn't particularly thrilled with my previous doctor's treatment plan. I decided to see Dr. Lomibao because there had to be another option. I was soooo glad I did!! Dr. Lomibao sat, listened and took notes like crazy. She really listened to my concerns and why I didn't want to be on steroids. When I finished, she put her pen down, looked me in the eyes and told me, "We will find something to help you." She reviewed all my options and provided the pros/cons on everything I could do. She provided me her most recommended options and then I was able to choose the best fit for me. It took a little bit of time, but I am now on a regimen that has my arthritis at the curb! You will not find a more personable, knowledgeable and caring physician around.

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One of the Best to ever do it!!!

I have been seeing Dr. Lomibao for almost 2 years. Follow-up hospital visit. She was new to me on our first visit she sat and asked so many questions in regard to the new diagnosis of my auto-immune disease. At first glance, some told me she looks young and she may not be as knowledgeable as others. I say to them she is freaking awesome and amazing. I never feel rushed or feel like I'm being pushed out quickly. Not that I take a lot of time but, as a patient you want to feel like your Dr. truly cares about what you're going through and find a way to solve the problem. During this recent pandemic, I've been teaching from home. I had to move my daughter home from college and I had to work the very next day. I was exhausted and had an appointment with Dr. Lomibao the very next day. My body was not cooperating and I left a message with her nurse and my Dr. did a virtual appointment to address my issues. Video or by phone was optional. They always return calls and are accommodating. God Bless you guys stay safe!

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I love Dr. Lomibao

Dr. Lomibao was the first Rheumatologist I saw after I started exhibiting symptoms of inflammatory arthritis in 2018. I have been appreciative of her analytical and compassionate nature since my first appointment! Dr. Lomibao doesn't just check boxes off her chart and move on to her next patient. During my appointments, she takes the time to relate to me and allows me space to communicate the various areas of my life that are affected by my illness. This has greatly affected the amount of trust I have for her. I am an over-thinker who loves knowing why and how aspects of my illness are affecting me, and Dr. Lomibao has never dismissed my questions or made me feel like I am wasting her time by asking a question. Dr. Lomibao and her staff have gone above and beyond to make me feel the best I possibly can! I am very grateful for their care.

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Caring and Open Expert Physician

I highly recommend Dr. Frances Lomibao if you are looking for a knowledgeable, kind, and proactive rheumatologist. Dr. Lomibao diagnosed me with RA this year, and has been so compassionate, caring, and informative every step of the way. She takes time to answer my questions in depth, and I always have a lot of them. She is open to my desire to find a way to treat this disease as holistically and naturally as possible, and I truly feel that we are a team united in the fight. Visiting with Dr. Lomibao feels like meeting up with a friend. I’m always nervous before doctor visits but her presence is so comforting, and she’s hilarious! She helps take the edge off of potentially receiving tough news. When we found that I would need to take medication (which wasn’t my plan originally), she spent so much time with me discussing treatments and helping me find what’s best for me. She made me feel comfortable with my treatment plan, and I appreciated her boldness to tell a crunchy hippie like me that while diet and lifestyle changes and supplements would help, it wouldn’t be enough for how my disease is progressing. I have a long history of poor medical care, so being able to partner with Dr. Lomibao is a true blessing.

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Five Stars

I have been under Dr. Lomibao's care for 2 1/2 years. She is an amazing rheumatologist that has a genuine care for her patients. I have had RA for 15 years and seen many doctors but she is by far the very best! If you need a physician who not only cares but gets to the bottom of your condition, look no further. I HIGHLY recommend Dr. Frances Lomibao! God bless her!

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